Exam 6 - HTN Olenik

Question 1

HTN treatment for pt with stable ischemic heart disease

Answer 1

ACE/ARB and beta blocker first, then can add DHP CCB if still uncontrolled

Question 2

HTN treatment for pt with HfrEF (Heart failure with reduced ejection fraction)

Answer 2

ACE/ARB/ARNI, mineralocorticoid receptor antagonists, diuretics and beta blocker are first line

Question 3

what class should be avoided in pts with HfrEF?

a. thiazides
b. beta blockers
c. DHP CCBs
d. non-DHP CCBs

Answer 3

d. non-DHP CCBs

Question 4

first line agents for initial HTN treatment (3)

Answer 4

-thiazide diuretics (best)
-CCBs
-ACEs/ARBs

Question 5

preferred combination therapy treatment for HTN

Answer 5

an ACE/ARB with a CCB or diuretic, basically any combo of those

(CCB/diuretic is acceptable but not preferred)

Question 6

HTN treatment for pt with HfpEF (preserved ejection fraction)

Answer 6

diuretics first line (if symptomatic); if persistent HTN, ACE/ARB or BB (if HR elevated)

Question 7

HTN treatment for pt with CKD

Answer 7

ACEi (or ARB if intolerant)

Question 8

HTN treatment for pt with kidney transplant

Answer 8

DHP CCBs first line over ACEi

(CCB reduces graft loss and maintains higher GFR)

Question 9

HTN treatment for secondary stroke prevention

Answer 9

ACEi/ARB, thiazide diuretic, or combo of those two

Question 10

what BP is needed to start antihypertensive treatment for secondary stroke prevention?

Answer 10

140/90+

Question 11

what is the preferred agent for pt with HTN and diabetes, in the presence of albuminuria?

Answer 11

ACEi or ARBs

Question 12

3 preferred agents for pregnant HTN patients

Answer 12

-methyldopa
-nifedipine
-labetalol

Question 13

what is the preferred HTN treatment for black patients without HF or CKD, including those with diabetes? (2 options)

Answer 13

thiazide or CCB

Question 14

true or false: an ARB may be useful for prevention of recurrence of A-Fib

Answer 14

true

Question 15

what drug class can help improve survival in pts with HTN and aortic disease? (from slide 19)

Answer 15

beta blockers

Question 16

LH is a 52 year old African American male who you are seeing in clinic for type 2 diabetes follow up. His medications include metformin and glipizide. While reviewing his chart you notice his blood pressure was 135/79 at his last PCP visit and today is 133/81. His ASCVD risk is 8.2% and kidney function is normal.

Which medication classes would be first-line for LH? (2)

Answer 16

thiazide diuretic or CCB

Question 17

TT is a 62 year old white female with a PMH significant for stroke and heart burn. Her medications include omeprazole and atorvastatin. Her primary care physician puts in a pharmacy consult for her newly diagnosed HTN. BPs for her last two clinic visits are 147/81 and 150/90.

What combo would you recommend to treat TT’s HTN?

Answer 17

thiazide and ACE inhibitor combo

Question 18

thiazides are more effective than loop diuretics with CrCl > ___ mL/min

Answer 18

> 30 mL/min

Question 19

how many times per day are all thiazide diuretics dosed?

a. once
b. twice
c. four times
d. as needed

Answer 19

a. once

Question 20

drug interaction for thiazide diuretics

Answer 20

lithium toxicity with concurrent use

Question 21

two CIs for thiazide diuretics

Answer 21

sulfa allergy, anuria

Question 22

CI for loop diuretics (1)

Answer 22

sulfa allergy (except for ethacrynic acid)

Question 23

first-line diuretic for resistant HTN

Answer 23

spironolactone

Question 24

do not initiate aldosterone antagonist with potassium > _____ mEq/L

Answer 24

> 5

Question 25

for aldosterone antags, consider holding or reducing dose if potassium > _____ mEq/L or SCr inc > _____%

Answer 25

5.5; 25%

Question 26

CI’s for eplerenone (3)

Answer 26

-impaired renal function (CrCl < 50 mL/min or SCr > 2 [males] or > 1.8 [female]
-T2DM and proteinuria
-concomitant use of potassium sparing diuretics

Question 27

2 potassium-sparing diuretic drugs

Answer 27

amiloride
triamterene

Question 28

if a pt is on spironolactone for resistant HTN, but develop gynecomastia, what drug can we switch it to?

Answer 28

eplerenone