Exam 6 lecture 3

Question 1

direct vasodilator agents

Answer 1

Minoxidil, hydralazine

Question 2

Direct vasodilators are reserved for pts with

Answer 2

Severe CKD/hemodialysis

Question 3

Which is more potent direct vasodilator

Answer 3

Minoxidil

Question 4

Can vasodilators be a monotherapy?

Answer 4

NO, concomitant use with BB or diuretic needed

Question 5

frequency of minoxidil

Answer 5

1-3f

Question 6

requency of hydralazine

Answer 6

2-4

Question 7

adverse effects of direct vasodilators

Answer 7

Palpitations, tachycardia, chest pain, headache, GI side effects, fluid retention

Question 8

Specific hydralazine adverse effects

Answer 8

Lupus (joint pain and generalized weakness)

Question 9

Boxed warning for minoxidil

Answer 9

May cause pericarditis and pericardial effusion that may progress to tamponate
May increase )2 demand and exacerbate angina

Question 10

A-1 blocker drugs

Answer 10

Doxasozin, Prazosin, Terazosin

all end with sin

Question 11

side effects for a-1 blockers

Answer 11

Orthostatic HTN

Question 12

Central a-2 agonist drugs

Answer 12

Clonidine, methyldopa, Guanfacine

last line due to adverse ffects

Question 13

side effects of central a-2 agonist

Answer 13

CNS, depression, dizzinessm fatugue

Question 14

which a-2 drug is the most preferred in pregnancy

Answer 14

Methyldopa

Question 15

Which form of clonidine is preferred and why

Answer 15

Patch is preferred due to reduced risk of rebound HTN

Question 16

How many times a day is methyldopa dosed

Answer 16

BID

Question 17

How many times a day is guanfacine dosed

Answer 17

QD

Question 18

what to monitor for BB

Answer 18

HR

Question 19

monitoring parameters for ACE/ARB, Aldosterone antagonist

Answer 19

BUN/Scr/K+

Question 20

What to do if patient is not at HTN goal

Answer 20

Consider switching to night time dosing for ACE/ARB/CCB
assess adherence
Educate on diet, exercise and smoking
Rule out white coat HTN

Question 21

What is resistant HTN

Answer 21

Failure to attain BP goal while adherent to regimen that include atleast 3 agents at MAX doses or when 4 or more agents are needed to control it

Question 22

STepwise treatment for tx reistant HTN

Answer 22

1. Maximize LSM
   Optimize 3 drug (ACE/ARB, CCB, thiazide) at max dose
2. if uncontrolled substitute optimized thiazide-like diuretics (chlorthalidone, indapamide) (stop hydrochlorothiazide and switch to these.
3. Add mineralcorticoid receptor antagonist (spironolactone, eplerenone)
4. Add BB if HR>70

Guanfacine at bedtime or clonidine patch if BB contraindicated (HR<70)

5. Hydralazine
6. minoxidil substitue for hydralizine

Question 23

Goals for hypertensive emergency

Answer 23

Hour 1- reduce BP by a max of 25%
Hour 2- Reduce BP<160/100-110
hours 6-48- reduce BP to goal

Question 24

What are the two types of hypertensive crisis

Answer 24

Urgency vs emergency

Question 25

difference between hypertensive urgency vs emergency

Answer 25

urgency- Systolic BP>180 and or diastolic BP>120 no evidence of target organ damage. Emergency- Systolic BP>180 and or diastolic >120 evidence of target organ damage

Question 26

symptoms patients report with target organ damage

Answer 26

H/a chest pain SOB back pain nummbness/weakness change in vision speaking difficulty

Question 27

do more people have hypertensive crisis or emergency?

Answer 27

60-75% crisis

Question 28

Most common causes of hypertensive emergency

Answer 28

Non-adherence others- Chronic HTN MEdication/substance pregnancy renal disease

Question 29

Is there a need for the ER for urgency? what about emergency?

Answer 29

Urgency- no need for ER HTN emergency- send to ER

Question 30

why should BP be lowered gradually

Answer 30

Risk for cerebral edema

Question 31

WHat are some medications used in hypertensive emergencies

Answer 31

DHP CCBs Vasodilators BB others

Question 32

What is the gold standard for hypertensive emergencies

Answer 32

Nicardipine IV

Question 33

CI of nicardipine IV

Answer 33

reflex tachycardia aortic stenosis

Question 34

What are the two DHP CCBs used in hypertensive emergencies

Answer 34

Nicardipine Clevdipine

Question 35

Clevdipine CI

Answer 35

Soy/egg allergies Severe aortic stenosis

Question 36

Vasodilators used in hypertensive emergenices

Answer 36

Nitroglycerin SNP Hydralazine

Question 37

What type of hypertensive crisis patients have benefits for nitroglycerin

Answer 37

Coronary ischemia

Question 38

What is something to note about nitroglycerin and SNP

Answer 38

Both cause tolerance in 24-48 hours

Question 39

WHat B blockers should be used in hypertensive emergencies

Answer 39

Labetalol IV push Esmolol

Question 40

What are other drugs that can be used for hypertensive emergencies

Answer 40

Enalaprilat IV push Clonidine oral

Question 41

What drug used in hyoertensive emergency is most likely to cause bradycardia

Answer 41

B blockers

Question 42

is hydralazine available as IV?

Answer 42

No

Question 43

What drugs to use to treat Acute decompensated HF with pumlonary edema? What drugs to avoid

Answer 43

Nitrate class (nitroglycerin or nitroprusside) Nicardipine and clevdipine are acceptable alternatives Avoid BB and non DHP CCBs

Question 44

How to treat Aortic dissection with hypertensive emergency

Answer 44

Initiate BB then vasodilator (nicardipine, clevdipine, Nitroprusside

Question 45

How to treat acute coronary syndrome with hypertensive emergency

Answer 45

Esmolol, labetalol, nitroglycerin, nicradipine, SNP Avoid BB if reduced HR (<60), heart block or airway disease

Question 46

What drugs should we avoid in AKI

Answer 46

SNP and Enalaprilat

Question 47

What BB does not cause a decrease in BP

Answer 47

Esmolol

Question 48

If patient has hypertensive emergency and stroke how to treat

Answer 48

Nicardipine, clevdipine, labetalol

Question 49

If patient has eclampsia /severe pre eclampsia how to treat

Answer 49

Hydralazine, labetalol, nicardipine