Hypertension and Heart-related meds

Question 1

Pharmacologic therapy and guideline for: DM w/ ACR <30mg/day

Answer 1

ACEI or ARB or DHP CCB or thiazide

ADA

Question 2

Pharmacologic therapy and guideline for: DM w/ACR ≥30mg/day

Answer 2

ACEI or ARB +/- DHP CCB +/- thiazide

ADA

Question 3

Pharmacologic therapy and guideline for: CKD

Answer 3

ACEI or ARB

JNC8, KDIGO

Question 4

Pharmacologic therapy and guideline for: CAD

Answer 4

BB + ACEI or ARB + thiazide +/- nitrate +/- CCB +/- aldosterone antagonist
AHA/ACC/ASH

Question 5

Pharmacologic therapy and guideline for: HF

Answer 5

ACEI or ARB or ARB/neprilysin inhibitor + BB +/- aldosterone antagonist +/- diuretic +/- hydralazine/isosorbide dinitrate if black
ACC/AHA/HFSA

Question 6

Pharmacologic therapy and guideline for: Recurrent stroke prevention

Answer 6

Diuretic +/- ACEI

AHA/ASA

Question 7

Pharmacologic therapy and guideline for: Black

Answer 7

Thiazide or DHP CCB

JNC8

Question 8

Pharmacologic therapy and guideline for: Non-black

Answer 8

Thiazide or ACEI or ARB or DHP CCB

JNC8

Question 9

What class and dosage is Chorthalidone

Answer 9

Thiazide/Thiazide like diuretics

12.5 - 25mg PO QAM

Question 10

What class and dosage is Hydrochlorothiazide

Answer 10

Thiazide/Thiazide like diuretics

12.5 - 25mg PO QAM

Question 11

What class and dosage is Metolazone

Answer 11

Thiazide/Thiazide like diuretics

2.5 - 5mg PO QAM

Question 12

What class and dosage is Indapamine

Answer 12

Thiazide/Thiazide like diuretics

1.25 - 2.5mg PO QAM

Question 13

What class and dosage is Furosemide

Answer 13

Loop diuretics

20 - 40mg PO BID

Question 14

What class and dosage is Bumetamide

Answer 14

Loop diuretics

0.5 - 4mg PO QAM or BID

Question 15

What class and dosage is Torsemide

Answer 15

Loop diuretics

5 - 10mg PO QAM

Question 16

What class and dosage is Amiloride

Answer 16

Potassium-sparing diuretics
5mg PO QAM
10mg PO QAM not monotherapy
CrCl 10-50ml/min- 50% of dose, CrCl <10ml/min- avoid use

Question 17

What class and dosage is Triamterene

Answer 17

Potassium-sparing diuretics
37.5mg PO QAM
75mg PO QAM not monotherapy
CrCl <50ml/min- avoid use, Severe hepatic impairment- CI

Question 18

Things to remember about Thiazide/Thiazide-like diuretics

Answer 18

Potassium-wasting
NSAID may diminish diuretic effects

Thiazide-type diuretics are a good 1st line choice in HTN
Specifically chlorthalidone

Good choice if patient has had a stroke (in combination with an ACEI)
Allow up to 4 weeks for full efficacy

Avoid diuretics, especially thiazides, if a patient has gout

Question 19

Things to remember about Loop diuretics

Answer 19

Potassium-wasting (more than thiazide)
NSAID may diminish diuretic effects

Good choice if patient has had a stroke (in combination with an ACEI)
Allow up to 4 weeks for full efficacy

May have BID dosing, Taking AM and in the afternoon to avoid nocturia

Loops are a more potent diuretic and preferred if edema present especially CKD and HF patients or when GFR < 30 ml/min/1.73

Question 20

Things to remember about potassium-sparing diuretics

Answer 20

Potassium sparing diuretics are weak diuretics, but can be used in combination with other diuretics to address hypokalemia
Not taking by itself
Increased potassium with ACEI, ARB, DRI, potassium supplements

Question 21

Drugs that act on the RAAS

Answer 21

ACEI
ARB
DRI (Aliskiren or brand name Tekturma)

Question 22

Lisinopril dosing

Answer 22

5-10-40mg PO daily

Question 23

Losartan dosing

Answer 23

Cozaar

25-50-100mg PO daily

Question 24

Olmesartan dosing

Answer 24

Benicar

5-20-40mg PO daily

Question 25

Valsartan dosing

Answer 25

Diovan | 80-160-320mg PO daily

Question 26

Monitor for diuretics

Answer 26

Monitor BP, HR, SrCr, Na+, K+ 4 weeks after initiation or dose titration and every 3-6 months thereafter

Question 27

Side effects of ACEI

Answer 27

Hyperkalemia Angioedema (more common than ARB) Cough Increased SCr

Question 28

Side effects of ARB

Answer 28

Hyperkalemia Angioedema Increased SCr

Question 29

Things to know about ACE and ARB

Answer 29

ACEI or ARB good 1st line option in HTN Very good choice if patient has: _ CKD or DM w/ACR >30mg/day _ Hx stroke (in combination with thiazide) _ Hx MI, CAD, HFrEF (in combination with a BB)

Question 30

Diltiazem dosing

Answer 30

Cardizem, Cartia XR: 120-240-360mg PO daily SR: 60-120-180mg PO BID

Question 31

Verapamil dosing

Answer 31

Calan, Verelan, Isoptin XR: 180mg (240-480 mg max) PO daily SR: 120-180mg (240-360mg max) PO daily

Question 32

Amlodipine dosing

Answer 32

Norvasc | 2.5-5-10mg PO daily

Question 33

Side effects for DHP CCB

Answer 33

Hypotension Flushing Headache Peripheral edema

Question 34

Side effects for NDHP CCB

Answer 34

``` DHP CCB side effect too, but mostly AV Block (Conduction disturbances) Bradycardia Nausea Constipation ```

Question 35

Monitoring for CCB

Answer 35

Monitor BP and HR within 2-4 weeks of dose change or initiation, then every 6 months or as clinically indicated. Education regarding ADRs with specific agent chosen at least at baseline and dose change.

Question 36

What class and dosage is Spirolactone?

Answer 36

Aldosterone antagonist | 12.5-25-50mg PO daily

Question 37

Side effects of Spirolactone

Answer 37

``` Gynecomastia Hyperkalemia Dizziness Increased SCr Other "steroid" ADR ```

Question 38

What class and dosage Hydralazine?

Answer 38

Direct vasodilator | 10-100mg (Max 300mg/day) PO 2-4x/day

Question 39

Side effect of Hydralazine

Answer 39

Edema, tachycardia, orthostatic hypotension, BP

Question 40

What class and dosage Cavedilol?

Answer 40

Non-selective BB with a-activity | IR: 6.25-25mg PO BID

Question 41

What class and dosage Metoprolol tartrate

Answer 41

Selective BB | IR: 25-50-200mg PO BID

Question 42

What class and dosage Metoprolol succinate

Answer 42

Selective BB | XL: 50-100-200mg PO daily

Question 43

Side effects of BB

Answer 43

``` Dizziness, orthostatic hypotension Fatigue Erectile dysfunction (less with vasodilatory BBs) Decreased exercise tolerance Bradycardia/AV block Hyperglycemia (β2 mediated) ```

Question 44

Monitoring of BB

Answer 44

Main monitoring is HR (bradycardia) and BP within 2-4 weeks after initiation or dose change. Educated regarding pertinent ADRs at least at initiation and dose change.

Question 45

What class and dosage Clonidine

Answer 45

Central a2-agonist | 0.1-0.2mg PO BID (Max benefit: 1.2mg/day)

Question 46

Side effects of central a2-agonist

Answer 46

Bradycardia, dizziness, drowsiness, DRY MOUTH, fluid retention, erectile dysfunction, orthostasis, depression, constipation, urinary retention Caution in elderly! Often used with diuretic to diminish fluid retention, especially methyldopa

Question 47

Monitoring of central a2-agonist

Answer 47

BP, HR, and ADRs in 1-2 weeks after initiation or dose change. Educated regarding pertinent ADRs at least at initiation and dose change

Question 48

What class and dosage Prazosin

Answer 48

a1-blocker | 1-20mg PO BID or TID

Question 49

What class and dosage Terazosin

Answer 49

a1-blocker | 1-5mg PO QHS

Question 50

What class and dosage Doxazosin

Answer 50

a1-blocker | 1-2mg PO daily

Question 51

Side effects of a1-blocker

Answer 51

“First-dose” effect (dizziness, faintness, orthostasis within 1-3 hours after first dose or dose changes), orthostatic hypotension, edema, dizziness, vivid dreams, depression Caution in elderly! Patient education: Take first dose at bedtime and rise slowly from sitting or laying positions

Question 52

Monitoring for a1-blocker

Answer 52

BP, HR, and ADRs in 1-2 weeks after initiation or dose change. Educated regarding pertinent ADRs at least at initiation and dose change