Hypertensive Meds Quiz Flashcards
Which classes of antihypertensive medications are most effective in low renin or volume expanded forms of hypertension?
A) Aldosterone antagonists
B) ACE inhibitors
C) Thiazide diuretics
D) Aldosterone antagonists and thiazide diuretics
D - thiazides, loops, and potassium sparing diuretics (including aldosterone antagonists) are most effective in low renin patient populations (elderly patients, AA, etc.) ACE inhibitors are more effective in high renin patients
A 73 y/o man having a prior medical history of COPD, CKD, and gout is admitted for a MI. Prior to discharge, you plan to start a beta blockers. Which of the following beta blockers would be the best choice based on his history?
A) Atenolol
B) Esmolol
C) Nadolol
D) Propanolol
A - because of the patient’s COPD, a B1 selective agent would be preferred over a non-selective agent. Of the agents listed, atenolol and esmolol are B1 selective, however, esmolol is only available in IV formulation, therefore atenolol is the correct answer.
A 59 year old man with Chronic Kidney Disease (CKD) (baseline CrCl 30-35 mL/min) was diagnosed with HTN and started on lisinopril 5mg PO QD (taken at 0800). He does not like taking medications, but has a very high health literacy and takes this new medication very regularly. He reliably and accurately monitors his blood pressure at home since his diagnosis. After a month of therapy, he returns for a follow up visit and reports his 0700 SBP ranges 140-160 mmHg, his 1400 BP ranges 100-120s mmHg, and his 2100 SBP ranges 130-150 mmHg. Given his preferences about avoiding multiple medications and also his medical history, what medication change should be made at this time?
A) Increase lisinopril to 10 mg PO QD
B) Continue lisinopril 5mg, add HCTZ 25 mg PO QD
C) Continue lisinopril 5mg, add amlodipine 5mg QD
D) Was not on appropriate medication initially, switch to amlodipine 5mg PO QD
A - an ACE inhibitor or ARB is indicated in this patient with CKD per JNC 8 guidelines. ACE i have a “flat dose response” and the patient is achieving mid-day blood pressures at goal but there are BP elevations in the PM. Therefore, the dose should be increased to sustain response for 24 hours. Polypharmacy should be minimized when possible (especially in a patient with a stated preference), and thiazides might be less effective in a patient with a reduced CrCl.
Which of the following factors is least associated with a higher risk of developing myopathy or rhabdomyolysis in patients taking statins?
A) Use of a low statin dose
B) Kidney disease
C) Female sex
D) Age 65 years or older
A - some of the known risk factors associated with increased or frequent side effects when using statins include the following:
Age 65 or older
Female sex
Using multiple cholesterol lowering medications (eg. fibrates, high dose niacin, lomitapide)
High statin dose
Smaller body frame
Kidney disease
Liver disease
Alcohol use
