Cardio Flashcards
J.V. is a 35-year-old male with no known past medical history who presented to his family physician for annual check-up. He was found to have blood pressure readings with SBP in the range of 130s and DBP in the low 80s. His home BP readings have been the same. Which of the following choices is the most appropriate next step at this time?
A. Recommend healthy life style changes and re-assess in 3-6 months
B. Calculate his 10-year CVD risk
C. Recommend annual BP checks
D. Recommend a first line anti-hypertensive medications with monthly follow up
E. Recommend lifestyle changes and two different classes of medications with monthly follow ups until BP is controlled
B. Calculate his 10-year CVD risk
SBP of 130‒139 OR DBP of 80‒89 is classified as HTN stage 1.
For patients with HTN stage 1, the decision whether or not to start medication depends on patient’s calculated 10-year CVD risk. Therefore, the most appropriate next step at this time would be to calculate his 10-year CVD risk:
If the 10-year CVD risk is less than 10%, we will recommend lifestyle changes with reassessment in 3‒6 months.
B.N. is a 47-year-old female who has been recently diagnosed with hypertension stage 2. Based on ACC/AHA guidelines, which of the following BP readings is/are considered “HTN stage 2?”
Select ALL that apply.
A. 130/85 mmHg
B. 140/80 mmHg
C. 135/92 mmHg
D. 135/85 mmHg
B, C
Hypertension stage 2 is defined as SBP ≥ 140 mmHg OR DBP ≥ 90 mmHg.
M.J. is a 62-year-old female with history of hypertension and significant albuminuria. Which of the following agents is recommended to slow progression of kidney disease? A. Hydrochlorothiazide B. Furosemide C. Amlodipine D. Losartan
D
Treatment with an ACE inhibitor is reasonable to slow progression of kidney disease. An ARB is reasonable if ACE inhibitors are not tolerated.
A 57-year-old African-American male patient has recently been diagnosed with hypertension. He has normal renal function with no microalbuminuria and his serum potassium level is 4.2 mEq/liter. In addition to lifestyle changes, which of the following medications would you recommend for the initial treatment of his newly diagnosed hypertension?
A. Tekturna B. Aceon C. Bisoprolol D. Chlorthalidone E. Lisinopril
D. Chlorthalidone
For black patients with hypertension, a thiazide-type diuretic such as chlorthalidone or a calcium channel blocker is recommended for initial therapy, except for those with chronic kidney disease or heart failure, who should receive an ACE inhibitor or an ARB.
Which of the following anti-hypertensive drugs is NOT recommended for initial treatment of hypertension in the absence of other indications?
A. Hydrochlorothiazide B. Benazepril C. Amlodipine D. Metoprolol E. Irbesartan
D
Beta-blockers generally are NOT recommended as initial therapy except for patients with other indications, such as coronary artery disease or left ventricular dysfunction.
Which of the following anti-hypertensive agents should be used with CAUTION in patients with high uric acid levels?
A. Doxazosin B. Verapamil C. Hydrochlorothiazide D. Lisinopril E. Avapro
C. Hydrochlorothiazide
Thiazides can increase uric acid, cholesterol, glucose and calcium levels.
Which of the following beta-blockers is taken with food?
A. Carvedilol
B. Bisoprolol
C. Atenolol
D. Esmolol
A
Which of the following medications can NOT be used for gestational hypertension?
A. Nifedipine ER
B. Labetolol
C. Methyldopa
D. Enalapril
D
ACEI/ARBs are contraindicated in pregancy.
Mr. J.S. is diagnosed with hypertensive emergency and admitted to hospital for further care.
Vitals: BP: 180/110 mmHg, Pulse: 88 Temp: 98.2 RR: 18
Allergy: None
Which of the following medications is NOT used to treat hypertensive emergency?
A. Nipride IV B. Cardene IV C. Corlpam IV D. Enalaprilat E. Losartan IV
E. Losartan IV
Hypertensive emergency (symptomatic) is treated with IV medications versus hypertensive urgency (asymptomatic) which is treated by oral agents and monitored daily.
Losartan or ARBs in general have no role in hypertensive emergency treatment. Among ACEIs, enalapril is available in IV (Enalaprilat, Vasotec).
Nitroprusside (Nipride), enalapril IV (Enalaprilat, Vasotec), esmolol (Brevibloc) and labetalol (Normodyne) are vasodilators which reduce BP by vasodilatory effects.
J.L. is a 45-year-old female patient with a history of migraine headaches, hypertension and Raynaud’s disease. Which one of the following medications can worsen Raynaud’s disease? Select ALL that apply.
A. Propranolol B. Nifedipine C. Verapamil D. Aliskiren E. Imitrex
A, E
Raynaud’s disease is a spasm of digital arterioles smooth muscles (digits means fingers), leading to blockage of blood supply to the distal end of fingers. Raynaud’s disease flares up in cold weather which can bring about blue or pale fingers and in severe cases significant ischemia and necrosis of affected finger(s). The drug of choice for stopping the spasm is dihydropyridine CCBs including nifedipine or nicardipine. Non-DHP CCBs such as verapamil have most of their effects on the cardiac muscle contractility (negative inotropic) and rate (negative chronotropic) with only minimal effect on the blood vessels; therefore, are of no use in Raynaud’s.
Triptans, ergots and beta-blockers can worsen Raynaud’s and subsequently cause necrosis of digits.
