Hypertension

Question 0

What is the difference between essential HTN and secondary HTN?

Answer 0

Essential- no known cause (95% cases)

Secondary- normalizes with treatment of underlying problem

Question 1

What is stage I HTN? Stage II?

Answer 1

Stage I: 140-159/90-99

Stage II: systolic >160 or diastolic >100

Question 2

When are loop diuretics indicated instead of thiazides for HTN?

Answer 2

Severe HTN in setting of CHF or cirrhosis; GFR <30-40

Question 3

What are 4 causes of secondary HTN?

Answer 3

Chronic renal disease; drugs (EtOH, contraceptives); Endocrine (pheochromocytoma, cushings); obstructive sleep apnea

Question 4

What are 6 side effects of loop and thiazide diuretics?

Answer 4

Hypokalemia/hypomagnesemia --> cardiac arrythmias
Diabetes
Hyperlipidemia
Uricemia
Erectile dysfunction
Volume depletion

Question 5

What are 3 side effects of spironolactone?

Answer 5

Gynecomastia
Menstrual irregularities
Hyperkalemia
(All especially in setting of renal failure, diabetes, ACEI)

Question 6

What are the 4 thiazide diuretics in order of increasing potency?

Answer 6

Hydrochlorothiazide < chlorthalidone* < indapamide < metolazone

Question 8

What are the 3 K+ sparing diuretics?

Answer 8

Spironolactone, triamterene, amiloride

Question 9

What are the 6 ACEI? Which is the shortest acting?

Answer 9

captopril (shortest), lisinopril, benazepril, quinapril, ramipril, enalapril (active metabolite- enalaprilat)

Question 10

What are 3 Angiotensin receptor blockers?

Answer 10

losartan
valsartan
irbesartan

Question 11

What are 4 side effects of enalapril and others in its class?

Answer 11

(ACEI/ARB)
cough (only ACEI)
hypotension 
decreased renal function
angioedema (rarely)

Question 12

What is microalbuminuria a sign of? What drug may help?

Answer 12

chronic renal disease: remaining glomeruli hyperfiltrate and will burn out easily so a ACEI/ARB can reduce GFR and may help sustain kidney function

Question 13

In what patients are ACEI/ARBs contraindicated in? (3)

Answer 13

Renal artery stenosis
Hyperkalemia
Pregnancy
Caution in renal failure

Question 14

What class of drugs may decrease likelihood of atrial fibrilation?

Answer 14

Angiotensin Receptor Blockers –> can remodel LV hypertrophy and lower risk

Question 15

What are the 4 Ca++ channel blockers? Which 2 are dihydropyridines and which are not?

Answer 15

Dihydropyridines- amlodipine, nifedipine

Non-dihydropyridines- verapamil, diltiazem

Question 16

What is the mechanism of action for verapamil and others in its class?

Answer 16

Ca++ channel blockers –>

Interact with L-type voltage gated plasma membrane Ca channel–> smooth muscle relaxation

Question 17

What are the 2 Ca++ blockers that can create reflex tachycardia and should not be used in patients with angina?

Answer 17

Dihydropyridines- amlodipine and nifedipine

Question 18

Which class of Ca++ blockers can decrease heart rate (chronotropic benefit) and decrease O2 demand?

Answer 18

Non-dihydropyridines: verapamil & diltiazem

Question 19

Which drug(s) can be used to treat Raynauds syndrome?

Answer 19

Dihydropyridines are more effective (amlodipine, nifedipine) but non-dihydropyridines can be used as well (verapamil, diltiazem)

Question 20

What is the most common side effect of Ca++ channel blockers? What are 4 others?

Answer 20

• constipation most common

- leg edema; hypotension; AV nodal block; worsening HF (non-dihydro’s)

Question 21

What is a Beta Blocker that may cause bronchospasm and decreased exercise capacity? What are 2 other important side effects?

Answer 21

Propranolol (non-selective)
crosses BBB–> depression if taken chronically
masks symptoms of hypoglycemia (sympathetic blockade)

Question 22

What is the primary reason for BP lowering with the used of Beta-blockers?

Answer 22

reduced cardiac output

Question 23

What are 4 B1-selective Beta-blockers? Which 2 are longer acting?

Answer 23

metoprolol, atenolol, nadolol & bisoprolol are longer acting

Question 24

What are 2 Beta-blockers that also have some alpha-blocking properties providing vasodilatory effects as well and make for more potent anti-HTNs? What are each used for?

Answer 24

1. Labetolol- hypertensive urgency

2. carvedilol- Acute coronary syndrome, CHF

Question 25

What are 2 second-tier anti-HTNs that have the added benefit of helping with benign prostatic hypertrophy? Why are they 2nd-line?

Answer 25

Alpha1-blockers: terazosin, doxazosin

more likely to cause cardiac complications than 1st line

Question 26

What are 2 vasodilators that act peripherally to reduce BP? Which one is used IV in ICU for acuted hypertensive urgency or pts with both HTN & CHF?

Answer 26

Hydralazine - ICU

Minoxidil - refractory HTN

Question 27

What Beta-blocker is given IV for AV nodal blocking in unstable patients and has a short half-life?

Answer 27

Esmolol (B1-selective)

Question 28

What are 2 central acting alpha2-agonists? Side effects?

Answer 28

clonidine*
Alpha methyl dopa if pregnant
SE: sudden discontinuation–> severe rebound HTN; orthostatic hypotension; dry mouth, sedation, depression

Question 29

What are 2 ganglion blocking agents? Mechanism of action?

Answer 29

Guanethidine (blocks NE release)

Reserpine (depletes NE, DA, 5HT central & peripheral)

Question 30

What drug is preferred if HTN and obese?

Answer 30

clorthalidone

Question 31

What drug is 1st line therapy for an athletic patient with HTN?

Answer 31

ACEI