21-31 Antihypertensive Agents

Question 1

a chronic elevation in arterial presssure above an arbitrarily defined normal valvue

Answer 1

chronic systemic arterial hypertension

Question 2

stage 1 HTN

Answer 2

140/90

Question 3

stage 2 HTN

Answer 3

160/100

Question 4

> 180 or >120 with no associated acute end organ damage

Answer 4

hypertensive urgency

bp must be reduced over hrs to days

Question 5

markedly elevated bps with presence of acute end organ damage

Answer 5

hypertensive emergency

requires immediate therapy to reduce bp within minutes to hrs

Question 6

both hypertensive urgencies and emergencies and is more reflective of the the high degree of bp elevation

Answer 6

hypertensive crisis

Question 7

bp that is uncontrolled despite the use of 3 or more antihypertensive drugs, taken at optimal doses, and of which one is a diuretic

Answer 7

resistant htn

Question 8

risk factors for RHTN

Answer 8

• old
• obese
• CKD
• DM
• obstructive sleep apnea
• high salt diet
• african american
• female

Question 9

idiopathic htn

Answer 9

essential/primary htn

90% of cases

Question 10

principle of htn treatment

Answer 10

treat with intent of reducing risk of cv events and thereby reducing cv morbidity and mortality

Question 11

bp goal for those over 60 yo

Answer 11

150/90

Question 12

diabetes and HTN –>

Answer 12

ACEi or ARB

Question 13

CKD and HTN –>

Answer 13

ACEi or ARB

Question 14

CAD and HTN –>

Answer 14

B blocker and ACEi or ARB

Question 15

LV dysfunction and HTN –>

Answer 15

diuretic and ACEi or ARB and B blocker

Question 16

previous ischemic stroke and HTN –>

Answer 16

ACEi with or without thiazide diuretic

Question 17

special pharmokinetics for ACEi

Answer 17

reduce dose in kidney failure (cleared by kidney)

reduce dose in pts with high plasma renin levels ( cause hyperresponsiveness)

Question 18

ACEi examples

Answer 18

captopril
lisinopril
fosinopril

Question 19

contraindications for ACEi

Answer 19

pregnancy
bilateral renal a. stenosis
hx of angioedema

Question 20

situations with potentially favorable effects for ACEi

Answer 20

low K
prediabetes
albuminuria

unfavorable:
high K
hyperkalemia
volume depletion

Question 21

common adverse effect of ACEi

Answer 21

coughing

Question 22

poor responders to ACEi

Answer 22

elderly african americans

Question 23

ARBs

Answer 23

losartan
valsartan
cadesartan

Question 24

contraindications for ARBs

Answer 24

pregnancy

bilateral renal a. stenosis

Question 25

potentially favorable effects of ARBs

Answer 25

low K prediabetes unfavorable: high K hyperkalemia volume depletion

Question 26

dihydropyridine calcium channel blockers for HTN

Answer 26

nifedipine amlodipine felodipine

Question 27

contraindications for dihydropyridine CCBs

Answer 27

left ventricular dysfunction

Question 28

siturations with potetially favorable effects from DHP- CCBs

Answer 28

reynaud syndrome elderly pts with isolated systolic HTN cyclosporine induced HTN potentially unfavaroable: peripheral edema, high HR

Question 29

alternative to b blockers in CAD

Answer 29

verapamil diltiazem non DHP CCB

Question 30

contraindications for nonDHP-CCB

Answer 30

second or third degree heart block LV dysfunction

Question 31

situations with potentially favorable effects with nonDHP-CCB

Answer 31

reynaud's migraines arrhythmia high HR unfavorable: peripheral edema, low HR

Question 32

contraindications for thiazides for HTN

Answer 32

allergic to sulfa gout hyponatremia hypokalemia

Question 33

first line therapy for compelling indications of HTN and LV dysfunction or previous ischemic stroke

Answer 33

thiazide diuretics

Question 34

situations with potentially favorable effects for thiazides

Answer 34

osteoporosis high K+ ``` unfavorable: gout prediabetes low K elevated glucose ```

Question 35

situations with potentially favorable effects for b-blockers for HTN

Answer 35

``` migraines high HR hyperthyroidism tremor preop HTN ```

Question 36

aldosterone antagonists

Answer 36

spironolactone | eplerenone

Question 37

role of aldosterone antagonists in HTN therapy

Answer 37

for RHTN | and those with LV dysfunction and CAD

Question 38

situations with potentially favorable effects for aldosterone antagonists and HTN

Answer 38

low K CKD unfavorable: high K

Question 39

alpha1 adrenergic receptor blockers

Answer 39

prazosin doxazosin terazosin

Question 40

added benefits of prazosin therapy for HTN

Answer 40

lowers LDL, TG and cholesterol

Question 41

adverse effects of alpha1 adrenergic receptor blockers

Answer 41

tolerance reflex tachycardia sexual dysfunction

Question 42

MOA clonidine

Answer 42

central alpha2 agonist

Question 43

indications for clonidine

Answer 43

labile HTN | early morning surges in HTN

Question 44

MOA a-methyldopa

Answer 44

central alpha2 agonist

Question 45

indications for a-methyldopa in HTN

Answer 45

pregnancy

Question 46

MOA hydralazine

Answer 46

arterial vasodilator

Question 47

adverse effect hydralazine

Answer 47

SLE | reflex tachycardia and sodium retention (use with diuretic and beta blocker or NDPH-CCB)

Question 48

MOA minoxidil

Answer 48

arterial vasodilator

Question 49

MOA sodium nitroprusside

Answer 49

arterial vasodilator

Question 50

indications for sodium nitroprusside

Answer 50

HTN emergency or emergency CHF

Question 51

adverse effects sodium nitroprusside

Answer 51

cyanide poisoning | methemoglobinemia

Question 52

MOA aliskiren

Answer 52

direct renin inhibitor

Question 53

adverse effect aliskiren

Answer 53

hyperkalemia if used with other drugs in pathway

Question 54

MOA reserpine

Answer 54

blocks transport of NE into storage vacuoles --> decreased sympathetic tone

Question 55

most effect use of reserpine for HTN

Answer 55

with a thiazide diuretic

Question 56

side effects reserpine

Answer 56

increased parasymp activity | diarrhea, bradycardia, stuffiness

Question 57

most common cause of apparent treatment ressistance

Answer 57

inadequate diuretics