Hypertension

Question 1

Drugs that Increase BP

Answer 1

• Amphetamine/ADHD Drugs
• Cocaine
• Decongestants
• ESA
• Immunosuppressants
• NSAIDs
• Systemic Steroids

Question 2

Zestoretic

Answer 2

Lisinopril + HCTZ

Question 3

Hyzaar

Answer 3

Losartan + HCTZ

Question 4

Benicar HCT

Answer 4

Olmesartan + HCTZ

Question 5

Diovan HCT

Answer 5

Valsartan + HCTZ

Question 6

Lotrel

Answer 6

Benazepril + Amlodipine

Question 7

Exforge

Answer 7

Valsartan + Amlodipine

Question 8

Tenoretic

Answer 8

Atenolol + Chlorthalidone

Question 9

Ziac

Answer 9

Bisoprolol + HCTZ

Question 10

Maxide/Dyazide

Answer 10

Triamterene + HCTZ

Question 11

IV HTN Medications

Answer 11

• Chlorothiazide
• Clevidipine
• Diltiazem
• Enalaprilat
• Esmolol
• Hydralazine
• Labetalol
• Metoprolol
• Nicardipine
• Nitroglycerin
• Propranolol
• Verapamil

Question 12

Natural Products for Lowering BP/CV Risk

Answer 12

• Fish Oils
• Coenzyme Q10
• L-arginine
• Garlic
• *Not recommended per HTN guidelines**
• Lifestyle management preferred (DASH diet, Na < 1500 mg/d)

Question 13

Preggo + HTN

Answer 13

• RAASi - warning for fetal tox. D/C as soon as you know patient is preggo
• Treat when SBP >= 160 OR DBP >= 105 (more lax goals)
• 1st line: labetalol or nifedipine ER (Adalat CC)
• Alt: methyldopa

Question 14

Thiazide Diuretic MoA/Info

Answer 14

• MoA: inhibits Na reabsorption in DISTAL convoluted tube (increases Na/Cl/H20/K excretion)
• CI: sulfonamide allergy
• Low electrolytes EXCEPT calcium (HYPERcalcemia)
• Avoid CrCl < 30
• Increases UA/LDL/TG/BG

Question 15

CCBs MoA/Info

Answer 15

• MoA: inhibits Ca+ from entering smooth muscle => peripheral arterial vasodilation
• DHP CCB end in “-pine,” otherwise Non-DHP CCB
• Can cause peripheral edema, flushing, tachycardia/palpitations
• Drug of choice in Raynaud’s syndrome
• NEVER use non-DHP CCBs in HF

Question 16

Clevidipine

Answer 16

• Lipid emulsion CCB, IV
• CI: allergy to soybeans or eggs
• Infection and hyperTG risk
• STRICT aseptic technique => only 12 hours after puncture
• 2 kcal/mL

Question 17

CCB DDI

Answer 17

• AVOID grapefruit juice and major CYP3A4i

- Must lower doses of simvastatin and lovastatin if used together

Question 18

RAASi

Answer 18

• Don’t double up any RAASi
• Angioedema risk - higher risk in black patients
• ALL have hyperkalemia risk
• ACEi/ARBs decrease lithium clearance/increases its toxicity

Question 19

ACEi Info

Answer 19

• ACEi (stop Ang I => Ang II), blocks bradykinin (dry cough)
• Captopril - TID; Enalapril - BID
• Warning: bilateral renal stenosis
• Don’t use w/in 36 hours of Entresto

Question 20

ARBs

Answer 20

• Blocks AngII from binging to receptor (stops vasoconstriction)
• Less cough, angioedema, and no washout with Entresto
• Olmesartan: “sprue-like enteropathy”

Question 21

K-Sparing Diuretics

Answer 21

• Aldosterone receptor antagonists: Spironolactone or eplerenone are preferred add-ons for resistant HTN
• Commonly used in HF
• Eplerenone is selective and doesn’t display endocrine SE (gynecomastia, impotence)

Question 22

K-sparing Diuretic Info

Answer 22

• Hyperkalemia warning (Triamterene esp.)
• Addison’s disease for spironolactone
• Increases SCr
• Also decrease lithium clearance

Question 23

B-Blockers

Answer 23

• Only first-line for comorbidities like post-MI or HF (bisoprolol, carvedilol preferred)
• DON’T D/C abruptly (rebound tachycardia)
• CI: severe bradycardia
• Can mask signs of low blood sugar or worsen Asthma/COPD (non-selective)

Question 24

B1 Selective BB

Answer 24

AMEBBA

• Atenolol (Tenormin)
• Metoprolol (Lopressor, Toprol XL)
• Esmolol (Brevibloc)
• Bisoprolol
• Betaxolol
• Acebutolol (w/ ISA)

Question 25

B1 and B2 Blockers

Answer 25

Non-selective - Nadolol - Pindolol (w/ ISA) - Propranolol - Timolol

Question 26

Other BB

Answer 26

B1 w/ Nitric Oxide Vasodilation -Nebivolol - Bystolic Non-selective with Alpha-1 Blocker - Carvedilol (Coreg) - Labetalol

Question 27

Centrally Acting Alpha2 Agonist

Answer 27

- Clonidine - oral, patch (remove before MRI, Qweekly) - Kapvay for ADHD - Guanfacine - Methyldopa - DILE risk * *DON'T D/C suddenly** - Antichol. SE

Question 28

Direct Vasodilator

Answer 28

- Hydralazine: DILE (vasodilation SE) - Minoxidil: SIGNIFICANT edema (OTC - Rogaine, hair growth) - SE: Flushing, HA, tachycardia, etc.

Question 29

Alpha Blockers

Answer 29

- Doxazosin - Prazosin - Terazosin - NOT recommended for HTN, should be used for BPH AND HTN (not HTN alone)

Question 30

HTN Emergency

Answer 30

- BP >= 180/120 AND acute organ damage - IV meds! - No more than 25% reduction in BP in 1st hours (then aim for 160/100 over next 2-6 hours)