HTN

Question 1

increasing sodium can lead to what in pts on diuretics

Answer 1

increase K loss

Question 2

SE of diuretics

Answer 2

” Hypokelmia
“ Incrased uric acid reabsorption & BSLower DBP 8-15mm Hg
“ Improved long-term survival
can also increase cholesterol but usually is transient

Question 3

diuretics effect Ca in what way?

Answer 3

reabsorption of Ca

can reduce fracture risk

Question 4

what populations do we see less effected by ACEI and why

Answer 4

elderly and AA are more likely to have low renin HTN

Question 5

these drugs block angiotensin II receptor

Answer 5

AIIRB

Question 6

Aliskiren (Tekturna) MOA

Answer 6

direct renin inhibitor (DRI)

just upstream of ACEI target

Question 7

Aliskiren CI with

Answer 7

Avoid concomitant use with ACEI or ARB in pt with diabetes

because of rash and angioedem

Question 8

Aliskiren indication

Answer 8

only if pts have already tried another drug but will probably have the same SE

Question 9

CCB dihydropyridines have most of their effect where

Answer 9

peripheral vascular

Question 10

CCB nondihydropyridines effect

Answer 10

directly on the heart

negative inotropic effect
negative conotropic effect because they directly block at the SA node and AV node

Question 11

CCB nondihydropyridines CI with

Answer 11

BB

because of effect directly on the heart

Question 12

when would you consider using a loop diuretic for HTN?

Answer 12

GFR less than 30

Question 13

dosing with loops

Answer 13

2x daily but not at night because you don’t want to get up an pee
no later than 12 noon

Question 14

resistant HTN defined as

what is recommended

Answer 14

3 drugs with elevated bp
or 4 drugs (max dose)

aldosterone antagonist are recommended here

be careful because a lot of pts would have secondary aldosteronism HTN and this could dramatically drop bp

Question 15

BB with ISA

Answer 15

intrinsic sympathetic activity

partial agonist
makes it look like partial agonist is an antagonist

binds to the receptor but the maximum activity is less than

Question 16

which bb do we see used most frequently for HTN

Answer 16

Atenelol
and
Metoprolol

Question 17

Alpha 2 agonist

Answer 17

will block NE release

Work in the CNS and block sympathetic outflow from the CNS

Question 18

Alpha 1 antagonist will cause what effect

Answer 18

Alpha 1 antagonist at the smooth muscle will cause vasodilation

Question 19

Doxazosin
Prazosin
Terazosin

are all

Answer 19

Alpha Blockers

Question 20

Doxazosin MOA

Answer 20

” Block post-synaptic alpha1 receptor

“ Potent vasodilation

Question 21

why don’t we use alpha blockers for HTN

Answer 21

not considered first line therapy

because higher incidence of developing HF

Question 22

Prazosin is also used for

Answer 22

PTSD

Question 23

ADE with alpha blockers

Answer 23

"	1st dose syncope (postural hypotension) 
"	Fluid retention
"	Dizziness
"	HA
"	Nausea
"	Floppy iris syndrome
stress incontinance in women

Question 24

counseling for pts on alpha 1 blockers

Answer 24

educate that on really hot days with alcohol they will have a higher risk of postural symptoms

feel “tired and washed out”

Question 25

Alpha2 agonist work on __________

Answer 25

" Alpha2 agonist work on vasomotor centers of the brain | " ↓PVR, CO--> ↓BP

Question 26

Clonidine is also used for | -0.2-1.2mg/d

Answer 26

will prevent peripheral manifestations of alcohol withdrawal but will not prevent seizures (benzos)

Question 27

Methyldopa is really only used in _____ why?>

Answer 27

pregnancy HTN because you need to dose all the time

Question 28

ADE with alpha 2 blockers like clonidine

Answer 28

``` " Severe rebound HTN & Insomnia " HA w/ palpitations if d/c suddenly " All have anticholinergic effect: Sedation, dry mouth, " Orthostatic hypotension " Bradycardia, fluid retention ```

Question 29

TCA will have what effect on a2

Answer 29

they increase NE levels so they work against each other

Question 30

Hydralazine Minoxidil are both

Answer 30

Direct Arterial Vasodilator " Direct arterial vasodilator (alters cellular Ca metabolism)

Question 31

ADE with direct arterial vasodialtors

Answer 31

``` " Reflex tachycardia---> " Angina exacerbated " HA " Lupus-like syndrome " Flushing " Fluid retention ```

Question 32

when would you use a direct arterial vasodilator

Answer 32

" Best to give these with BB & DHP CCBs to help with this + diuretic d/t increased HR response from arterial dilation

Question 33

" Minoxidil also used for

Answer 33

hair growth (Rogaine) can also make facial feature more corse

Question 34

Reserpine | Peripheral Adrenergic Inhibitors

Answer 34

" Depletes catecholamine stores (Norepi NT) ---> ↓PVR

Question 35

Reserpine (Peripheral Adrenergic Inhibitors) avoid in

Answer 35

peptic ulcer disease PUL

Question 36

HTN emergency

Answer 36

life threatening complications

Question 37

HTN crisis

Answer 37

>180/120

Question 38

goal to reduce MAP by 25% in minutes to hours (NOT < 140/90)

Answer 38

goal to reduce MAP by 25% in minutes to hours (NOT < 140/90)

Question 39

Particularly good for elevated BP with myocardial ischemia dilates venous (primarily) and coronary vessels → decreases . preload, myocardial O2 demand

Answer 39

Nitroglycerin

Question 40

Fenoldopam (Corlopam)

Answer 40

May be good for kidney insufficiency | selective D1-agonist and a2 receptor agonist; vasodilator and increases renal blood flow.

Question 41

Labetalol – mixed beta/alpha blocker Onset 5-10 min, duration 30-60 min Not in acute HF used for

Answer 41

HTN crisis need person supine b/c of high risk of orthostasis

Question 42

PAH group

Answer 42

based on associated etiology with group 1 isiopathic