HTN

Question 1

1 drug treatment reduces HTN by

Answer 1

15 mmHg

Question 2

what lifestyle modifications can be done to reduce hypertension

Answer 2

• exercise
• weight reduction
• moderation of dietary salts, fats, alcohol
• avoid or reduce smoking

Question 3

once a patient is on a HTN drug, can he/she come off of it?

Answer 3

no, once on it, on it for life

Question 4

in elderly hypertensives, why would you not want to decrease BP to diastolic < 90 mmHg

Answer 4

• at this BP, coronary perfusion may become inadequate; could cause increase in morbidity and mortality

Question 5

DOC: HTN

Answer 5

thiazide diuretics

Question 6

What is special about the thiazide Indapamide

Answer 6

can also cause vasodilation

Question 7

explain MOA of thiazide diuretics and how they reduce BP

Answer 7

• 2 pronged attack: increase sodium and water excretion

1. short term effect: decrease body Na+ -> decreased blood volume -> decreased CO -> lowers BP
2. long term effect: decrease sodium content of smooth muscle cells -> decrease muscle sensitivity to vasopressors, activate K+ channels -> decrease peripheral vascular resistance -> lowers BP

Question 8

list the common side effects of diuretics

Answer 8

• impotence (E.D)
• gout due to hyperuricemia
• hypokalemia -> muscle cramps, arrhythmia
• reduced glucose tolerance (decreased insulin release)
• increased plasma lipid concentration

Question 9

most side effects of thiazide diuretics can be avoided by using lower doses. can you use a lower dose to treat HTN

Answer 9

yes, antihypertensive doses are much lower than those for diuresis

Question 10

contraindication to thiazide

Answer 10

sulfa allergy

Question 11

thiazides are often used in combination with B-blockers. Why?

Answer 11

• thiazides decrease BP and will cause reflex tachycardia
• B-blockers help to inhibit that reflex

Question 12

thiazide diuretics are more effective in what patient populations

Answer 12

• african american
• elderly

Question 13

when should loop diuretics by used to treat HTN

Answer 13

• when patient has severe renal insufficiency or CHF
• most thiazides do not work with low kidney function

Question 14

thiazides are often used in combo with what drugs to prevent hypokalemia

Answer 14

potassium sparing

Question 15

MOA of sympatholytics

Answer 15

• decrease BP by reducing sympathetic vasomotor tone
  
  • only system that is affected: BV due to sympathetic tone prevalence

Question 16

sympatholytics work best when used in combo with diuretics? why?

Answer 16

• sympatholytics activate baroreflexes and generally cause Na+ and H2O retention

Question 17

list alpha 2 agonists that are centrally acting sympatholytics

Answer 17

• clonidine
• methyldopa

Question 18

MOA of clonidine and methyldopa

Answer 18

• stimulate alpha2 receptors -> decrease in peripheral sympathetic nerve activity
• effect
  
  • decreased sympathetic outflow
  • decreased renin secretion

Question 19

which of clonidine and methyldopa decreases HR and CO more

Answer 19

clonidine

Question 20

route of administration of clonidine and methyldopa

Answer 20

• orally
• clonidine may be used as a patch

Question 21

DOC HTN in pregnancy

Answer 21

methyldopa

Question 22

adverse effects common to both clonidine and methyldopa

Answer 22

• sedation
• xerostomia (dry mouth)

Question 23

adverse effect of methyldopa

Answer 23

hemolytic anemia with a positive coombs test

Question 24

sudden withdrawal of clonidine can cause

Answer 24

hypertensive crisis

Question 25

List the alpha 1 adrenergic antagonists that are used for treatment of HTN

Answer 25

* Prazosin * Terazosin * Doxazosin

Question 26

indications/theraputic effects of a1 adrenergic antagonists

Answer 26

* a1 blockers: reduce NE caused vasoconstrction -\> **dilate arteries and veins -\>**BP falls due to decreased peripheral resistance * **does not adversely effect plasma lipids** * beneficial in BPH

Question 27

adverse effects of alpha1 antagonists

Answer 27

* **first dose phenomenon:** postural HTN may be pronounced with the first dose * Na+ and water retention (increase in renin) * reflex tachycardia

Question 28

list the non-selctive B antagonists used in treatment of HTN

Answer 28

* propranolol * nadolol * timolol

Question 29

list the Beta 1 antagonists used in treatment of HTN

Answer 29

* metoprolol * atenolol * nebivolol * acebutolol

Question 30

how does B-blockers reduce BP

Answer 30

* B1: reduce CO * B1: reduce renin secretion

Question 31

beta blockers are most effective in what patient population

Answer 31

* caucasian * young

Question 32

beta blockers are preferred for patients with what conditions

Answer 32

* angina * post MI * migraine

Question 33

beta blockers are least preferred for patients with what conditions

Answer 33

* high physical activity * african * asthma * DM * hypercholesterolemia * peripheral vascular disease

Question 34

MOA of Carvedilol and Labetalol

Answer 34

block alpha 1, beta 1 and beta 2 receptors

Question 35

indications of Labetalol? route of administration

Answer 35

* IV * decrease BP in * **hypertensive emergencies** * **pregnancy**; use if methyldopa isn't working

Question 36

indications of Carvedilol

Answer 36

* HTN and CHF, especially after an MI * lipid neutral

Question 37

adverse effects of carvedilol and labetalol

Answer 37

* orthostatic hypotension * bronchospasm * hepatotoxicity (labetalol)

Question 38

All vasodilators relax arterial smooth muscle, which vasodilator also relaxes veins

Answer 38

sodium nitroprusside

Question 39

effects of drugs that vasodilate decrease with time due to

Answer 39

* reflex tachycardia * increased renin secretion

Question 40

which vasodilators are used for **chronic oral treatment**

Answer 40

* hydralazine * minoxidil

Question 41

which vasodilators are used **IV for emergenies**

Answer 41

* Nitroprusside * Fenoldopam

Question 42

List the drugs that act through nitric oxide

Answer 42

* Hydralazine * Sodium nitroprusside

Question 43

MOA of hydralazine

Answer 43

* dilates **arterioles** but not veins through NO

Question 44

indications of Hydralazine

Answer 44

* chronic therapy of **severe** hypertension * combination therapy * used in severe HTN or hypertensive emergencies in **pregnancy**

Question 45

adverse effects of Hydralazine

Answer 45

* HA, N, palpitations, sweating, flushing (from vasodilation) * causes **SLE in slow acetylators**

Question 46

list the three drugs that can cause SLE in a slow acetylator

Answer 46

1. Hydralazine 2. Isoniazid 3. Procainamide

Question 47

Indications of sodium nitroprusside

Answer 47

* rapidly lowers BP and effect disappears in minutes after discontinuation * used for emergency hypertensive situations

Question 48

sodium nitroprusside route of administration? what is it metabolized into

Answer 48

* IV (press it in) * metabolized to thiocyanate (cyanide)

Question 49

adverse effects of sodium nitroprusside

Answer 49

* cyanide accumulation