Unit 11 Cardiovasular Pt. 2

Question 0

In the general nonblack population, including diabetics, initial anti hypertensive treatment should include :

Answer 0

Thiazide type diuretic, calcium channel blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker.

Question 1

According to JNC guidelines in the general population aged >60years Pharmacologic treatment should be initiated to lower systolic and diastolic pressure with a goal of :

Answer 1

SBP < 150
DBP < 90

Grade A recommendation

Question 2

In the African American population, including diabetics, initial antihypertensive treatment should include

Answer 2

A Thiazide type diuretic or calcium channel blocker.

Question 3

ACEIs or ARBs should not be combined with :

Answer 3

NSAIDS: lower response of hypertension to therapy
Potassium-sparing diuretics: can produce hyperkalemia
Diuretics and NSAIDs: lead to nephrotoxicity

Question 4

Calcium channel blockers and CYP3A4 inhibitors can produce significant hypotension! What are these inhibitors

Answer 4

Antimicrobials and antidepressants

Erythromycin, Clindamycin, Ciprofloxacin, macrolides, azole antifungals, grapefruit juice, amiodarone.
(Hint: Note that erythromycin and Clindamycin are included but Azithromycin is not)

Question 5

Beta blockers are metabolized by CYP2D6. Inhibitors can result in bradycardia, hypotension, or heart failure. These inhibitors are :

Answer 5

Some antidepressants, cimetidine, Benadryl, and amiodarone.

Question 6

Calcium Channel blockers have the most significant interactions and can result in severe

Answer 6

Hypotension

Question 7

When used together, Diuretics and NSAIDs carry the potential risk of :

Answer 7

Dehydration, reduced renal function, and unnecessary hospitalization.

Geriatric patients are at highest risk.

Question 8

When hypertension is first diagnosed in pregnancy prescribe :

Answer 8

Methyldopa

Category B

Question 9

African Americans have more difficult to treat Htn with higher BP and recommended therapy is :

Answer 9

CCBs or Thiazide Diuretics

Question 10

Mechanism of action: Nitrates

Answer 10

Relax vascular smooth muscle via stimulation of intracellular cyclic guanosine monophospohate cGMP.
Reduce myocardial oxygen demand by decreasing preload.
Major dilation of venous bed.

Question 11

Key components to risk reduction and prevention :

Answer 11

Hypertension, cigarette smoking, lipid abnormalities, diabetes mellitus, obesity/weight management, physical inactivity.

Question 12

Nitroglycerin is very unstable. Loss in potency related to:

Answer 12

Heat, sun, temperature, expiration date

Question 13

Glycosides such as Digoxin are indicated for :

Answer 13

Heart failure
Atrial fibrillation
Atrial flutter

Question 14

Mechanism of action : Digoxin

Answer 14

Inotropic effect on cardiac cells.
Increased force of contraction of cardiac muscle.
Increases cardiac output.

Question 15

Loop diuretics are given for

Answer 15

Fluid retention

Question 16

Certain drugs can exacerbate heart failure and should be avoided if possible :

Answer 16

Calcium channel blockers
NSAIDs
Antiarrhythmic agents
Thiazolidinediones

Question 17

Beta blockers are indicated for :

Answer 17

-olol

Htn, angina, chf, selected arrhythmias, migraine prophylaxis, MVP, alcohol withdrawal.

Question 18

Mechanism of action : Beta blockers

Answer 18

Competitive blockade of b-adrenergic receptor.
Decreased heart rate and contractility.
Decreased BP, myocardial oxygen demand.

Question 19

Avoid Beta blockers in:

Answer 19

African Americans, asthma, COPD, severe PVD, Raynaud’s phenomenon, depression, bradycardia, 2nd or 3rd degree heart block, hypoglycemia prone diabetics, and elderly.

Question 20

Post MI for secondary prevention all patients should receive

Answer 20

Beta blocker therapy.

B-blockers have been shown to improve survival in post MI patients by reducing the incidence of sudden death.

Question 21

Treatment of choice for chronic stable and unstable angina:

Answer 21

Beta blockers.

Question 22

Indications for calcium channel blockers :

Answer 22

-dipine (Nifedipine, Verapamil, Diltiazem)
Hypertension, vasospastic angina, arrhythmias.

Off label use: Raynaud’s , stable angina

Question 23

Mechanism of action: calcium channel blockers

Answer 23

Block inward movement of calcium through the slow channels of cell membranes causing:
Negative Inotropic and neg chronotropic effect, decreased cardiac output, decreased after load.
Works on 1.cardiac muscle, 2. conduction system (AV & SA), 3.vascular smooth muscle.

Question 24

Treatment principle for chronic stable angina :

Answer 24

First line therapy: beta blocker and nitrate
Second line: if unable to tolerate b-blocker or symptoms are not controlled we’ll start long acting Diltiazem, Verapamil, Amlodipine, or Felodipine.

Question 25

Calcium channel blockers are not recommended in treatment of :

Answer 25

CHF

Question 26

Calcium channel blockers are recommended as safe for :

Answer 26

African Americans
Elderly patients
Patients with hyperlipidemia
Patients on NSAIDs

Question 27

Patient education calcium channel blockers :

Answer 27

Don’t take with grapefruit juice !

Serum digoxin will need to monitored if pt is on dig

Question 28

Indications for ACE Inhibitors:

Answer 28

-pril
HTN, CHF, Renal Impairment, post MI
Prolongs survival in: heart failure, coronary heart disease, acute MI
Slows progression of: chronic renal failure, diabetic neuropathy

Question 29

Mechanism of action ACEIs:

Answer 29

Block angiotensin converting enzyme (ACE- responsible for conversion of angiotensin I to angiotensin II)
Angiotensin II receptors are blocked which blocks the potent vasoconstrictor and stimulus for aldosterone release from adrenal glands. This leads to less water absorption in distal renal tubule.
ACEIs also inhibit breakdown of bradykinin - possible reason for cough side effect.

Question 30

ACEIs result in:

Answer 30

Decreases systemic vascular resistance
Decreased BP without changes in heart rate
Increased renal perfusion
Decrease renal vascular resistance: no change in GFR

Question 31

Advantages of ARBs over ACEIs:

Answer 31

ARBs (angiotensin receptor blockers -artan)

No dry cough, decreased incidence of angioedema, second line tx. because of cost.

Question 32

_________ should be given to all patients with a symptomatic or symptomatic heart failure.

Answer 32

ACEIs (-pril)

Reduces preload, after load, systemic BP and increases renal blood flow.
Also slow the progression of diabetic neuropathy.

Question 33

Ace inhibitors should be avoided in :

Answer 33

Renal failure (can cause hyperkalemia)
Pregnancy (significant fetal risk)
Blacks (less effective monotherapy, must be used in comb with diuretic)
Use of potassium containing meds
(Monitor supine BP while titraing and watch for angioedema without urticaria)

Question 34

Indications for antiarrhythmic agent:

Answer 34

Paroxysmal supraventricular tachycardia (PSVT)
Atrial fibrillation (A. Fib)
Premature ventricular contractions (PVCs)

Question 35

Mechanism of action antiarrthymics

Answer 35

(Quinidine, lidocaine, amiodarone, dig, verapamil, B-blockers etc)
Decrease electrical irregularity
*all antiarrthymics have potential to cause arrhythmias.

Question 36

Indications for diuretics:

Answer 36

Hypertension
CHF
Renal Failure
Cirrhosis

Question 37

Treatment principles for diuretics:

Answer 37

Salt restriction
Thiazide: First line (HCTZ no greater than 25mg start small)
Loop: second line (Furosemide 40mg)
Other diuretics as needed for special conditions