Pathophysiology and Pharmacotherapy of Hypertension 3

Question 1

What are the primary first line agents for hypertension

Answer 1

Thiazide/thiazide type-diuretics, ACE inhibitors, ARBs, CCBs

Question 2

What the secondary line agents for hypertension

Answer 2

Beta blockers, potassium sparing diuretics,

Question 3

Drug combinations with similar mechanisms of action/clinical effects should usually be avoided but what are the exceptions

Answer 3

Diuretics, non-DHP and DHB-CCB

Question 4

When would ACEI and ARBs be preffered over the other first line agents for hypertension

Answer 4

If a patient has CKD

Question 5

What are the preferred first line medications for black patients who have hypertension

Answer 5

Thiazides and CCBs

Question 6

What are the preferred first line medications for black patients who have CKD Stage 1 or 2 with proteinuria, CKD Stage 1 or 2 without proteinuria

Answer 6

ACEI or ARBs/ Thiazide or CCBs

Question 7

What are the preferred medications for black patiens with and chronic heart disease after a heart attack

Answer 7

Beta blockers and ACEI/ARBs

Question 8

When a patient has heart failure with reduced ejection fraction what agents show great efficacy

Answer 8

BBs, ACEI/ARBs, Anti-aldosterone

Question 9

When a patient has had an MI what agents show great efficacy

Answer 9

BB, ACEI

Question 10

T/F: When a patient as Diabetes all of the first line agents should be considered first

Answer 10

False: If a patient has diabetes all of the first line agents should be considered except thiazides, ACE/ARBs are first if albuminuria is present

Question 11

If a patient is pregnant what medications should be used to treat hypertension

Answer 11

methyldopa, nifedipine, labetalol

Question 12

T/F: If a person has BPH the best agent may be an alpha-blocker, if a person has atrial fibrillation/flutter rate Non-DHP CCBs and BBs should be avoided

Answer 12

True

Question 13

What first line agent should be avoided to treat hypertension if th patient has gout as well

Answer 13

Thiazides

Question 14

T/F: If someone has COPD/Ashtma if BBs are used they need to be as selective as possible

Answer 14

True

Question 15

What first line drugs should be avoided if a patient is hyperkalemic

Answer 15

ACEI/ARBs

Question 16

What drugs should be avoided if the patient has bradycardia/heart block

Answer 16

BB and Non-DHP CCBs

Question 17

T/F: The ALLHAT study showed that Alph-Blockers can compete with first line hypertension medications

Answer 17

False: Alpha-Blockers have an increased risk of CVD when compared to the first line treatments

Question 18

What must disease history must a patient have in order to reccomend a beta-blockers as a first line medication

Answer 18

Coronoray artery disease, myocardial infarction or Chronic heart failure

Question 19

T/F: When a patient has a BP of 160/100 it is recommend to either start them on two medications or add a 2nd one to therapy

Answer 19

True

Question 20

Why does combining and ACEI/ARBs and a diuretic have complementary effects

Answer 20

Diuretics can trigger RAAS -> ACE can blunt this effect leading to additive BP lowering

Question 21

T/F: Combing ACEI/ARB with DHP-CCB have a complementary effect due to lessening peripheral edema due to the CCB

Answer 21

True

Question 22

What is the definition of resistant Hypertension

Answer 22

Not at goal while on 3 BP medications (including a diuretic) OR controlled on 4 or more greater medications

Question 23

What are the risk factors for having persistent hypertension

Answer 23

65 or older, obesity, DM, being Black

Question 24

What are treatment options for treating Resitant hypertension

Answer 24

Asses/improve adherence, correct secondary causes, change diet, DC meds that aide in hypertension

Question 25

T/F: If a patient has resistant hypertension then adding a beta or alpha blocker has shown efficacy in controlling the hypertension

Answer 25

False: If a patient has resistant hypertension then adding an Anti-aldosterone diuretic has shown efficacy in controlling the hypertension

Question 26

When a patient is first put on therapy when should they be evaluated again

Answer 26

In a month

Question 27

T/F: The closer a patient’s PDC is to 1 the better the adherence

Answer 27

True

Question 28

What is one of the best ways to increase adhearance

Answer 28

Involve family members

Question 29

What complications can arise due to a hypertensive emergency

Answer 29

Stroke, MI, acute renal failure, retinal hemorrhage

Question 30

What BP readings signify a hypertensive Emergency

Answer 30

SBP greater than 180 or DBP greater than 120

Question 31

T/F: Sudden BP drops can lead to target organ damage

Answer 31

True

Question 32

T/F: If a patient is having a hypertensive emergency they should take their medication immediately

Answer 32

False: If a patient has a hypertensive emergency they should be admitted to the ICU

Question 33

Without compelling conditions what is the goal to reduce the BP

Answer 33

Reduce by 25% in the first hour, reduce to 160/100 over the next 2-6 hours, then normalize over 1 to 2 days

Question 34

What are the compelling conditions that would make a hypertensive emergency be treated much more aggressively

Answer 34

Aortic dissection, severe preeclampsia/eclampsia, pheochromocytoma

Question 35

If patient has aortic dissection what should the blood pressure be lowered to in the 1st hour, preeclampsia/eclamsia and phenochromyctoma

Answer 35

less than 120, less than 140