Anti-Hypertensives

Question 1

Stage 1 Hypertension

Answer 1

140-159/90-99

Question 2

Stage 2 HTN

Answer 2

> 160/>100

Question 3

Isolated systolic HTN

Answer 3

> 140/

Question 4

Hypertensive Crisis

Answer 4

encompasses both hypertensive urgencies and emergencies

more reflective of high degree BP elevation

Question 5

Hypertensive urgency

Answer 5

SBP >180 or DBP>120

NO ASSOCIATED END ORGAN DAMAGE

reduced over hours to days

Question 6

Hypertensive emergency

Answer 6

markedly elevated BP’s

PRESENCE OF ACUTE END ORGAN DAMAGE

reduce BP within mins to hrs

Question 7

Resistant HTN

Answer 7

uncontrolled despite optimal usage of three or more anti-hypertensive drugs

Question 8

ACE Inhibitors (3 examples)

Answer 8

Captopril
Lisinopril
Fosinopril

Question 9

ACE Inhibitor MOA

Answer 9

inhibits ACE to decrease AT II

also INCREASE bradykinin - serves as a vasodilator

Question 10

Clinical Use of ACE-I’s

Answer 10

first line for uncomplicated HTN

first line for compelling indications of: diabetes, CKD, CAD, left ventricular dysfunction, ischemic stroke

Question 11

Pharmacologic Aspects of ACE-I’s

Answer 11

reduce dose with kidney failure

elevated levels of renin causes hyperresponsiveness to ACE-I’s - need to decrease dose as well

Question 12

Avoid ACE-I’s in

Potentially unfavorable effect in?

Answer 12

PREGNANCY

Hyperkalemia, Volume depletion

Question 13

Adverse effects of ACE-I’s

Answer 13

Coughing - d/t bradykinin build up

Question 14

Angiotensin Receptor 1-Blockers (3 examples)

Answer 14

Losartan, Valsartan, Candesartan

Question 15

AR-1 Blockers MOA

Answer 15

block angiotensin receptor-1

does not cause build up of bradykinin

Question 16

Dihydropyridine CCB’s (3)

Answer 16

Nifedipine
Amlodipine
Felodipine

Question 17

Avoid use of Dihydropyridine CCB’s in

also unfavorable effects with?

Answer 17

left-ventricular dysfunction

high-normal heart rate or tachycardia or peripheral edema

Question 18

Non-dihydropyridine CCB’s

Answer 18

Verapamil

Diltiazem

Question 19

Non-Dihydropyridine CCB’s Clinical use

Avoid use in

Answer 19

first line/add on for uncomplicated HTN

add on for diabetes

alternative to B-blockers

do not use in LV DYSFUNCTION

Question 20

Thiazide diuretics Role in HTN therapy

Answer 20

first line/add on for uncomplicated HTN

first line for LV dysfunction, previous ischemic stroke

Question 21

Alpha-1 Blockers

Answer 21

Prazosin
Doxazosin
Terazosin

Question 22

Central alpha-2 agonists

Answer 22

Clonidine

Alpha-methyldopa

Question 23

Central Alpha-2 Agonist important side effect

Answer 23

rebound HTN

Question 24

Alpha-methyldopa importantly used for

Answer 24

gestational HTN

chronic HTN management in pregnancy

Question 25

Hydralazine MOA

Answer 25

decreases Ca in smooth muscle - leads to vasodilation also opens K channels - leads to hyperpolarization

Question 26

Hydralazine particularly useful in what two patient populations

Answer 26

severe chronic kidney disease gestational HTN

Question 27

Adverse effects of Hydralazine

Answer 27

drug-induced lupus compensatory tachycardia and Na retention

Question 28

Minoxidil MOA

Answer 28

opens K channels - relaxes arteriolar VSMC's increases blood flow to heart, skin, skeletal muscle, GI, CNS

Question 29

Clinical use of Minoxidil

Answer 29

only for severe refractory HTN combo with Beta-blockers and diuretics

Question 30

Adverse effects of minoxidil

Answer 30

reflex increase in myocardial contractility

Question 31

Sodium nitroprusside MOA Delivered how?

Answer 31

donates NO - causes cGMP-mediated Ca sequestration decreases PRE-LOAD and AFTERLOAD Intravenous - short term

Question 32

Sodium nitroprusside adverse effects

Answer 32

methemoglobinemia cyanide poisoning cell death

Question 33

Aliskiren MOA

Answer 33

directly inhibits renin prevents formation of angiotensin I from angiotensinogen

Question 34

Aliskiren adverse effects/precautions

Answer 34

Hyperkalemia NEVER USE IN PREGNANCY

Question 35

Reserpine MOA

Answer 35

inhibits vesicular storage of catecholamines

Question 36

Reserpine most effectively used in combo with what?

Answer 36

thiazide diuretic

Question 37

Resistant HTN Management considerations What diuretic is preferred?

Answer 37

Excessive dietary Na - reduction should be integrated Considering change in diuretics Chlorthalidone