Extra

Question 1

Which diuretics are safe to use in patients with renal impairment?

Answer 1

loop diuretics

Question 2

Which hypertensive mediation is first line for pregnant patients?

Answer 2

Methyldopa - Alpha 2 Agonist

Question 3

JNC 8: goal

Answer 3

140/90; unless > 60 yo: 150/90

Question 4

JNC 8: Non-black

Answer 4

thiazide, CCB, ACEI, or ARB

Question 5

JNC 8: African Americans

Answer 5

thiazide or CCB

Question 6

JNC 8: Chronic Kidney Disease

Answer 6

regimen should include an ACEI or ARB (including African Americans)

Question 7

JNC 8: If goal not reached

Answer 7

stress adherence to medication and lifestyle

increase dose or add a second or third agent from one of the recommended classes.

choose a drug outside of the classes recommended above only if these options have been exhausted. Consider specialist referral.

Question 8

Beta Blockers in Hypertension

Answer 8

not much evidence that it helps in hypertension

used with an ACE-I and ARB in patients with coronary artery disease or heart failure

Question 9

ASH Goals

Answer 9

goal: <140/90; unless >80 yo 150/90 or 140/90 with diabetes or kidney disease

Question 10

ASH first line of treatment

Answer 10

lifestyle changes

Question 11

ASH Stage 1 Treatment

Answer 11

(140-159/90-99) consider delay in medication

black CCB or Thiazide

Non-black; under 60 – ACE-I or ARB; over 60 – CCB or Thiazide

Question 12

ASH Stage 2 Treatment

Answer 12

(over160/100)

all patients start with two drugs: CCB or Thiazide plus ACE-I or ARB

Question 13

ASH Hypertension + Diabetes Treatment

Answer 13

ACE-I or ARB

Black - okay to start with CCB or thiazide

Question 14

ASH Hypertension + Chronic Kidney Disease Treatment

Answer 14

ACE-I or ARB

Question 15

ASH Hypertension + Coronary Artery Disease Treatment

Answer 15

Beta Blocker plus ACE-I or ARB

Question 16

ASH Hypertension + Stroke History Treatment

Answer 16

ACE-I or ARB

CCB may show better outcomes in black patients

Question 17

ASH Hypertension + Heart Failure Treatment

Answer 17

ACE-I or ARB plus Beta Blocker + diuretic + spironolactone

add CCB if needed

Question 18

What are the different classes of diuretics best at?

Answer 18

Thiazides - hypertension

loop diuretics - diuresis, relieving symptoms of heart failure

spironolactone (aldosterone antagonist) - improving symptoms of heart failure

Question 19

ACC/AHA Heart Failure Treatment - Stage A

Answer 19

patients at high risk for heart failure but without structural heart disease or symptoms of heart failure

address risk factors: treat hypertension, encourage smoking cessation, treat lipid disorders, optimize diabetes treatment, encourage exercise, and discourage excessive alcohol use

drugs: ACE-I or ARB

Question 20

ACC/AHA Heart Failure Treatment - Stage B

Answer 20

patients with cardiac disease but without limitations of physical activity; ordinary physical activity does not cause undue fatigue, dyspnea, or palpation

structural heart disease: previous MI, LV remodeling, low EF, valvular disease

address risk factors

Drugs: ACE-I or ARB + beta blocker

Question 21

ACC/AHA Heart Failure Treatment - Stage C

Answer 21

HF symptoms

patients with known structural heart disease, and SOB, fatigue, reduced exercise tolerance

treatment plan: salt restriction

drugs: diuretics, ACE-I, and beta blockers

in selected patients: ARBs, digoxin, aldosterone receptor antagonists, hydralazine/nitrates, devices (biventricular pacing, implantable defibrillation)

Question 22

ACC/AHA Heart Failure Treatment - Stage D

Answer 22

end-stage heart failure

patients with marked symptoms at rest despite medical therapy

treatment plan: continue interventions under stages A through C; end of life care/hospice; specialized interventions (heart transplant, chronic inotropes, mechanical support)

Question 23

Initial Treatment of Acute Heart Failure

Answer 23

treat congestion: IV diuretics, IV vasodilators

IV diuretics: furosemide, torsemide, bumetanide, ethacrynic acid

IV vasodilators: nitroglycerin, nitroprusside, nesiritide

treat hypoperfusion: positive inotropes (make the heart beat harder – push blood around better)

IV: dobutamine, dopamine, phosphodiesterase inhibitors

Question 24

Four Groups Targeted for Statin Treatment

Answer 24

established ASCVD (secondary prevention): 75 or under – high-intensity statin (moderate if not a candidate for high-intensity); older than 75 – moderate intensity

LDL >190 mg/dL: high-intensity statin (moderate if not a candidate for high-intensity)

diabetes mellitus, 40-75 yo, LDL 70-189: moderate intensity (high intensity if ASCVD risk is greater than 7.5)

primary prevention without DM, 40-75 yo, estimated 10 year risk of 7.5% or greater + LDL 70-189: moderate or high intensity statin

Question 25

What is the only recommended treatment for hypercholesterolemia in pregnant women?

Answer 25

Bile Acid Sequestrants (Renins), but more commonly treatments are just held during pregnancy

Question 26

Vaughn Williams Classification of Antiarrhythmic Drugs

Answer 26

Class I - Na channel blocker: IA—intermediate potency; IB—lowest potency, minimal effect on conduction velocity at normal heart rates; IC—greatest potential for slowing ventricular conduction

Class II - BB blockers

Class III - K channel blocker

Class IV - CCB (diltiazem, verapamil)

classes I and III affect depolarization and its rate; can slow down steps in the cardiac conduction process

classes II and IV have more of a rate control affect, although Ca is involved in the cardiac cycle as well (CCB)