Week 3

Question 1

What order should hypertensive medications be prescribed in?

Answer 1

• Thiazide diuretics
• ACE inhibitors
• Angiotensin Receptor blockers
• Calcium channel blockers

(beta blockers)

Question 2

Which hypertensive medication is best for a patient with diabetes?

Answer 2

ACE inhibitors. They prevent or delay micro and microvascular complications.

Question 3

What is the best hypertensive medication to use in pregnant women?

Answer 3

Labetalol

Question 4

Mechanism of action for thiazides?

Answer 4

Block sodium and chloride (Na/Cl) channels in the distal convoluted tubule of the nephron and inhibit the reabsorption of sodium and water. This also causes a loss of potassium and calcium ions.

Question 5

Mechanism of action for ACE inhibitors

Answer 5

Reduce levels of angiotensin II by inhibiting angiotensin converting enzyme. This causes vasodilation and decrease in blood volume. This also causes an increase in levels of bradykinin by inhibiting kinase II.

Question 6

Mechanism of action for Angiotensin receptor blockers (ARBS)

Answer 6

Block angiotensin II receptors on blood vessels and in the heart causing dilation of arterioles and veins. There is also a decrease in release of aldosterone which increases renal excretion of Na+ and H20.

Question 7

Mechanism of action for Calcium Channel Blockers

Answer 7

Block calcium channels and decrease electrical velocity which slows down the heart rate, causes vasodilation, reduces arterial pressure, increases coronary perfusion, decreases the force of contraction.

Question 8

Mechanism of action for Beta Blockers

Answer 8

Block the action of epinephrine to slow down the heart rate, reduce the force of contraction, and cause vasodilation.

Question 9

What drug class is recommended for african americans with hypertension?

Answer 9

Diuretics have been shown to reduce morbidity and mortality. CCBs, beta blockers and thiazde diuretics are recommended for treatment.

Question 10

What drug class is recommended for African Americans with hypertension?

Answer 10

Diuretics have been shown to reduce morbidity and mortality. CCBs, beta blockers and thiazide diuretics are recommended for treatment.

Beta blockers and ACEi should be used if they are strongly indicated for a comorbid condition (type 1 diabetes with proteinuria or hypertensive nephrosclerosis)

Question 11

Prescribing considerations when carbamazepine is prescribed with warfarin

Answer 11

Carbamazepine (anti seizure medication) decreases the effects of warfarin by inducing drug metabolizing enzymes which increases the dose of warfarin needed to keep the INR within a therapeutic range.

Question 12

Beta blockers and nitroglycerin for treating angina

Answer 12

• Beta blockers are the first line of medications for stable angina they block the action of epinephrine to slow down the heart and reduce contractile force. Nitroglycerin is used during stable angina when the heart requires more oxygen and causes relaxation of smooth muscle cells resulting in vasodilation and reduced venous return.
• With both of these drugs there is the possibility of reflex tachycardia, when the BP drops the heart compensates by pumping faster to circulate blood. This negates the effectiveness of the nitroglycerin. Resting does not slow heart rate when the baroreceptor reflex is the cause of the tachycardia.

Question 13

What are two types of beta blockers? Give examples of each.

Answer 13

Cardio selective
- Atenolol
- Metoprolol
Non-cardio selective
- Coreg
- Labetalol
- Nadolol
- Propranolol
- sotalol

Question 14

The risk for what is increased when discontinuing a beta blocker suddenly?

Answer 14

Angina, MI and death

Question 15

What happens when beta blockers are given to patients with asthma?

Answer 15

Increase airway reactivity and cause airway narrowing and asthma attack due to blockage of the beta receptors

Question 16

Mechanism of action for Loop Diuretics

Answer 16

Inhibit reabsorption of Na and Cl in the proximal, distal convoluted tubules and the thick ascending loop of Henle (prevents passive reabsorption of water – tied to the Na)

Question 17

Mechanism of action for Angiotensin receptor inhibitors (ARIs)

Answer 17

Blocks the receptors that angiotensin acts on in the heart, blood vessels and kidneys causing vasodilation, aldosterone suppression, increased diuresis.

Question 18

Mechanism of action for Aldosterone receptor agonists

Answer 18

Blocks the effects of aldosterone by attaching to receptors. Blocks aldosterone in the distal nephron to retain K+ and excrete Na+.

Question 19

Conditions in which thiazide diuretics are contraindicated?

Answer 19

• gout
• diabetes
• hyperlipidemia

Question 20

Monitoring needs for patients taking diuretics

Answer 20

• VSS
• Daily weight
• Electrolytes (Na, Cl, K, Cr, BUN)
• Kidney function
• dehydration
• hypotension

Question 21

What type of medication should be prescribed to patients with heart failure who experience fibrotic changes?

Answer 21

Aldosterone antagonists cause fibrotic changes.

Aldosterone agonists can be added to ARBs, ACEs, DRIs to eliminate residual effects of aldosterone which these meds do not block entirely.

One example is spironolactone

Question 22

What effects do cardiac glycosides have and give an example.

Answer 22

Increases the force of ventricular contraction by the heart thereby increasing cardiac output

Digoxin

Question 23

What happens when quinidine and digoxin are combined?

Answer 23

Quinidine is an anti-dysrhythmic drug. When used together it causes digoxin plasma levels to rise which could result in toxicity. Do not use together.

Question 24

What is the atherosclerotic cardiovascular disease risk score?

Answer 24

• Risk assessment tool that helps determine the patient’s absolute risk for developing clinical coronary disease over the next 10 years
• used to guide decision-making for many preventive interventions, including lipid and blood pressure management.

Question 25

When should the the atherosclerotic cardiovascular disease risk score be used?

Answer 25

When patients have risk factors that are modifiable or treatable to help prevent disease.

Question 26

What ages can statin drugs be prescribed for?

Answer 26

10-75

Question 27

What is ezetimibe (Zetia)?

Answer 27

Drug that acts on the cells of the brush border of the small intestine to inhibit dietary cholesterol absorption. Inhibits reabsorption of cholesterol secreted into the bile. Reduces LDL, TG, and apolipoprotein B, small increase in HDL.

Question 28

When would ezetimibe (Zetia) be prescribed?

Answer 28

Adjunct to diet modification for reducing LDL, and apolipoprotein B in patients with primary hypercholesterolemia. Can be used alone or with a statin.

Question 29

Mechanism of action for nitrates

Answer 29

Decrease cardiac oxygen demand by dilating veins which decreases preload and increases oxygen supply by relaxing coronary vasospasm.

Question 30

Contraindications for ranolazine

Answer 30

Ranolazine is an anti-anginal drug that causes QT prolongation.
It is not for use in patient with preexisting QT prolongation or for those taking other drugs that can prolong QT interval

Not for use with CYP3A4 inhibitors (grapefruit juice HIV protease inhibitors, macrolide antibiotics, azole antifungals and some CCBs).