Antihypertensives + emergency

Question 1

a Diuretic used as a first line agent for treating primary hypertension

Answer 1

Hydrochlorothiazide
(may be less effective than chlorthalidone )

Question 2

What four drug classes are used in the treatment of primary hypertension?

Answer 2

1. Thiazide diuretics
2. ACE inhibitors
3. Angiotensin II receptor blockers (ARBs)
4. Dihydropyridine Ca2+ channel blockers

Question 3

Black and elderly patients respond well to which drugs for treatment of primary hypertension ?

Answer 3

1) hydrochlorothiazide

2) long-acting dihydropyridine Ca2+ channel blockers

Question 4

first line treatment for hypertension in patients with heart failure, MI, and/or diabetes

Answer 4

-ACEi
(“ACE casino tables”)

-angiotensin II receptor blockers

Question 5

Hypertensive emergency occurs when …

Answer 5

systolic BP >180 or diastolic BP >120 with end-organ damage

Question 6

an α- and β-antagonist, can be used for hypertensive emergency

Answer 6

Labetalol

(“Alpha and beta organ stops”)

Question 7

Many agents used in hypertensive emergencies are potent…

Answer 7

Potent Vasodilators

(“Dilated red smoke stack”)

Question 8

Potent vasodilation (e.g. following hypertensive therapy) may cause …

Answer 8

hypotension followed by reflex tachycardia and increased renin levels

Question 9

Vasodilation (e.g. following hypertensive therapy) reduces…

Answer 9

Afterload

(sailor unloads scale)

Question 10

IV Ca2+ channel blockers that may be used in hypertensive emergency

Answer 10

​Clevidipine
(“clover on nice card”)

Nicardipine
(“nice card”)

Question 11

Hydralazine can ..

Answer 11

dilate arterioles, and decreased after-load via increasing cGMP

• **has little effect on venous circulation**

cause hypotension, which may induce a reflex tachycardia that can worsen angina

Question 12

Hydralazine is often co-administered with a …

Answer 12

β-blocker to minimize the reflexive sympathetic activation and tachycardia

Question 13

Hydralazine can rarely cause…

Answer 13

drug-induced lupus, which may manifest as myalgias, arthralgias, and joint swelling

Question 14

what can be combined with Hydralazine in order to treat LV systolic dysfunction?

Answer 14

organic nitrate (e.g. nitroglycerin)

• provides a mortality benefit for some patients with heart failure
• hydralazine is a vasodilator (decrease afterload), nitrates are venodilators (decrease preload)

Question 15

Nitroprusside can ..

(“Nitro-pressure speedboat”)

Answer 15

-cause vasodilation via nitric oxide
(“nitrous oxide exahust”)→increasing cGMP (“grumpy old fart in the water”), which is useful during the treatment of hypertensive emergency

• causes arteriolar AND venous dilation
  (“both shirt sleeves and pants are dilated “)

Question 16

Nitroprusside side effect

Answer 16

cyanide poisoning especially with prolonged use or renal impairment

(“cyanide exhaust pipe gas”)

Question 17

D1 receptor agonist that may be used to treat hypertensive emergency…

Answer 17

Fenoldopam

(“Old lady Pam)

Question 18

Fenoldopam is a …

Answer 18

D1 receptor agonist that may be used to treat hypertensive emergency by increasing levels of cAMP, causing vasodilation in most arterial beds

• especially in renal arteries ,coronary, peripheral, and splanchnic vessels
• ​causes increased excretion of Na+ and water→natriuresis

Question 19

Esmolol And Metoprolol are …

Answer 19

Beta-1 antagonists used for hypertensive emergencies.

• IV beta blockers administration treats hypertensive emergency

(“Muted beta bugle players surrounded by posion ivy”)