HTN

Question 1

Initial drug selection for HTN

Answer 1

thiazide
dihydropyridine CCB
ACE or ARB*** CKD
if BP >20/10 mmHg above goal start 2 drugs

Question 2

Initial drug selection for HTN

Answer 2

thiazide
dihydropyridine CCB
ACE or ARB*** CKD
if BP >20/10 mmHg above goal start 2 drugs

Question 3

thiazide diuretics MOA

Answer 3

distal convoluted tubule by inhibiting Na reabsorption - increasing Na and H2O excretion, K and Mag = decrease preload and BP

Question 4

Thiazide warnings

Answer 4

severe renal disease, progressive liver disease, glaucoma, lupus, gout, dyslipidemia, DM
metabolic alkalosis, photosensitivity

Question 5

Thiazide DDI

Answer 5

drugs that cause Na and H2O retention, decreases Li clearance = increased Li toxicity, increase dofetilide = increase in QT prolongation

Question 6

Dihydropyridine CCB MOA

Answer 6

selective on vascular smooth muscle causing peripheral arterial vasodilation = decrease SVR and BP and coronary artery vasodilation

Question 7

Dihydropyridine CCB indications

Answer 7

HTN, chronic stable and vasospastic angina, Raynauds syndrome, nifedipine drug of choice in pregnancy, amlodipine use in HF w. reduced EF

Question 8

Dihydropyridine CCB SE

Answer 8

peripheral edema, HA, flushing, palpitations, reflec tachycardia, fatigue, nausea, gingival hyperplasia

Question 9

Non-dihydropyrdine CCB MOA

Answer 9

selective for the mycardium, decrease BP by decreasing forse of ventricular contraction (negative inotrope) and decrease HR ( negative chronotrope)

Question 10

Non-dihydropyrdine CCB

Answer 10

used to control HR in certain arrhythmias (AF), chronic stable and vasospastic angina

Question 11

Non-dihydropyrdine CCB contraindications

Answer 11

cardiogenic shock
2nd or 3rd degree heart block
dilt: acute MI or pulmonary congestion
verap: severe left vent dysfx

Question 12

ACE MOA

Answer 12

block conversion of angiotensin I and II = decrease in vasoconstriction and decrease in aldosterone secretion
block degradation of bradykinin

Question 13

ACE warnings

Answer 13

angioedema, hyperkalemia, renal impairment, metabolic acidosis

Question 14

ACE contraindications

Answer 14

pregnancy
use w/ Entresto (sacubitril/vlasartan) within 36 H
use w/ Tekturna (aliskiren)

Question 15

ARBs MOA

Answer 15

block angiotensin II from binding to angotensin II receptor on vascular smooth muscle = prevents vasoconstriction and aldosterone secretion (adrenal gland) prevention Na and H2O retention

Question 16

beta blockers MOA

Answer 16

block beta I and II - decrease HR and contractility

Question 17

beta blockers indications

Answer 17

HTN - post MI, stable angina, stable HF, tachyarrhythmias, migraine & glaucoma

Question 18

cardio selective beta blockers
AMEBBA

Answer 18

atenolol (tenormin)
metoprolol (Toprolol or Lopressor)
esmolol (Brevibloc)
betaxolol (Kerlone)
bisoprolol
acebutolol

Question 19

beta blocker contraindicaions

Answer 19

DM, asthma, COPD, bradycardia, heart block,

Question 20

HTN in pregnancy which drugs to use

Answer 20

methyldopa, labetalol, nifedipine XR, hydralazine

Question 21

IV meds for HTN crisis

Answer 21

hydralazine, nitroglycerin, labetalol, esmolol, clonidine, phentolamine, nitroprusside, nicardipine

Question 22

beta blockers SE

Answer 22

dyslipidemia, wt gain, fluid retention, fatigue, depression, decreased libido, dizziness