Antihypertensives

Question 1

Drugs that may interfere with antihypertensive meds, or meds that may cause HTN

Answer 1

Oral contraceptives
Corticosteroids
NSAIDS
Over the counter cold remedies containing ephedrine or sympathomimetics

Question 2

Fibromuscular dysplasia

Answer 2

Fibrosis and aneurysm formation in the middle and distal renal arteries
Most common in younger women

Question 3

Primary Hyperaldosteronism Diagnostics

Answer 3

Serum renin level (low)
Urine aldosterone levels
Increased serum aldosterone level that does not suppress after saline-induced volume expansion
CT to differentiate between adrenal adenomas and hyperplasia.

Question 4

Aortic Coarctation

Answer 4

narrowing of the aorta (typically just distal to the left subclavian artery), is a congenital defect that obstructs aortic outflow leading to elevated pressures proximal to the coarctation (i.e., elevated arterial pressures in the head and arms). Distal pressures, however, are not necessarily reduced

Question 5

B/P =

Answer 5

CO X PVR

Question 6

Diuretics

Answer 6

Cause diuresis which reduces plasma and stroke volume causing a decrease in cardiac output and blood pressure.

Most common adverse affect (except for the K+ sparing diuretics) is hypokalemia.

Question 7

Diuretic: Thiazides

Hydrochlorothiazide (HCTZ)*

Answer 7

Inhibits NaCl reabsorption in the distal convoluted tubule of the nephron.
rarely does K+ have to be administered with this drug.

Question 8

Loop Diuretics
Furosemide (Lasix)* 
Torsemide (Demedex)
Bumetanide (Bumex)
Metolazone (Zaroxolyn)

Answer 8

Selectively inhibit NaCl reabsorption in the thick ascending limb of the loop of Henle.
Usually needed when renal function declines.
Stronger incidence of hypokalemia (need oral K+)

Question 9

K+ sparing diuretics:
Aldactone (Spironolactone)*
Midamor (Amiloride)
Dyrenium (Triamterene)

Answer 9

Antagonize the effects of aldosterone at the late distal and cortical collecting tubule in the nephron.
Weak when used alone, but spare K+ and Magnesium loss.

Question 10

Combination HCTZ and K+ sparing diuretics:

Answer 10

Altactazide (Spironolactone/HCTZ)
Dyazide (Triamterene/HCTZ)
Maxzide (Triamterene/HCTZ) stronger dose
Moduretic (Amiloride/HCTZ)

Question 11

What is meant by Cardioprotective?

Answer 11

Negative inotropic effect (decrease 02 consumption by the heart by decreasing the force of the contraction)
Negative chronotropic effect (decrease heart rate)

Question 12

ACE inhibitors are considered the first line drug of choice to treat high blood pressure in cases that involve:

Answer 12

Diabetics
Congestive heart failure
Chronic kidney failure in both diabetics and non-diabetics
Myocardial infarction that weakens the heart muscle (systolic dysfunction)

Question 13

Calcium Channel Blockers: Dihydropyridines

Answer 13

Highly vascular selective

Amlodipine (Norvasc)

Question 14

Calcium Channel Blockers: Non-dihydropyridines

Answer 14

Also used to treat dysrhythmias, angina, headaches…used for conduction disturbances
Verapamil (Calan, Isoptin)
Diltiazem (Cardizem)

Question 15

What to use for pregnant with HTN

Answer 15

Alpha 2 Receptor AgonistsCentrally acting sympatholytic: Methyldopa (Aldomet)

Question 16

Drug that causes Lupus-like syndrome?

Answer 16

Vasodilator: Hydralazine

Question 17

Hypertensive Crisis

Answer 17

A sudden increase in blood pressure associated or potentially associated with end organ damage.

Question 18

Hypertensive Urgencies Treatment

Answer 18

No End organ damage:
Treat with oral meds
Captopril (Capoten)
Clonidine

End organ damage:
Hospital admission (ICU) + IV treatment
Nitroprusside**
Nitroglycerin