Hypertension

Question 1

BP goal for adults over 60 without diabetes or CKD?

Answer 1

Less than 150/90

Question 2

In patients 18-59 without major comorbidities and in patients over 60 who have diabetes, CKD, or both the BP goal is:

Answer 2

Less than 140/90

Question 3

In black patients without CKD what medications should be used to treat HTN?

Answer 3

CCB or thiazides

Question 4

In patients of all races and ages with CKD what is first line pharmacological treatment of hypertension?

Answer 4

ACEI or ARB alone or in combo with another class

Question 5

Metoprolol, bisoprolol, betaxolol, acebutolol are what?

Answer 5

Beta-1 selective beta blockers that are possibly safer in patients with COPD, asthma, diabetes, and PVD.

Question 6

What is the only diuretic indicates in the treatment of HTN?

Answer 6

Thiazides

Question 7

Thiazides MOA:

Answer 7

Inhibit reabsorption of sodium and chloride in the thick ascending loop of henle and the early distal tubules which decreases plasma volume and SV.

Question 8

Loop diuretics are indicated for?

Answer 8

Patients in heart failure (presence of edema)

Question 9

What is MOA of an ACEI?

Answer 9

Prevents formation of angiotensin II a potent vasoconstrictor. Also inhibits degradation of bradykinin and increases synthesis of vasodilating prostaglandins. This reduces arterial pressure, preload, and afterload.

Question 10

What do ACEI end in?

Answer 10

-pril

Question 11

Can you use an ACEI or an ARB in pregnancy?

Answer 11

No

Question 12

Biggest side effect of an ACEI?

Answer 12

Chronic dry cough (d/t increased bradykinins)

Question 13

What do ARBs end in?

Answer 13

-sartan

Question 14

MOA of an ARB:

Answer 14

Blocks binding of angiotensin II. This decreases ADHD secretion, aldosterone secretion which stops vasoconstriction and increases Na and water elimination.

Question 15

ARBs should not be used with:

Answer 15

ACEI or renin inhibitor

Question 16

What classes of HTN medications cause first dose effect?

Answer 16

ARB, Alpha 1 blockers, Alpha 2 blockers

Question 17

What is the first-dose effect?

Answer 17

Fatigue, dizziness, and syncope. Lay down for 30 minutes after first few doses.

Question 18

MOA of CCB?

Answer 18

Inhibit movement of calcium ions across the cell membrane causing muscle relaxation and vasodilation in the CV system.

Question 19

2 types of CCB:

Answer 19

Dihydropyridines: amlodipine, nicardipine

Nondihydropyridines: diltiazem, verapamil

Question 20

Dihydropyridines are:

Answer 20

Potent vasodilators

Question 21

Nondihydropyridines are:

Answer 21

Used to treat tachyarrhythmias. They decrease HR and slow cardiac conduction at the AV node.

Question 22

Vasodilators such as hydralazine and minoxidil should be reserved for patients with:

Answer 22

Essential or severe HTN.

Question 23

Vasodilators MOA:

Answer 23

Cause smooth muscle relaxation resulting in a reduction of BP.

Question 24

Alpha 1 peripheral blockers are used in:

Answer 24

Patients with BPH. Not usually prescribed solely for HTN treatment.

Question 25

HTN pregnancy drug of choice:

Answer 25

Methyldopa

Oral hydralazine can be used in conjunction with methyldopa if needed

Question 26

In patients over 75 with impaired kidney function what should be used for HTN?

Answer 26

CCBs and thiazides instead of ACEI and ARBs due to risk of hyperkalemia, increased creatinine, and further renal impairment.

Question 27

Causes of HTN?

Answer 27

Primary: 95%, disease of aging
Secondary: exact cause known

Question 28

What is first line treatment in children?

Answer 28

Lifestyle change

If medication needed initiate and ACE inhibitor

Question 29

In geriatric population without diabetes or CKD what is initial pharm treatment?

Answer 29

Thiazides

Question 30

What medications are ok during breastfeeding?

Answer 30

Diuretics and betablockers

Methyldopa and labetalol for pregnancy are fine to continue

Question 31

What meds are contraindicated in breastfeeding?

Answer 31

ACEI and ARBs

Question 32

Spironolactones main side effects:

Answer 32

Gynecomastia and hyperkalemia

Question 33

ACEI and ARB side effects:

Answer 33

Cough and angioedema (both more with the ACEI) and hyperkalemia

Question 34

Beta-blockers are not first-line therapy and should be reserved for:

Answer 34

Post-mi/ CHF

Question 35

Side effects of beta-blockers:

Answer 35

Fatigue, decreases HR, adversely affect glucose and mask hypoglycemia symptoms

Question 36

CCBs cause what side effect:

Answer 36

Edema

Question 37

Vasodilators cause what side effects and are usually prescribed with:

Answer 37

Reflex tachycardia and fluid retention

Usually require diuretic and beta-blocker