Chronic Illness DOC

Question 1

First-line medications for primary hypertension

Answer 1

Thiazide diuretics
ACE-I
ARBs
Dihydropyridine CCBs

Question 2

CKD

Answer 2

Initial therapy
ACEIs or ARBs
Treatment goal: SBP < 120 mm Hg (if tolerated)

Question 3

Diabetes

Answer 3

Initial therapy:
For patients with microalbuminuria or overt proteinuria: ACEIs or ARBs (protective against diabetic nephropathy)

For patients without albuminuria: any first-line agent (ACEIs, ARBs, CCBs, OR thiazide diuretics)

Treatment goal: blood pressure < 130/80 mm Hg

Question 4

CHF

Answer 4

Initial therapy
HFrEF: guideline-directed medical therapy

Beta blockers (carvedilol, or metoprolol succinate, or bisoprolol)
Recommended for use in compensated CHF

Must be used cautiously in decompensated CHF
Contraindicated in cardiogenic shock

Diuretics, including aldosterone antagonists

ACEIs OR ARBs

Angiotensin receptor-neprilysin inhibitor

HFpEF
Current volume overload: diuretics

No current volume overload: ACEIs or ARBs PLUS beta blockers
Avoid nitrates.
Treatment goals
< 130/80 mm Hg

Question 5

Asthma

Answer 5

Initial therapy
ARBs, CCB, OR thiazide diuretics (no preference)

Cautions
Avoid beta blockers unless for a particular indication.

Use cardioselective beta blockers when necessary (noncardioselective beta blockers can cause bronchoconstriction).

ARBs may be preferred over ACEIs (increased risk of cough)

Question 6

Osteoporosis

Answer 6

Initial therapy: thiazide diuretics (↓ renal calcium excretion → ↓ bone loss)

Question 7

Gout

Answer 7

Initial therapy
ARBs (e.g., losartan, have an uricosuric effect), ACEIs, and CCBs
Thiazide diuretics should be avoided (↑ uric acid levels).

Question 8

Migraine

Answer 8

Initial therapy: beta blockers OR CCBs