Drugs to Treat HTN and HTN Urgency/Emergency

Question 1

What is the difference between primary HTN and secondary HTN in terms of treatment?

Answer 1

Drugs lower BP but do not treat underlying cause for primary HTN while people can be cured of secondary HTN

Question 2

What are causes of secondary HTN?

Answer 2

1) Renal parenchymal disease
2) Renovascular disease
3) Primary aldosteronism
4) Obstructive sleep apnea
5) Drug or alcohol induced
6) Pheochromocytoma

Question 3

Where do thiazide diuretics act on?

What transporter is blocked?

Answer 3

1) Distal convoluted tubule

2) Na-Cl cotransporter

Question 4

What drug is used to manage HTN by inhibiting sodium reabsorption in the distal tubules via blockade of Na+-Cl cotransporter?

When is it not effective in patients?

Answer 4

1) Hydrochlorothiazide

2) In patients with low GFR

Question 5

Unlike thiazides what can work in patients with low GFR in the treatment of HTN?

Answer 5

Furosemide (loop diuretic)

Question 6

What blocks epithelial sodium channels in the collecting ducts?

What is its clinical application in terms of HTN?

Answer 6

1) Amiloride

2) Counteract K+ loss induced by other diuretics in the Tx of HTN

Question 7

What is a competitive antagonist of aldosterone receptors?

What is its clinical application in terms of HTN?

Answer 7

1) Spironolactone

2) Counteract K+ loss induced by other diuretics in the Tx of HTN

Question 8

What is the difference between amiloride and spironolactone?

Answer 8

The steroid effects of spironolactone are slow on and slow off

Question 9

What is a competitive inhibitor of angiotensin converting enzyme that is used to treat HTN by preventing the conversion of angiotensin I to angiotensin II?

Answer 9

Captopril

Question 10

What is the most common reason to stop ACE inhibitor?

What deadly reason to stop it?

Answer 10

1) Coughing

2) Angioedema (Pt can be choked by their swollen tongue)

Question 11

What is a competitive non peptide angiotensin II receptor antagonist that is used to treat HTN by blocking the effects of angiotensin II?

Answer 11

Losartan

Question 12

The decrease in angiotensin II has what effect on efferent tone?

What can this precipitate in patients with bilateral renal stenosis?

What can this precipitate in diabetic patients?

Answer 12

1) Decreases it
2) Renal failure
3) Preserve renal function

Question 13

At what trimesters of pregnancy is ACE inhibitors contraindicated?

Answer 13

All of them

Question 14

What CCBs is the most widely used CCB in the treatment of HTN in part due to a very long half life?

Answer 14

Amlodipine

Question 15

Which category of CCBs have the most pronounced effect in vasodilation?

Answer 15

Dihydropyridines (nifedipine and amlodipine)

Question 16

What is a competitive antagonist of postsynaptic α1-adrenergic receptors used to treat HTN but not used anymore because they increase chance of stroke and CHF?

Answer 16

Prazosin

Question 17

What is an alpha-2 adrenergic receptor agonist that crosses the BBB and used for the treatment of HTN?

What can happen if a dose is missed?

Answer 17

1) Clonidine

2) Rebound HTN

Question 18

What is a selective agonist for α2-adrenergic receptors that remains a drug of choice for gestational HTN?

Answer 18

α-methyldopa

Question 19

What nonselective beta-adrenergic blocker competitively blocks response to beta1- and beta2- adrenergic stimulation and can be used in the Tx of HTN?

Answer 19

Propranolol

Question 20

What competitive β1-selective adrenergic receptor antagonist can be used in the Tx of HTN?

Answer 20

Atenolol and metoprolol

Question 21

The sudden abrupt stopping of α2-agonist leads to?

This ultimately results in?

Answer 21

1) Excessive SNS tone

2) Rebound HTN and death

Question 22

What causes direct vasodilation of arterioles and is used in hypertensive emergencies such as pregnancy?

Answer 22

Hydralazine

Question 23

What causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle and can be used in the management of hypertensive crises?

Answer 23

Nitroprusside

Question 24

What is the choice of therapy for renal vascular HTN?

Answer 24

Drugs that block RAS and statin therapy

Question 25

If a patient has angina along with HTN what class of drugs are given?

Answer 25

Beta blockers

Question 26

In the treatment of HTN in patients with CKD, what is the first line therapy used if they are displaying albuminuria?

Answer 26

ACE inhibitor

Question 27

In the treatment of HTN in patients with aortic disease what class of drugs are given?

Answer 27

Beta blockers

Question 28

In black adults with HTN but without HF or CKD, including those with DM, initial antihypertensive treatment should include?

Answer 28

Thiazide-type diuretic or CCB

Question 29

Women with HTN who become pregnant, or are planning to become pregnant, should be transitioned to what drugs during pregnancy?

Answer 29

Methyldopa, nifedipine, and/or labetalol

Question 30

What dihydropyridine CCBs can be given as an IV antihypertensive drug for hypertensive emergencies?

Answer 30

Nicardipine and Clevidipine

Question 31

What NO dependent vasodilators can be given as an IV antihypertensive drug for hypertensive emergencies?

Answer 31

Sodium nitroprusside and Nitroglycerin

Question 32

What direct vasodilator can be given as an IV antihypertensive drug for hypertensive emergencies?

Answer 32

Hydralazine

Question 33

What beta-1 selective adrenergic blocker can be given as an IV antihypertensive drug for hypertensive emergencies?

Answer 33

Esmolol

Question 34

What combined alpha-1 selective and nonselective beta adrenergic blocker can be given as an IV antihypertensive drug for hypertensive emergencies?

Answer 34

Labetalol

Question 35

What nonselective alpha adrenergic blocker can be given as an IV antihypertensive drug for hypertensive emergencies induced by catecholamine excess?

Answer 35

Phentolamine