Sketchy Pharm: Primary Hypertension and Hypertensive Emergency

Question 1

Two antihypertensive drugs are usually needed for patients with BPs more than ______________ above the upper recommended limit.

Answer 1

20/10

Think of the life preservers: “2 recommended for more than 20 lbs.”

Question 2

Which three agents are recommended for first-line treatment of essential hypertension?

Answer 2

• Hydrochlorothiazides (kid on HIGH dive with muscular THIGHs)
• Dihydropyridine calcium channel blockers (Calci-YUM ice cream machine)
• ACE inhibitors (gambling Aces table near hot tub)

Question 3

CCBs and thiazides are particularly helpful in which patients?

Answer 3

Elderly African-American patients (like the older AA man in the hot tub near the Dippin’ Calci-Yum machine and his muscular thighs)

Question 4

ACE inhibitors should be prescribed to those with hypertension and ________________.

Answer 4

past MIs or current diabetes (guy playing broken heart string guitar near jar of candy on Aces table)

Question 5

What are key clinical components of hypertensive emergency?

Answer 5

• BP above 180/120 (like the 180º protractor near the 12” ruler on the workstation in the boiler room)
• New-onset signs of organ damage such as pulmonary edema, neurologic damage, or kidney failure (this is somewhat loosely represented by the “end-organ damage” done to the Titanic’s boiler room)

Question 6

What agents can be given to someone with hypertensive emergency?

Answer 6

• IV B1 antagonists (like the bugles being blocked on the deck)
• IV labetalol (like the labetalol organ)
• Dihydropyridine CCBs (woman in lifeboat with Calci-Yum)
• Hydralazine (HYDRo lifeboat)
• Nitroprusside (NO agent that stimulates GMP like the GruMP next to the NITRO-powered boat in the background)
• Fenoldopam (OLD mam PAM)

Question 7

All of the potent arterial dilators can cause what two counterproductive side effects?

Answer 7

• Reflex tachycardia (doctor with heart-shaped reflex hammer)
• Activation of the RAAS system (doctor with yellow umbrella)

Question 8

Arterial vasodilators decrease ________-load.

Answer 8

after

Question 9

Which CCBs are used in hypertensive emergency?

Answer 9

The dihydropyridines, specifically nicardipine and clevidipine (like the NIce CARD read by the woman in the lifeboat that has a CLoVer on it)

Question 10

List four antihypertensive agents that are safe in pregnancy.

Answer 10

• Alpha methyldopa (pregnant Christine in the phantom Sketch)
• Nifedipine (pregnant woman cutting apple in CCB Sketch)
• Labetalol (pregnant organist in beta-blocker Sketch)
• Hydralazine (pregnant woman being loaded onto HYDRo rescue lifeboat in this Sketch)

Question 11

What side effects do you need to keep in mind when administering hydralazine?

Answer 11

• Hypotension (woman fainting) from excess arteriolar dilation
• Exacerbation of angina from reflex tachycardia (angina anvil on fire hose) –can be blocked with B1 blocker
• Lupus (wolf on boat) –also remember that hydralazine is the H in SHIPP-E (the lupus-causing drugs)

Question 12

Hydralazine combined with ___________ has been shown to prevent mortality in CHF patients.

Answer 12

nitroglycerin (like the heart balloon tied to the TNT being thrown at the ice berg)

Question 13

What is unique about nitroprusside compared to the other nitrate drugs?

Answer 13

It causes equal arterial and venous dilation, whereas the other nitrates mostly cause venous dilation.

(Think of the guy driving the nitro-pressure boat with equally dilated sleeves and pants.)

Question 14

Nitroprusside causes what adverse effect, particularly in those with renal impairment?

Answer 14

Cyanide poisoning (like the CN pipe pumping cyan gas in the driver’s face)

Question 15

How does fenoldopam work?

Answer 15

It is a D1 agonist (like the single dope rope held by OLD lady PAM).

It causes dilation of the arteries (like the dilated arm sleeves) with increased renal perfusion (represented by the spilling peanuts and kidney that she’s standing on).