Antihypertensives

Question 1

What are some examples of beta receptor blockers?

Answer 1

Propranolol and metoprolol

Question 2

What does cardiac output depend upon?

Answer 2

Venous return (venous tone, blood volume)
Heart rate and contractility

Question 3

What does total peripheral resistance depend upon?

Answer 3

Resistance vessel diameter (arterial tone)

Question 4

What could cause secondary hypertension?

Answer 4

OTC and prescription drugs (estrogens, NSAIDS, stimulants, decreased compliance)
Other conditions (renal artery stenosis, coarctation of the aorta, primary hyperaldosteronism)

Question 5

What are some non-pharmacological treatments of hypertension?

Answer 5

Sodium restriction, weight loss, exercise, alcohol, smoking cessation and relaxation

Question 6

What are the first line single agents for hypertension?

Answer 6

Diuretic, ACEI or ARB, CCB and beta-adrenergic antagonists (not in uncomplicated)

Question 7

What else can be used in the treatment of hypertension?

Answer 7

alpha 1 adrenergic receptor antagonists, alpha 2 adrenergic agonists and vasodilators

Question 8

What does the dose response curve look like with diuretics for blood pressure lowering?

Answer 8

Relatively flat (increasing dose produces little improvement in effect)

Question 9

What are loop diuretics useful in?

Answer 9

Renal impairment (GFR

Question 10

When are K sparing diuretics useful in hypertension?

Answer 10

When the increased blood pressure is due to mineralcorticoid excess.

Question 11

What are some problems with K sparing diuretics?

Answer 11

Hyperkalemia and estrogenic effects (gynecomastia, impotenence)

Question 12

How do ACEI’s work in hypertension?

Answer 12

Decrease AII levels, total peripheral resistance and aldosterone. Increases plasma potassium
Little or no reflex increase in cardiac output

Question 13

How do ARB’s work in hypertension?

Answer 13

Blocks AII receptors, decreases total peripheral resistance and aldosterone. Increases plasma potassium
Little or no reflex increase in cardiac output

Question 14

When are ACEI’s and ARB’s recommended?

Answer 14

In uncomplicated hypertension, recommended if concurrent condition (heart failure, post MI, systolic dysfunction, proteinuria, left ventricle dysfunction)

Question 15

When are dihydropyridines used for hypertension?

Answer 15

Need the long acting agents
Reduce resistance without apparent cardiac actions
Useful when beta blockers are contraindicated

Question 16

When are non-dihydropyridines used for hypertension?

Answer 16

If there is also a concern about heart rate control in atrial fibrillation or in patients with angina

Question 17

What is a medication that every post MI or heart failure patient should be on?

Answer 17

beta-blocker, unless there is a concomitant disorder (asthma) where you must weigh the pros and cons.

Question 18

When are beta blockers used for hypertension?

Answer 18

Not uncomplicated. In hypertension when concomitant disease also benefit (post MI, heart failure)

Question 19

What are some problems with beta-blockers?

Answer 19

Not metabolically neutral (increase TGs/decrease HDLs), avoid sudden withdrawal, erectile dysfunction, increased incidence of type 2 diabetes, doesn’t protect against strokes

Question 20

When should you avoid beta blockers?

Answer 20

Asthma, COPD, peripheral vascular disease, insulin dependent diabetes (caution), physically active

Question 21

What disorders are beta blockers good to use in?

Answer 21

Glaucoma, supraventricular arrhythmia, heart failure, MI, angina

Question 22

When would an alpha 1 antagonist be used in hypertension?

Answer 22

Not effective as a single agent

Decreases insulin resistance, BPH and decreases nightmares in PTSD

Question 23

What are some problems with alpha 1 antagonists?

Answer 23

Fluid retention with long term treatment (give with diuretic)
With first dose there is an initial large blood pressure drop
Orthostatic hypotension

Question 24

When are alpha 2 agonists used?

Answer 24

Adjunct to general anesthetic (sedation)

Question 25

What happens when you rapidly come off of alpha 2 agonists?

Answer 25

Rebound hypertension

Question 26

What should vasodilators be given with for hypertension?

Answer 26

Given with a beta-blocker and a diuretic

Used in pregnancy

Question 27

What are some problems with vasodilators?

Answer 27

Lupus-like syndrome
Increased SNS-myocardial stimulation
Headache, flushing, nausea, hypotension, tachycardia, angina

Question 28

When is sodium nitroprusside used?

Answer 28

For hypertensive encephalopathy

Question 29

What is the rule about dose titration for antihypertensives?

Answer 29

Should only use one dose titration. Increasing initial dose has limited effect on decreasing blood pressure further but does increase side effects

Question 30

What should you do if you are looking for a new hypertensive treatment for a patient?

Answer 30

Switch between drug classes before combining or adding drugs.

Question 31

What is the goal blood pressure for hypertension generally?

Answer 31

140/90 mmHg or less

Question 32

What antihypertensives are best for younger patients?

Answer 32

ACEI. ARB or beta antagonist

Question 33

What antihypertensives are best for black or elderly patients?

Answer 33

thiazides or long acting calcium channel blockers

Patients with other indications (post MI) might need an ACEI or ARB