Hypertension/HF

Question 1

1st line for htn

non black

Answer 1

thiazide
dhp ccb
ace or arb

Question 2

1st line for htn

Answer 2

thiazide or dhp ccb

Question 3

1st line for htn

ckd stage 3 or albumineria

Answer 3

ace or arb

Question 4

when 2 start 2 drugs in htn

Answer 4

if stage 2 htn AND BP?20/10 above goal

Question 5

meds that can worsen htn

Answer 5

amphetamine and adhd
cocaine
decongestants(pseudofed)
erythropoiesis-stimulating agents (by increasing blood viscosity)
immunosupprents (e.g cyclosporine)
nsaids
steroids

Question 6

Lisinopril/hctz brand name

Answer 6

Zestoretic

Question 7

Losartan/ hctz

Answer 7

Hyzaar

Question 8

olmesartan/ hctz

Answer 8

Benicar HCT

Question 9

valsartan/hctz

Answer 9

Diovan HCT

Question 10

benazepril/amlodipine

Answer 10

Lotrel

Question 11

valsartan/amlodipine

Answer 11

exforge

Question 12

Highlights for thiazides

Answer 12

contraindicated w. sulfa allergy
side effects: decrease K, Na, Mg
increase ca, ua, bg, ldl/tg
dosing: start at 12.5 mg daily
MDD: Chlorthalidone 25mg daily, hctz 50 mg daily

not effective if Crcl<30 ml/min

DDI: nsaids, lithium

Question 13

DHP CCBS

Answer 13

vasodilatory effects
minimal cardiac effect

**amlodipine safest dhp ccb for bp control in pt w dhp

NIFEDIPINE ir NOT USED IN HTN

can cause gingival hyperplasia

cyp3a4 substrates (ex: clevidipine)

Question 14

non dhp ccbs

Answer 14

bradycardia
constipation
do not use in heart failure

can cause gingival hyperplasia

Question 15

clevidipine

Answer 15

dhp ccb in a lipid emulsion
provides 2kcal/mL
hyperTG
si w soybean, soy , or egg allergy
change bottle and tubing q12h due to risk of bacterial growth in lipid emulsions
IV

Question 16

ACE ARB

Answer 16

CI: pregnancy
angioedema
bilateral renal artery stenosis
-356 hour of entresto

cough, Increase potassium, renail impairment
drugs: lithium

Question 17

olmesartan SE

Answer 17

DIARRRHEA and weightloss

Question 18

beta blockers

Answer 18

not first line unless compeling indication
common side effects: decreased hr, fatigue, dizziness, depression

additive risk of bradycardia w. non dhp ccb, digoxin, amiodarone, clonidine

metoprolol notes:
metoprolol and labetalol must be taken w food or immediately after eating

10 mg iv metoprolol =25 mg PO metoprolol

Question 19

drugs that cause drug induced lupus DILE

Answer 19

methyldopa
hydralizine

Question 20

other drug classes

a2- agonists

Answer 20

decrease sympathetic outflow

clonidine (catapress)-
change patch q7days
can cause rebound htn if taken off abruptly
Clonidine (Kapvay not for htn)

Question 21

Hypertensive crisis
hypertensive urgency vs emergency

Answer 21

emergency: target organ damage
ex: stroke, MI, flash pulmonaryedema, damage to kidneys, encephalopathy

Question 22

treatment of hyperensive urgency

Answer 22

decrease bp gradually over 1-2 days
PO: captopril, labetalol, clonidine, hydralizine

Question 23

treatment of hypertensive emergency

Answer 23

kidneys/heart/brian failinng
decrese bp by 25% in the first hour. then gradual lowering
IV: clevedipine, nitroprusside (cyanide toxzicity),
ntg (mi)
nicardipine, labetalol (stroke)

Question 24

drugs that can cause worsen of HF

Answer 24

ddp4 inhibitors (alogliptin)

immunosupressants (tnf inhibitors like infklixamab)

non chb ccb

antiarrythmics (less risk w. amiodarone. Class 1)

tzd’s (pioglitazone)

itraconazole

anthracyclines

nsaids

Question 25

hfpef EF aka diastolic hf

Answer 25

IMPAIRD VENTRICULAR RELAXATION AND FILLING DURING DIASTOLE
>/50%

Question 26

hfmref EF

Answer 26

40-50%
mized systolic and diastolic dysfunction

Question 27

Hfref ef

Answer 27

aka systolic dysfunction
impaired ability to eject blood during systole

Question 28

which drugs have a motarlity benefit in HF

Answer 28

BB (carvedilol, bisoprolol, metoprolol)
ACE/ARBS/arni
ARA
sglt2

BIDIL( isosorbide nirate/ hydralazine) not 1st line

Question 29

which drugs can be used in hf but dont have mortality benefit

Answer 29

digoxin
loop diuretics

Question 30

loop diuretics in hf

Answer 30

dont decrease mortality
sulfa allergy- choose ethacrynic acid
ototoxicity

furosemide iv:po 1:2

20 mg iv=40 mg PO furosemide

Question 31

Target doses of ace in HF

Answer 31

most aCE is 40 mg FOR hf
*ENALAPRIL 20 MG bid

RAMIPRIL 10 mg

Question 32

target does of arbs in HF

Answer 32

losartan -50-150 mg daily
valsartan 150 mg bid

Question 33

ARAS RISKS

Answer 33

do not use if K>5 or Crcl<30

Question 34

BIDIL

Answer 34

isosorbide nirate/ hydralazine) not 1st line

only use in black pts.

Question 35

meds decreases hospitalizations in hf

Answer 35

ivabridine (should be in normal sinus rhythm, hr atlest 70 bpm and should be on a beta blocker target dose

digoxin- therepeutic range 0.5-0.9 in HF( higher levels increase rate of mortality
increases contractility
renally cleared
toxicity-n/v, decreased appetite, decreased hr, yellow green vision, arrythmias
antidoite: digifab

Question 36

electrolyte imbalances that increase risk for digoxin toxicity

Answer 36

hypokalemia
hypomagnesemia
hypercalcemia

Question 37

target doses in hf for BB

Answer 37

metoprolol xl: 200 mg/day
carvedilol 25 mg bid (in pts who weigh <85 kg

Question 38

zestril is brand name for

Answer 38

lisinopril

Question 39

Coozar is brand name for

Answer 39

losartan

Question 40

olmesartan is generic for

Answer 40

benicar