Hypertension

Question 1

ACEi

Answer 1

ex. ramipril
AE: dry cough, acute increase in SCr, hyperkalemia, angioedema
CI: pregnancy
DDI: lithium
Caution: bilateral renal artery stenosis
ACE+CCB>ACE+diuretic

Question 2

ARB

Answer 2

ex. candesartan
AE: acute increase in SCr, hyperkalemia, angioedema (less than ARB)
CI: pregnancy
DDI: lithium
Caution: bilateral renal artery stenosis

Question 3

Aliskiren (direct renin inhibitor)

Answer 3

AE: diarrhea, cough, rash, fatigue
CI: pregnancy

Question 4

Thiazide diuretics

Answer 4

Hydrochlorothiazide
AE: hypokalemia, hyponatremia, hyperuricemia, hyperglycemia, hyperlipidemia
DDI: lithium

Question 5

Thiazide-like diuretics

Answer 5

Chlorthalidone, indapamide, metolazone
*preferred over thiazides bc additionally lowers coronary events and all cause mortality plus longer half life
AE: hypokalemia, hyponatremia, hyperuricemia

Question 6

DHP CCB

Answer 6

eg. amlodipine, nifedipine ER
vascular selective, vasodilate to reduce BP
AE: ankle edema, flushing, headache, palpitations (reflex tachycardia)

Question 7

non-DHP CCB

Answer 7

eg. verapamil, diltazem
non-vascular selective, vasodilate (reduce BP) and affect heart (decrease HR; no reflex tachycardia)
AE: headache, dizziness, bradycardia, worsening HF, constipation (V)

Question 8

BB

Answer 8

AE: bradycardia, sleep disturbances, hypoglycemia (if on insulin), increase TG, decrease HDL
Caution: heart block, asthma, elderly (avoid monotx in >60y)
Taper; can cause withdrawal

Question 9

nonselective BB
cardioselective BB
intrinsic sympathomimetic BB
a1 blocking BB
vasodilating BB

Answer 9

nonselective: propanolol, nadolol, sotalol, timolol
cardioselective: metoprolol, bisoprolol, atenolol, acebutolol - safer in asthma, diabetes
ISA: pindolol, acebutolol, penbutolol - less bradycardia
a1: labetolol, carvedilol - no reflex tachycardia
vasodilating: cartelol, carvedilol, labetolol - beneficial in HF

Question 10

Pregnancy antihypertensives

Answer 10

1st line: labetolol, methyldopa, nifedipine ER, other BB (acebutolol, propanolol, metoprolol, pindolol)
2nd line: clonidine, hydralazine
AVOID: ACE/ARB, atenolol, spironolactone, diuretics

Question 11

alpha antagonists

Answer 11

prazosin, doxazosin
AE: ortho hypo, headache, drowsiness, nasal congestion, syncope

Question 12

MRA

Answer 12

Mineralocorticoid Receptor Antagonists
Epleronone, Spironolactone
Monitor K, SCr
maybe effective in resistant HTN (tried >3 drugs)

Question 13

What BP to go to ER

Answer 13

> 200/120mmHg

Question 14

What BP is pharmacotx indicated?

Answer 14

> 160/100mmHg

Question 15

new antihypertensive, when to follow up? increase dose?

Answer 15

2-4w follow up, 4w increase dose

Question 16

What otc to avoid for uncontrolled HTN

Answer 16

1st gen antihistamines
Oral decongestants