HTN

Question 1

Physiologic Control of Blood Pressure and MOAs of Antihypertensives

Answer 1

[ BP = CO x PVR]

Question 2

essential HTN

Answer 2

Systolic BP > 140 mmHg or diastolic BP > 90mmHg with no underlying or specific identifiable cause

Question 3

when to start treatment for pts 60 and older?

Answer 3

150/90

Question 4

when to start tx for those pts younger than 60?

Answer 4

diastolic BP 90 or greater (30-59 grade A)

systolic BP < 140

Question 5

initial treatment for blacks?

Answer 5

thiazide diuretics or CCBs

Question 6

how to treat population aged 18 years or older with CKD and hypertension

Answer 6

ACE or ARB

Question 7

what classes should not be used together?

Answer 7

ACE and ARB

Question 8

first line treatment in most cases?

Answer 8

• thiazide diuretics (hydrochlorothiazide (HCTZ), chlorthalidone)
• blocks reabsorption of NaCl at the distal convoluted tubule
• DO NOT use in pts w/ gout, hyperuricemia or Hx of severe hyponatremia

Question 9

loop diuretics

Answer 9

• blocks reabsorption of Na+ in ascending loop of Henle

- Furosemide (Lasix)

Question 10

K sparing diuretics

Answer 10

• block reabsorption of Na+ via Na+ channels in collecting duct but reduce K+ secretion into urine
• can cause hyperkalemia w/ACE I
• spironolactone (Aldactone)
• Unique ADRs - gynecomastica, ED, amenorrhea

Question 11

ACE Inhibitors MOA

Answer 11

• block the conversion of Angiotensin I to Angiotensin II (potent vasoconstrictor), also blocks degradation of bradykinin (potent vasodilator), thereby reducing PVR   blood pressure
• C/I in pregnancy

Question 12

ACE ADRs

Answer 12

nonproductive cough (10-20%), rash, angioedema, hyperkalemia, decreased renal function, dizziness, abnormal taste. Little or NO sexual dysfunction

Question 13

ACE endings

Answer 13

“pril”

Question 14

ARB MOA

Answer 14

block the binding of angiotensin II to its receptors in vascular smooth muscle  vasodilation   PVR   blood pressure
blocks the binding of angiotensin II to its receptors in the adrenal cortex   aldosterone secretion   blood volume   stroke volume   cardiac output   blood pressure

Question 15

ARB endings

Answer 15

“SARTAN”

Question 16

beta blockers

Answer 16

• useful post MI
• avoid abrupt withdrawls
• “LOL”

Question 17

cardioselective (B1) specific beta blockers

Answer 17

• atenolol

- metoprolol

Question 18

carvedilol

labetalol

Answer 18

alpha/beta blocker used for CHF

alpha/beta blocker, can be used in pregnancy

Question 19

CCB precautions

ADRS

Answer 19

• peripheral edema and reflex tachycardia are common
• constipation, bradycardia, flushing, fatigue, headache, dizziness, peripheral edema, reflex tachycardia (if too much vasodilation), CHF, heart block and hypotension (w/ diltiazem and verapamil)

Question 20

DHP vs

non DHP CCBs

Answer 20

• amlodipine (all end in pine)….little effect on cardiac tissue
• diltiazem and verapamil

Question 21

A1 blockers

Answer 21

• used mainly for BPH
• Causes significant orthostatic hypotension and syncope
• C/I w/PDE-5 inhibitors
• “azosin”

Question 22

centrally acting agents

Answer 22

• refractory HTN after all else fails, avoid rapid withdrawal
• clonidine, alpha 2 agonist
• methyldopa, may cause coombs positive hemolytic anemia
• ADRs – bradycardia, heart block, impotence, dry mouth, sedation, depression and other CNS side effects b/c centrally acting

Question 23

direct vasodilators are reserved for…

Answer 23

refractory HTN, can cause reflex tachy or angina

• hydralazine, HTN secondary to pre-eclampsia, Lupus like syndrome
• minoxidil (rogaine)

Question 24

direct renin inhibitor

Answer 24

aliskiren, MOA – inhibits renin-angiotensin-aldosterone system earlier in cascade than ACE inhibitors or ARBs

Question 25

hyptertensive crisis

Answer 25

Diastolic blood pressure > 120 mmHg

Question 26

hypertensive emergency vs

urgency

Answer 26

target organ damage

no target organ damage

Question 27

Intravenous Therapeutic Options for Hypertensive Emergency

Answer 27

Dopamine receptor agonist Fenoldopam

Good choice in pts w/ renal dysfunction