First line HTN meds

Question 1

What is BP?

Answer 1

Surrogate marker for CV risk

Question 2

What is the cause of HTN in most pts?

Answer 2

Primary/essential HTN

Question 3

What is HTN w/ an identifiable cause?

Answer 3

Secondary HTN

Question 4

What is the MAP formula?

Answer 4

Cardiac output x Total peripheral resistance

Question 5

What hormonal aspects are involved in HTN?

Answer 5

Renin
Angiotensis
Aldosterone
Bradykinin

Question 6

When does pharmacotherapy start for HTN?

Answer 6

SBP > 130

DPB > 80

Question 7

What do the new guidelines mean for HTN pts?

Answer 7

Lots more need meds

Question 8

What is the 1st line agent for HTN?

Answer 8

Thiazide diuretics

Question 9

What are examples of thiazide diuretics?

Answer 9

Chlorthalidone

Hydrochlorthizade

Question 10

Which thiazide diuretics are effective for CrCl <30?

Answer 10

Indapamide

Metolazone

Question 11

Is the hypotensive effect of thiazide diuretics longer or shorter than the half life?

Answer 11

Longer

*not sure why

Question 12

What is the half life of chlorthalidone?

Answer 12

45-60 hours

Question 13

What is the half life for hydrochlorthiazide?

Answer 13

8-15 hours

Question 14

What time of day do you give thiazides and why?

Answer 14

AM

Minimize nocturnal diureses

Question 15

Are chlorthalidone and hydrochlorthizaide effective at CrCl<30?

Answer 15

No

Question 16

For what populations do you use thiazides with caution in?

Answer 16

Pts > 65
Females
Pts w/ low or borderline low serum Na+

Question 17

What is the max of hydrochlorthiazide and chlorthalidone?

Answer 17

HCTZ: 25-50 mg
C: 25 mg

Question 18

What do ACEIs do?

Answer 18

Block RAAS-mediated conversion of AT to ATII (potent constrictor)

Question 19

What do ACEIs prevent?

Answer 19

LV hypertrophy

Question 20

When are ACEIs 1st line?

Answer 20

LV dysfunction
CKD
DM
Prevention of ischemic stroke

Question 21

How many times daily are ACEIs dosed? What is an exception?

Answer 21

1/day

Catopril

Question 22

At higher doses of which ACEI meds do pts require BID dosing?

Answer 22

Enalapril
Benazepril
Moexipril

Question 23

What do ALL ACEIs do?

Answer 23

Increase serum K+

Question 24

What is an SE of ACEIs?

Answer 24

GFR decrease

Question 25

What happens to SCr when on ACEI that does not call for DC?

Answer 25

Increase of 30% or absolute increase of < 1 mg/dL

Question 26

What happens if SCr increases more than previously listed while on ACEIs?

Answer 26

Discontinuation or dose reduction

Question 27

What populations is the SE of angioedema more prevalent?

Answer 27

African Americans | Smokers

Question 28

What does angioedema do w/ ACEIs?

Answer 28

Precludes any future ACEIs

Question 29

What % of pts develop dry, persistent cough?

Answer 29

20%

Question 30

What does the ACEI cough warrant?

Answer 30

Switching to an ARB

Question 31

When are ACEIs completely contraindicated?

Answer 31

Pregnancy | Category X

Question 32

What do you not combine w/ ACEIs?

Answer 32

ARBs | Aliskiren

Question 33

How is Enalapril administered, what is the dose, and how often (ACEI)?

Answer 33

IV, PO 5-40 mg 1-2/day

Question 34

What is the dosing of Lisinopril and how often is it given?

Answer 34

10-40 mg | 1/day

Question 35

Do ARBs block bradykinin metabolism?

Answer 35

No

Question 36

What does the lack of bradykinin metabolism do to make ARBs more preferable for some pts?

Answer 36

Little to no bradykinin induced cough

Question 37

What are ARBs missing due to continued bradykinin metabolism?

Answer 37

Myocardial remodeling | Regression of myocyte hypertrophy and fibrosis

Question 38

Should you use ACEIs and ARBs together?

Answer 38

No duh

Question 39

Why shouldn't you use ACEI and ARBs together?

Answer 39

Increased risk of hyperkalemia

Question 40

When can you not use ARBs?

Answer 40

Pregnancy

Question 41

What is the rate of SEs with ARBs?

Answer 41

The lowest incidence of SEs of all hypertensives

Question 42

Give two examples of ARBs | Is there generic availability?

Answer 42

Losartan Valsartan Yes

Question 43

What are the two classes of calcium channel blockers?

Answer 43

Dihydropyridines | Non-dihydropyridines

Question 44

Are dihydropyridines vasodilators or rate controllers?

Answer 44

Vasodilators

Question 45

Are non-dihydropyridines vasodilators or rate controllers?

Answer 45

Rate controllers

Question 46

What is a SE of dihydropyridine CCB?

Answer 46

Reflex tachycardia due to potent vasodilation

Question 47

With what agents is CCB reflex tachycardia more likely?

Answer 47

More pronounced w/ 1st generation DHP

Question 48

With what agents is reflex tachycardia less likely?

Answer 48

Much less pronounced with newer agents

Question 49

What is IR nifedipine associated with? | What is an example? What does this mean?

Answer 49

Increased adverse CV advents Ex: AMI in angina pts Means not approved for HTN

Question 50

What are some examples of dihydroperidine that are dosed once per day?

Answer 50

Amlodipine Felodipine Nifedipine LA Nisoldipine

Question 51

What are some examples of non-dihydropyridine CCBs?

Answer 51

Verapamil | Diltiazem

Question 52

What is a negative SE of verapamil?

Answer 52

Constipation

Question 53

When is combination therapy recommended for HTN?

Answer 53

Stage 2 HTN pts

Question 54

What is an advantage of combination BP pharmacotherapy?

Answer 54

Better BP control w/ fewer SEs

Question 55

What are some examples of dihydroperidine that are dosed twice per day?

Answer 55

Isradipine | Nicardipine SR