Ch 47: Drugs for Hypertension

Question 1

How many classes of drugs can be used to treat hypertension?

Answer 1

14 classes!

p. 499

Question 2

In the 2014 hypertension guidelines, treatment of hypertension should be initiated at a SBP > or equal to…

Answer 2

…140, or DBP > or equal to 90.
The same apples to the over 60 population, with the exception of not initiating treatment until SBP is > or equal to 150.

(p. 499)

Question 3

In the U. S., primary hypertension affects about…

Answer 3

…30% of adults.

p. 500

Question 4

What is the formula for arterial pressure?

Answer 4

Cardiac output x peripheral resistance

p. 502

Question 5

Cardiac output is determined by…

Answer 5

…heart rate, contractility, blood volume, venous return.

p. 502

Question 6

Peripheral resistance is determined by…

Answer 6

…arteriolar constriction.

p. 502

Question 7

Fortunately, when BP has been suppressed with drugs for an extended time, the baroreceptors…

Answer 7

…become reset at a lower level.

p. 503

Question 8

What are the 5 categories of sympatholytic drugs? (a.k.a. antiadrenergic drugs)

Answer 8

1) beta blockers
2) alpha1 blockers
3) alpha/beta blockers
4) centrally acting alpha2 agonists
5) adrenergic neuron blockers

(p. 507)

Question 9

Which 3 classes of drugs are contraindicated during pregnancy?

Answer 9

ACE inhibitors, ARB’s, and direct renin inhibitors

p. 508

Question 10

What is the only direct renin inhibitor available right now?

Answer 10

aliskiren

p. 508

Question 11

In patients with renal disease (i.e. nephrosclerosis), which two classes of drugs work best for treating hypertension?

Answer 11

ACE inhibitors and and ARB’s

p. 510

Question 12

Why must beta blockers be used with caution in patients with diabetes?

Answer 12

They can suppress glycogenolysis and mask early signs of hypoglycemia.

(p. 511)

Question 13

The incidence of secondary hypertension in children is…

Answer 13

…much higher than in adults.

p. 511

Question 14

By age 65, most Americans have…

Answer 14

…hypertension. It almost always presents as isolated systolic hypertension.

(p. 511)

Question 15

Why does treatment of hypertension in older adults carry a significant risk of orthostatic hypotension?

Answer 15

Because cardiovascular reflexes are blunted.

p. 512

Question 16

In terms of adverse effects of antihypertensive drugs, practically all of these drugs can…

Answer 16

…interfere with sexual function.

p. 512

Question 17

The major cause of treatment failure in patients with chronic hypertension is…

Answer 17

…lack of adherence to the prescribed program.

p. 512

Question 18

A hypertensive emergency exists when…

Answer 18

…diastolic BP exceeds 120 mm Hg.

p. 513

Question 19

What are the guidelines for how rapidly hypertensive crisis should be treated?

Answer 19

It must be treated rapidly (BP lowered within an hour) if there is papilledema, intracranial hemorrhage, MI, or acute congestive heart failure.
If these things are not present, it is preferable to lower the BP more slowly (over 24-48 hrs) in order to reduce the risk of cerebral ischemia, MI, and renal failure, all of which can occur with a rapid reduction in BP.

(p. 513)

Question 20

What is the usual rate for nitroprusside?

Answer 20

0.3 to 3 mcg/kg/min.
(Dosage range in Epic is 0.25 - 10 mcg/kg/min.)

(p. 513)

Question 21

Fenoldopam lowers BP by…

Answer 21

…activating dopamine1 receptors on arterioles to cause vasodilation.

(p. 513)

Question 22

As a result of its MOA, fenoldopam differs from other hypertensives in that it…

Answer 22

…helps maintain (or even improve) renal function.

p. 513

Question 23

What is the most common complication of pregnancy?

What is the incidence?

Answer 23

Hypertension
about 10%

(p. 513)

Question 24

Patients who have chronic hypertension during pregnancy are at increased risk of developing preeclampsia. Unfortunately, reducing BP…

Answer 24

…does not lower this risk.

p. 513

Question 25

What drug is given for seizure prophylaxis during pregnancy?

Answer 25

Magnesium sulfate

p. 514

Question 26

When started before 16 weeks of gestation, low-dose _______ reduces risk of preeclampsia by about 50%.

Answer 26

aspirin

p. 514

Question 27

Which two drugs are usually used for treating chronic hypertension of pregnancy?

Answer 27

methyldopa and labetalol

p. 513, 515

Question 28

Hyperuricemia is a common side effect of thiazide diuretics. What is the normal range for serum uric acid?

Answer 28

2.2 - 8.0 mg/dl

from patho textbook

Question 29

What are 2 examples of commonly used alpha1 blockers?

Answer 29

doxazosin and terazosin

p. 507

Question 30

What classes of drugs are preferred for treating hypertension in diabetic patients?

Answer 30

ACE inhibitors, ARB’s, CCB’s (and diuretics in low doses)

p. 511

Question 31

Which classes of drugs are recommended for management of hypertension following an MI?

Answer 31

beta blockers, ACE inhibitors, and aldosterone antagonists

p. 509

Question 32

How do the alpha1 blockers work?

Answer 32

By preventing stimulation of alpha1 receptors on arterioles and veins, thereby preventing sympathetically mediated vasoconstriction.

(p. 507)

Question 33

Name 5 alpha1 blockers.

Answer 33

prazosin
terazosin
doxazosin
tamsulosin
phentolamine

Question 34

Three of the beta-blockers have a trait known as intrinsic sympathomimetic activity (ISA), which means they can produce mild activation of beta receptors while…

Answer 34

…blocking receptor activation by strong agonists (like norepinephrine). As a result, HR at rest is slowed less than with other beta blockers.

(p. 507)

Question 35

What are the 3 beta blockers that have ISA?

Answer 35

acebutolol
penbutolol
pindolol

(p. 506)

Question 36

Which two sympatholytic drugs block both alpha and beta receptors?

Answer 36

carvedilol and labetalol

p. 506