antihypertensive pharm & mgmt

Question 1

ACE inhibitor SE x6

Answer 1

• cough
• angioedema
• hypotension (more common HF)
• GFR drop (AKI reverses with d/c)
• hyperkalemia
• metallice taste (2-4%)

Question 2

ARB SE x5

Answer 2

• hypotension (more common HF)
• GFR drop (AKI reverses with d/c)
• hyperkalemia
• metallice taste (2-4%)
• angioedema rare

NO cough (d/t lack of effect on bradykinin - rate of cough similar to placebo)

Question 3

ACE-i & ARB: renal & cardio protective effects

Answer 3

• improved outcomes with DM1 & proteinuria (decreased cardiovascular risk)
• systolic HF & myocardial ischemia (prevents remodeling & decreases progression of atherosclerosis)

Question 4

beta blocker MOA

Answer 4

• competitively block catecholamines @ B1 receptors
• lowers PVR: inhibits renin release & angiotensin II/aldosterone production
• ↓ CNS adrenergic outflow = resets baroreceptors
• a1 blockade: ↓ BP by peripheral vasodilation

Question 5

beta blockers: B1 selective

Answer 5

atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nebivolol (Bystolic)
bisoprolol (Zebeta)
acebutolol (Sectral)

Question 6

beta blockers: +A1 blockade

Answer 6

carvedilol (Coreg)

labetalol (Trandate)

Question 7

beta blockers: SE

Answer 7

• bradycardia
• sedation, depression, fatigue, sexual dysfunction
• diabetics: impaired glucose tolerance, decreased hypoglycemia awareness
• increased risk exacerbation in bronchospastic disease
• withdrawal effects (nervousness, tachycardia, angina, increased BP)

Question 8

beta blockers: withdrawal effects & why

Answer 8

nervousness
tachycardia
angina
increased BP

d/t ↑ sympathetic activity
AVOID ABRUPT D/C