HTN 3

Question 1

• “Last resort” medication
• Clonidine (Catapres)
• Methyldopa

Answer 1

Central Alpha Agonists

Question 2

MOA:

Stimulate Alpha 2 adrenergic receptors in the brain which reduces CNS sympathetic outflow

Answer 2

Central Alpha Agonists

Question 3

Which med is okay in pregnancy?

Answer 3

Central Alpha Agonist : Methyldopa

Question 4

How do you prevent rebound HTN when using Central Alpha Agonists?

Answer 4

Avoid abrupt cessation

Question 5

Which med?

Side effects:

• Anticholinergic side effects
• Bradycardia
• Orthostatic hypotension
• Dizziness
• Rebound HTN

Answer 5

Central Alpha Agonists

Question 6

What are the 3 side effects of Central Alpha Agonist : Methyldopa

Answer 6

• Hepatitis
• Hemolytic anemia
• Fever

Question 7

1 contraindication of Central Alpha Agonists

Answer 7

Methyldopa in liver disease

Question 8

End in “zosin”

Answer 8

Alpha Blockers

Question 9

Which med?

• Not utilized frequently
• Doxazosin (Cardura)
• Terazosin (Hytrin)
• Prazosin (Minipress)

Answer 9

Alpha Blockers

Question 10

MOA:

• Targets Alpha 1 receptors on vascular smooth muscle, causing a decrease in peripheral vascular resistance (PVR)
• –> thus decreasing BP

Answer 10

Alpha Blockers

(Zosin)

Question 11

Which med?

• Use in mild - moderate HTN
• Not for monotherapy
• ALLHAT trial showed increased risk of HF w/ _____
• Compelling indication for BPH (which means this med is helpful for both BPH and HTN)

Answer 11

Alpha Blockers

• doxazosin

Question 12

Which med?

Side effects:

• Orthostatic Hypotension (severe w/ 1st use)
• Reflex tachycardia
• Dizziness

Answer 12

Alpha Blockers

(zosin)

Question 13

What tx should you always start a patient on w/ HTN?

Answer 13

Lifestyle interventions

Question 14

After implementing lifestyle changes, when should you FU w/ pt?

Answer 14

3 to 6 months

Question 15

After initiating pharmacologic therapy, how soon should you reassess pt?

Answer 15

1 month

(monitor labs if necessary depending on meds given)

Question 16

If the patient is not at their goal BP after starting a medication at the 1 month FU, what should you do?

Answer 16

• Increase dose

or

• add 2nd medication

Question 17

If the patient is not at their goal BP after being placed on 3 medications, what should you do?

Answer 17

Consider consulting a HTN specialist

Question 18

• Once the patient’s BP is controlled, how often should FU appointments be?
• What 2 things should you monitor?

Answer 18

• Every 3 to 6 months
• Serum K and creatinine once or twice annually **(electrolytes)**

Question 19

Which guidelines?

• 1st: Diuretic
• Follow compelling indications

Answer 19

JNC 7

Question 20

Which guidelines?

• 1st: Thiazides / ACE-I / ARB / CCB
• African Americans: Thiazides / CCB
• ***CKD patients: ACE or ARB***

Answer 20

JNC 8

Question 21

Which guidelines?

• 1st: TZD (Thiazolidinediones) / CCB / ACE-I / ARB

Answer 21

AHA/ACC 2017

Question 22

Which 2 meds would you give patients w/ CKD?

Answer 22

• ACE-I
• ARB

Question 23

Which 2 meds would you give for recurrent stroke prevention patients?

Answer 23

• Diuretics
• ACE-I

Question 24

Heart failure patients can receive all meds except for which one?

Answer 24

• CCB

Question 25

Which 2 meds should you not give post-MI patients?

Answer 25

* ARB * CCB

Question 26

Which 2 meds should you not give patients w/ high risk of coronary disease?

Answer 26

* ARB * Aldo ANT

Question 27

DM patients can receive all but which med?

Answer 27

Aldo ANT

Question 28

What is the goal BP of patients w/ _stable ischemic heart disease?_

Answer 28

\< 130/80

Question 29

Which meds to give for patients w/ _stable ischemic heart disease?_

Answer 29

* Beta Blockers * ACE-I * ARBs

Question 30

If a patient w/ _stable ischemic heart disease_ BP goal is not met and they _have angina_ what should you do?

Answer 30

add CCB (dihydropyridine)

Question 31

If a patient w/ _stable ischemic heart disease_ BP goal is not met, _without angina_, what should you do?

Answer 31

add **CCB (dihydropyridine)** or **Thiazide** or Minerlocorticoid receptor antagonist **(spironolactone)**

Question 32

* What is the BP goal of a patient _w/ HF_ _w/ reduced ejection fraction?_ * What med should you NOT give this pt?

Answer 32

* \< 130/80 * CCB - nondihydropyridine

Question 33

What is the goal BP of a patient w/ CKD (chronic kidney disease)?

Answer 33

\< 130/80

Question 34

* What tx for patient w/ CKD, w/o albuminuria? * What tx for patient w/ CKD, w/ albuminuria?

Answer 34

* Use the usual 1st line med * ACE-I or if they can't tolerate that, give ARB

Question 35

* What is the BP goal of pt w/ DM? * Which classes of drugs are most useful in these patients? * DM patient w/ albuminuria, what should you give?

Answer 35

* \< 130/80 * ALL classes are useful in DM patients * ACE-I or ARB

Question 36

* What 3 medications are given to pregnant women w/ HTN? * \*\*\*What 3 meds are _NOT_ given to pregnant women??\*\*\*\*\*\*

Answer 36

* Methyldopa, Nifedipine, Labetalol * **\*\*\*DO NOT GIVE:** ACE-I, ARB, or DRI\*\*\*

Question 37

Prognosis for HTN patients is poor in which 5 diseases?

Answer 37

1. Cardiovascular Disease 2. Cerebrovascular Disease 3. Kidney Disease 4. Retinopathy 5. Vascular Disease

Question 38

* In patients w/ HTN and Cardiovascular Disease, prognosis is poor if the patient has _Left Ventricular Hypertrophy._ * _As well as:_ Women over ___ years old Men over ____ years old

Answer 38

Women \>65 Men \>55

Question 39

**Carotid wall thickening or plaque** is associated with _which disease_ as an indicator of poor prognosis in patients w/ HTN?

Answer 39

Cerebrovascular disease

Question 40

**Low eGFR and Microalbuminuria** are associated with _which disease_ as an indicator of poor prognosis in patients w/ HTN?

Answer 40

Kidney Disease

Question 41

**ABI (ankle brachial index) \<9** is associated with _which disease_ as an indicator of poor prognosis in patients w/ HTN?

Answer 41

Vascular Disease

Question 42

* _Failure to achieve BP_ goal in patient adhering to full dose tx of _3 drug regimen_ (thiazide diuretic) * _Achieving BP goal_, but requires _4+ antihypertensives_

Answer 42

Resistant HTN

Question 43

* What BP measurement classifies pt has "Hypertensive Urgency?" * What are the sxs? * What is the etiology?

Answer 43

* SBP \> or equal to 180 * Asymptomatic * Etiology: non-compliant w/ meds or non-compliant w/ low Na diet

Question 44

* What is the BP measurement of a patient w/ a "Hypertensive Emergency?" * What is it associated with?

Answer 44

* DBP \> or equal to 120 * Acute End-Organ Damage

Question 45

* How do you tx Hypertensive Urgency? (Overall Goal) * Which drug is contraindicated?

Answer 45

* Gradual reduction to safe levels (\<160/100) * If too rapid, can lead to: * cerebral ischemia * myocardial ischemia * MI * Sublingual Nifedipine

Question 46

When would it be appropriate to send a patient w/ Hypertensive Urgency to the ED?

Answer 46

New occurence of HTN

Question 47

What is the tx for pt w/ Hypertensive Emergency?

Answer 47

Hospitalized (ICU)