Pharm HTN

Question 1

What are the first line HTN agents?

Answer 1

Thiazide diuretics
ACEs
ARBs
D-CCB
ND - CCB

Question 2

Thiazide drugs?

Answer 2

Hydrochlorothiazide
Chlorthalidone
Indapamide

Question 3

Thiazide diuretic adverse effects

Answer 3

Hyponatremia
Hypokalemia
Hyperuricemia
Extracellular fluid depletion

Question 4

In what groups should ACEi/ARBs be avoided?

Answer 4

Angioedema
Pregnancy

Question 5

With what labs should you use caution with ACEi/ARBs

Answer 5

SBP <80
SrCr >3mg/dL
Na <130
K >5
Bilateral renal artery stenosis

Question 6

D-CCB MOA and adverse effects?

Answer 6

Potent vasodilator - best for HTN and angina

Flushing
Reflex tachy
headache
peripheral edema

Question 7

Secondary HTN agents?

Answer 7

Beta blockers
Potassium sparing diuretics
Loop diuretics
Central alpha agonists
Direct renin inhibitor
Direct arterial vasodilators
Alpha-1 blockers

Question 8

Which beta blockers are B1 selective

Answer 8

Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol

Question 9

Which meds are potassium sparing diuretics?

Answer 9

Amiloride
Triamterene
AA - spironolactone and eplerenone

Question 10

Which meds are central alpha agonists

Answer 10

Clonidine
Guanfacine
Methyldopa

Question 11

Which meds are direct arterial vasodilators

Answer 11

Hydralazine
Minoxidil

Question 12

Which meds are loop diuretics

Answer 12

Furosemide
Bumetanide
Torsemide

Question 13

What is a direct renin inhibitor

Answer 13

Aliskiren

Question 14

Which meds are Alpha 1 Blockers

Answer 14

Prazosin
Doxazosin
Terazosin

Question 15

Normal BP

Answer 15

<120 AND <80

Question 16

Elevated BP

Answer 16

120-129 AND <80

Question 17

Stage 1 HTN

Answer 17

130-139 OR 80-89

Question 18

Stage 2 HTN

Answer 18

> =140 OR >=90

Question 19

Individual 40-70 years old each increment of __mm Hg SBP or __mm Hg DBP doubles the risk of CVD across the range of ___/__ - ___/___ mm Hg

Answer 19

20
10
115/75 - 185/115

Question 20

AntiHTN meds cause
____% reduced stroke
____% reduced MI
____% reduced HF

Answer 20

35-40
20-25
50

Question 21

In what case is the BP threshold >=140/90 rather than 130/80

Answer 21

No clinical CVD and 10 risk <10% AND
Secondary stroke prevention

Question 22

Always make sure you use the _____ BP to make treatment decisions

Answer 22

Average

Question 23

Approach to patient with BP <120/80

Answer 23

Promote healthy lifestyle and reassess in 1 year

Question 24

Approach to patient with BP 120-129/80

Answer 24

Promote healthy lifestyle and reassess in 3-6 months

Question 25

Approach to patient with BP 130-139/80-89 AND ASCVD <10%

Answer 25

Promote healthy lifestyle and reassess in 3-6 months

Question 26

Approach to patient with BP 130-139/80-89 AND ASCVD >10%

Answer 26

Promote healthy lifestyle AND use BP lowering med Reassess at 1 month If at goal, reassess in 3-6 months If not at goal, assess adherence and consider therapy intensification, reassess at 1 month

Question 27

Approach to patient with BP >=140/90

Answer 27

Promote healthy lifestyle AND implement either 1 or 2 BP lowering meds Reassess at 1 month If at goal, reassess at 3-6 month If not at goal, assess adherence and consider therapy intensification, reassess at 1 month

Question 28

Approach to patient is stable ischemic heart disease with HTN

Answer 28

BB or ACE/ARB as first line If goal not met, add D-CCB, thiazide diuretic and/or aldosterone agonist

Question 29

Approach to patient with HFpEF and HTN

Answer 29

manage volume overload first with diuretics Then, use ACE/ARB and BB titrated to achieve SBP<130 *avoid ND-CCB

Question 30

Approach to patient with HFrEF and HTN

Answer 30

Titrate GDMT to reach SBP<130 ACE/ARB BB Diuretics as needed AA

Question 31

Approach to patient with DM and HTN

Answer 31

All first line agents effective If albuminuria, use max tolerated ACE/ARB as first line monitor serum creatinine, eGFR, and serum K levels

Question 32

Approach to patient with CKD and HTN

Answer 32

ACE inhibitor to slow progression ARB if ACE not tolerated No preferred agent in patient with CKD and no significant proteinuria

Question 33

Approach to patient with kidney transplant and HTN

Answer 33

ARB or D-CCB are first line

Question 34

Secondary stroke prevention in patient with HTN

Answer 34

restart antihypertensive treatment after the first few days of event thiazide diuretic, ACE/ARB, or combination

Question 35

Approach to patient with COPD and HTN

Answer 35

ARB CCB Diuretic BB B1 selective for selected pts

Question 36

Approach to patient with HTN and depression

Answer 36

Do not use chlorthalidone if patient on SSRI/SNRI --> hyponatremia Avoid BB --> depression is adverse effect Avoid clonidine

Question 37

Approach to patient with sexual dysfunction and HTN

Answer 37

BB or AA Phosphodiesterase inhibitors are safe with antihypertensive meds

Question 38

Approach to african american patient with HTN

Answer 38

Thiazide diuretic OR CCB >=2 meds recommended

Question 39

Approach to elderly patient with HTN

Answer 39

If limited life expectancy and multiple comorbidities, weigh risk/benefit ratio BP lowering prevents cognitive decline/dementia

Question 40

Effects of antihypertensives on women

Answer 40

2 x more likely to have adverse effects More likely to have ACE cough HypoK and hypoNa more common with diuretics

Question 41

Approach to patient that is pregnant and HTN

Answer 41

Transition to: Methyldopa Nifedipine Labetalol DO NOT use ACE, ARB or direct renin inhibitor

Question 42

How to manage HTN urgency

Answer 42

Treat outpatient with oral antihypertensives Reduce BP no more than 25% in 24 hours Follow up 1 week after episode

Question 43

How to manage HTN emergency

Answer 43

IV antihypertensives Lower MAP no more than 25% in the first hour then 160/110 in next 2-6 hours Once stabilized titrate down IV agent and transition to oral therapy

Question 44

HTN emergency best treatment options

Answer 44

Preferred: labetalol and esmolol NTG and sodium nitroprusside for patients with MI, acute pulmonary edema or aortic dissection

Question 45

What is the one exception to lowering BP slowly

Answer 45

Aortic dissection

Question 46

All medication options for HTN emergency

Answer 46

Labetolol Esmolol Nicardipine Clevidipine NTG Sodium nitroprusside Fenoldopam Hydralazine Enalaprilat