Hypertension Drugs

Question 1

PE dx workup for HTN

Answer 1

BP
Fundoscopic exam
BMI
Carotid, ab, femoral bruits
Thyroid gland palpation
Heart and lung
Abdominal exam--kidneys, masses, aortic pulsations
LE edema
Neuro exam

Question 2

DX labs for HTN

Answer 2

EKG
UA
BG, HCT
serum K, creatinine, Ca
Lipids

Question 3

Chlorthalidone vs HCTZ

Answer 3

Chlorthalidone has much longer half life

Question 4

HF drug choice

Answer 4

ACE/ARB, BB, diuretic, aldosterone antagonist

Question 5

Post MI drug choice

Answer 5

BB, ACE, aldosterone antagnoist

Question 6

High CAD risk

Answer 6

ACE, Diuretic, BB, CCB

Question 7

DM

Answer 7

Diuretic, ACE/ARB, BB, CCB

Question 8

Kidney Dz

Answer 8

ACE/ARB

Question 9

Recurrent stroke prevention

Answer 9

Diuretic, ACE

Question 10

Diuretics MOA

Answer 10

Initially induces natriuresis, decreased plasma volume, decreased CO, GFR, renal blood flow.
Chronic use: diuresis reduces, effects from decreased in PVR (decreased adrenergic tone)
1st line d/t decreased mortality and well-tolerated
Lower SBP 15-20mmHg and DBP 8-15
ESP effective in AA and elderly

Question 11

Thiazide ADRs

Answer 11

Decreased K, increased uric acid, increased glucose, increased cholesterole

Question 12

Thiazide agents:

Answer 12

HCTZ 12.5-50mg qd
Chlorthalidone-12.5-25mg qd (2x more potent)
Indapamide: 1.25-2.5 mg qd–sulfonamide diuretic

Question 13

Beta blockers

Answer 13

MOA: decrease contractility, CO, heart rate. Blund sympathetic reflex with exercise, inhibit peripheral NE release
ADR: low, dose-dependent. Fatigue, decreased HR
Use: cocomitant conditions: post MI, HF, angina
Decrease SBP 10-20, DBP 10-15
Not great in AA or elderly

Question 14

Calcium antagonists

Answer 14

Most effective agent in elderly and AA, can be first line but not preferred
MOA: decrease Ca entry into smooth muscles, coronary and peripheral vasodilation, decrease BP
Verapamil and diltiazem: block AV node, decrease HR, and contractility

Question 15

ACEI

Answer 15

MOA: decrease BP via peripheral arterial vasodilation w/o sig changes in CO, GFR. reduce preload
More protective in DM and renal dz

Question 16

ARBs

Answer 16

Primarily second line in pts who do not tolerate ACEI

Question 17

Aliskiren

Answer 17

MOA: direct renin inhibitor
Use: HTN
ADE: rash, diarrhea, increased CK, cough, hypotension, angioedema
D/Is: atorvastatin, ketoconazole

Question 18

a1 receptor vs a2 receptor

Answer 18

Alpha 1 is post synaptic, 2 is both post and pre–works as feedback mechanism. Alpha 2 agonist will reduce NE release.

Question 19

A1 adrenergic antagonists

Answer 19

Doxazosin, prazosin (shorter 1/2 life), terazosin
MOA: blocks post synaptic a1 receptor; inhibits uptake of NE in smooth muscle and causes vasodilation
2nd line tx
Uses: BPH, HTN, PTSD

Question 20

A1 antagonist ADRs

Answer 20

ADRs: Postural HoTN! FIRST DOSE SYNCOPE. floppy iris syndrome, stress incontinence
D/I: B-blockers, verapamil

Question 21

Prazosin dose

Answer 21

2-30mg/d bid-tid

Question 22

Terazosin dose

Answer 22

1-10 mg/d qd

Question 23

Doxzaosin

Answer 23

1-16 mg/d qd

Question 24

Alpha2 adrenergic agonist MOA

Answer 24

work in vasomotor centers of brain
stimulate central pre-synaptic a2 receptors–inhibit efferent sympathetic activity
decrease PVR and CO; decrease BP
can be used monotx, but 2nd line
causes fluid retention–use with diuretic

Question 25

Clonidine uses

Answer 25

A2 adrenergic agonist