Exam 1: Hypertension

Question 1

What classifies as elevated blood pressure?

Answer 1

120-129 systolic AND <80 diastolic

Question 2

What classifies stage 1 hypertension?

Answer 2

130-139 systolic OR 80-89 diastolic

Question 3

What classifies as stage 2 HTN?

Answer 3

> 140 systolic OR >90 diastolic

Question 4

What is secondary hypertension?

Answer 4

Increased BP resulting from an identifiable medication or medical condition

Question 5

What are the major conditions that can cause secondary Hypertension?

Answer 5

Renal disease, renovascular disease, OSA, thyroid disease, coarctation of the aorta, primary hyperaldosteronism, Cushing, pheocromocytoma, or medication induced

Question 6

What is the gold standard for diagnosing HTN?

Answer 6

Ambulatory blood pressure monitoring

Question 7

What is the basic testing you should order for patients with primary HTN?

Answer 7

Fasting blood glucose, CBC, lipid profile, serum creatinine with GFR, serum sodium/K+/Ca+, TSH, urinalysis, and EKG

Question 8

What should you order in patients with DM or CKD when testing for primary HTN?

Answer 8

Urinary albumin

Question 9

What is the first line treatment for all patients with essential HTN?

Answer 9

Lifestyle changes

Question 10

What are the 4 first line medications for treatment for HTN?

Answer 10

Diuretics, Angiotensin Converting Enzyme Inhibitors (ACE inhibitors), Angioteninogen Receptor Blockers (ARB), and calcium channel blockers (CCB)

Question 11

For stage 1 HTN, what is the recommended pharmacologic treatment?

Answer 11

A single antihypertensive drug, titrations up or adding a second medication as needed to reach target BP

Question 12

For stage 2 HTN, what is the recommended pharmacologic treatment?

Answer 12

2 first line agents of different classes

Question 13

If the patient has CKD and albuminuria, what should the first medication be for HTN?

Answer 13

An Ace inhibitor

Question 14

If a patient has DM and albuminuria, what medications should be given for HTN?

Answer 14

ACE or ARB

Question 15

If a patient has heart failure, what medication for HTN should be avoided if the EF is low?

Answer 15

CCBs

Question 16

What are the 4 types of diuretics?

Answer 16

Thiazide-type diuretics, loops diuretics, potassium sparing diuretics, and aldosterone antagonists

Question 17

What is the MOA of Diuretics?

Answer 17

Decreases the body’s sodium stores by inhibiting sodium reabsorption in the nephron.

They reduce plasma volume and peripheral vascular resistance

Question 18

What are the contraindications for thiazide type and loop diuretics?

Answer 18

Hypersensitivity to sulfas

Question 19

What is the preferred diuretic in heart failure?

Answer 19

Loop diuretics

Question 20

What is the preferred diuretic in primary aldosteronism?

Answer 20

Aldosterone antagonists

Question 21

What are the contraindications for aldosterone antagonists?

Answer 21

Renal impairment

Question 22

What is the MOA of ACE inhibitors?

Answer 22

Inhibit the RAAS system and stimulate bradykinin which has a vasodilator effect

Question 23

What kind of drug is spironolactone?

Answer 23

Aldosterone antagonist

Question 24

What kind of drug is furosemide?

Answer 24

Loop diuretic

Question 25

What kind of drug is triamterene?

Answer 25

Potassium sparing diuretic

Question 26

What kind of drug is chlorthalidone?

Answer 26

Thiazide type diuretic

Question 27

What kind of drugs are lisinopril, quinapil, and enalapril?

Answer 27

ACE inhibitors

Question 28

What are the contraindications of ACE inhibitors?

Answer 28

Pregnancy, angioedema, renal artery stenosis YOU CANNOT COMBINE WITH ARB

Question 29

What are the compelling indications for ACE inhibitors?

Answer 29

DM, CKD, post MI, and heart failure

Question 30

What is the MOA of ARBs?

Answer 30

Inhibit the RAAS system

Question 31

What are the contraindications of ARBs?

Answer 31

CANNOT COMBINE WITH ACE INHIBITORS Pregnancy and renal artery stenosis

Question 32

What are the two kind of calcium channel blockers?

Answer 32

Non-dihydropyridine (more of a cardiac depressant) and dihydropyridine (more of a vasodilator)

Question 33

What is the MOA of CCBs?

Answer 33

Inhibition of calcium influx into arterial smooth muscle cells, which reduces peripheral vascular resistance

Question 34

What are the contraindications of Non-dihydropyridines?

Answer 34

Avoid use with beta blockers, heart failure with reduced EF

Question 35

What are the contraindications of dihydropyridines?

Answer 35

Avoid in heart failure with reduced EF

Question 36

What are the two types of Beta blockers?

Answer 36

Cardioselective (B1) and noncardioselective (B1 and B2)

Question 37

What is the MOA of beta blockers?

Answer 37

Blocks the activity of catecholamines at B adrenoreceptors, which leads to decreased cardiac output, some decreased PVR, and decreased renin activity

Question 38

What kind of drugs are verapamil and diltiazem?

Answer 38

Non-dihydropyridine

Question 39

What kind of drugs are amlodipine, nifedipine, and felodipine?

Answer 39

Dihydropyridines

Question 40

What kind of drugs are propanalol, atenolol, and metoprolol?

Answer 40

Beta blockers

Question 41

What are the contraindications of beta blockers?

Answer 41

Bronchospastic disease, conduction abnormalities, and acute decomp of CHF

Question 42

What is the MOA of central alpha agonists?

Answer 42

Stimulate a2 adrenergic receptors in the brain which reduces CNS sympathetic outflow. **generally reserved for last line due to CNS adverse effects

Question 43

What are the contraindications of central alpha agonists?

Answer 43

Methydopa in liver disease

Question 44

What is the MOA of alpha blockers?

Answer 44

Targets a1 receptors on vascular smooth muscle, causing peripheral vascular resistance to decrease, thus decreases BP

Question 45

What is the compelling indication for alpha blockers?

Answer 45

BPH

Question 46

What is the MOA of direct renin inhibitors?

Answer 46

Inhibit enzyme activity of renin, reducing the activity of angiotensin 1 and 2 and aldosterone

Question 47

What are the contraindications of direct renin inhibitors?

Answer 47

Use with an ACE or ARB in DM, pregnancy

Question 48

What are the side effects of direct renin inhibitors?

Answer 48

Hyperkalemia, renal impairment, hypersensitivity reactions

Question 49

What are the side effects of alpha blockers?

Answer 49

Orthostatic HTN, reflex tachycardia

Question 50

What are the side effects of beta blockers?

Answer 50

Bradycardia, bronchospasm

Question 51

What are the side effects for Ace inhibitors?

Answer 51

Hyperkalemia, acute renal failure, and angioedema

Question 52

What are the side effects of thiazide type loop diuretics?

Answer 52

Electrolytes imbalances and gout

Question 53

What are the side effects of ARBs?

Answer 53

Hyperkalemia, acute renal failure, and angioedema

Question 54

What are the side effects of CCBs?

Answer 54

Cardiodepressant, dizziness, HA

Question 55

What is hypertensive urgency?

Answer 55

Asymptomatic severe HTN and no evidence of end organ damage (Diastolic greater than 120)

Question 56

What is hypertensive emergency?

Answer 56

Severe HTN and evidence of acute end organ damage

Question 57

What is cardiogenic shock?

Answer 57

A status of cellular and tissue hypoxia that most commonly occurs when there is circulatory failure that manifests as hypotension

Question 58

What kind of drug is Aliskiren?

Answer 58

Direct renin inhibitor

Question 59

What kind of drugs are the “Zosins”?

Answer 59

Alpha blockers

Question 60

Wha kind of drugs are verapamil and diltiazem?

Answer 60

Non-dihydropyridines