HTN

Question 1

Contraindications for Thiazides and Spironolactone

Answer 1

hyperlipidemia, gout, DM, preferred in pt’s with creatinine clearance >30ml/min

Question 2

Lasix is effective in pt’s with creatinine clearance of?

Answer 2

<30ml/min

Question 3

Spironolactone is ideal in pt’s with what condition?

Answer 3

HF

Question 4

Loop diuretics are indicated in the presence of?

Answer 4

• edema associated with congestive heart failure, hepatic cirrhosis, and renal disease
• In general, loop diuretics should be reserved for hypertensive patients with chronic renal insufficiency and/or need more severe diuresis

Question 5

Beta-1 receptors, located predominantly where, and regulate what?

Answer 5

located predominantly in the heart and kidney, regulate heart rate, renin release, and cardiac contractility

Question 6

Beta-2 receptors, located predominantly where, and regulate what?

Answer 6

located in the lungs, liver, pancreas, and arteriolar smooth muscle, regulate bronchodilation and vasodilation.

Question 7

MOA of B-blockers

Answer 7

reduce BP by blocking central and peripheral beta receptors, which results in decreased cardiac output and sympathetic outflow.

Question 8

What are the cardioselective B-blockers?

Answer 8

• metoprolol tartrate (Lopressor)
• metoprolol succinate (Toprol-XL)
• tenolol (Tenormin)
• nebivolol (Bystolic)
• bisoprolol (Zebeta)

may be safer than nonselective beta-blockers for patients with asthma, chronic obstructive pulmonary disease, and peripheral vascular disease

Question 9

Contraindications for B-blockers?

Answer 9

should be avoided in patients who have sinus bradycardia, asthma (if needed, low-dose cardioselective beta-blockers are preferred), chronic obstructive pulmonary disease, second- or third-degree heart block, or overt cardiac failure

Question 10

MOA of ACEI?

Answer 10

• exert an antihypertensive effect by the inhibiting ACE enzyme, which converts angiotensin I to angiotensin II, which is a potent vasoconstrictor
• ACEIs also inhibit the degradation of bradykinin and increase the synthesis of vasodilating prostaglandins. ACEIs decrease morbidity and mortality rates in patients with congestive heart failure, post-MI, and systolic dysfunction

Question 11

MOA of ARBs?

Answer 11

• ARBs block the vasoconstriction and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the angiotensin II receptor found in many tissues
• They are indicated for patients with hypertension, nephropathy in type 2 diabetes, and heart failure and those who cannot tolerate the side effects associated with ACEIs.

Question 12

MOA of CCBs?

Answer 12

• Calcium channel blockers (CCBs) share the ability to inhibit the movement of calcium ions across the cell membrane
• The effect on the cardiovascular system is muscle relaxation and vasodilation

Question 13

What are the nondihydropyridines CCBs?

Answer 13

• verapamil (Calan)

* diltiazem (Cardizem)

Question 14

MOA of the nondihydropyridines CCBs?

Answer 14

decrease heart rate and slow cardiac conduction at the AV node

Question 15

What are the dihydropyridines CCBs?

Answer 15

• amlodipine [Norvasc]
• felodipine [Plendil]
• nifedipine [Procardia XL]
• nicardipine [Cardene SR]
• nisoldipine [Sular]
• isradipine [DynaCirc]

Question 16

MOA of the dihydropyridines CCBs?

Answer 16

potent vasodilators

Question 17

MOA of peripheral Alpha-1 Receptor Blockers?

Answer 17

• effective in patients with benign prostatic hypertrophy and not usually prescribed solely for HTN treatment
• Peripheral alpha-1 receptor blockers act peripherally by dilating both arterioles and veins, causing relaxation of smooth muscle.

Question 18

MOA of Alpha-2 Receptor Blockers?

Answer 18

Central alpha-2 agonists stimulate alpha-2 adrenergic receptors in the brain, resulting in decreased sympathetic outflow, cardiac output, and peripheral resistance