Hypertension Lecture PDF

Question 1

If a patient’s SBP and DBP are in 2 diff categories for hypertension, then which category do we follow?

Answer 1

The value that places the BP in the higher classification

Question 2

Sites where antihypertensive agents act (4)

Answer 2

• brainstem (suppress sympathetic outflow to heart)
• a1 adrenergic receptors on blood vessels (promote vasodilation of arterioles and veins)
• B1 adrenergic receptors on heart (blockade B1 receptors prevents sympathetic stiulation of the heart, decreasing HR and myocardial contractility
• RAAS blockers

Question 3

Sodium nitroprusside function and drug class

Answer 3

A drug used for hypertensive emergencies to dilate vascular smooth muscle acting almost immediately acting but stops upon cessation
-a 1 adrenergic receptor blocker

Question 4

Blood pressure threshold to initiate pharmacologic therapy

Answer 4

Repeated BP after 3-6 months of nonpharmocologic therapy to make lifestyle choices of >140/90

Question 5

In non-african patients, these 4 drug classes are recommended for initial HTN

Answer 5

• thiazide type diuretics
• ca2+ channel blockers
• ACE inhibitors
• ARB’s

Question 6

In african patients, these 2 drug classes are recommended for initial HTN

Answer 6

Thiazide diuretics sometimes alongside Ca2+ channel blockers

Question 7

Black patients produce much less….

Answer 7

…renin so as a result they are not impacted nearly as much by ACEI or ARB’s

Question 8

Adults with stage 2 Htn should be treated with…

Answer 8

A combo of nonpharm therapy and 2 antihypertensive drugs of different classes (not combining ACEI’s and ARBs)

Question 9

Initiation of Htn therapy with more than one agent may reach goal BP sooner but increases risk of…

Answer 9

….orthostatic hypotension

Question 10

Most patients started on Htn therapy need to be followed up within _____ to adjust medication dosage and see presence of adverse effects until stabilized, then visits can occur every ____

Answer 10

1 to 2 months, 3-6 months

Question 11

Agents for HTN therapy with duration of action longer than ____ are desirable in case of missed doses

Answer 11

24 hrs

Question 12

Potential favorable effects of HTN therapy for concomitant diseases (ACE and ARBs, thiazide diuretics, B blockers, Ca2+ channel blockers, a blockers)

Answer 12

• ACE and ARB’s are beneficial to DM and CHF as well
• Thiazide diuretics slow deminieralization in osteoperosis
• B blockers can treat atrial tachyarrhythmias, migraine
• ca2+ channel blockers useful in raynauds
• a blockers useful in prostatism?

Question 13

Potential unfavorable effects of HTN therapy for concomitant diseases (thiazide diuretics, B blockers, ACEI and ARBS, aldosterone antagonists and K+ sparing diuretics)

Answer 13

• thiazide diuretics in pts with gout or hyponatremia
• B blockers avoided in asthma, 2nd, or 3rd degree heart block
• ACEI and ARBS contraindicated in pregnancy
• aldosterone antagonists and K+ sparing diuretics can cause hyperkalemia

Question 14

NSAIDS decrease action of these 3 drug classes

Answer 14

• diuretics
• B blockers
• ACE inhibitors

Question 15

Drug treatment for HTN in stable ischemic heart disease

Answer 15

-B blocker and either ACEI or ARB

Question 16

Drug treatment for HTN in patients with heart failure and/ one class to avoid

Answer 16

• B blocker and either ACE or ARB

- avoid ca2+ channel blockers

Question 17

Drug treatment for HTN in patients with diabetes

Answer 17

-B blockers can mask hypoglycemia and should be used cautiously, ACEI or ARBs are better than ca2+ channel blockers

Question 18

Drug treatment for HTN in patients with chronic kidney disease

Answer 18

-ACEI or an ARB

Question 19

An ACEI or an ARB is recommended for black patients with HTN and CKD ________ DM

Answer 19

With or without

Question 20

ACEI induced angioedema and race

Answer 20

Occurs 2-4 times more frequently in blacks, cough more common in blacks and asians

Question 21

Postural hypotension

Answer 21

Condition particularly present in older adults with systolic HTN, diabetes, on diuretics, venodilators, or some psychotropic agents that results in decrease in standing SBP by greater than 10mmHg, associated with dizziness and fainting

Question 22

HTN in children or adolescents is much more often due to…

Answer 22

…2ndary hypertension (underlying disease)

Question 23

Fenoldopam (corlopam) function

Answer 23

IV indicated drug for short term management of hypertensive emergencies by activating dopamine receptors

Question 24

Labetalol (trandate) function

Answer 24

Blocks a1 and B1 adrenergic receptors for hypertensive emergencies that produces arteriolar dilation

Question 25

Clevidipine (Cleviprex) function

Answer 25

Ca2+ channel blocker dihydropyridine with very short half life administered by IV infusion with rapid effects that fade upon cessation