Antihypertensives 🤯

Question 1

Once you’re on HTN meds, when can you stop taking them

Answer 1

Never

Question 2

What are the 2 effects of diuretics on BP?

Answer 2

Decrease CO by decreasing blood volume

Decrease peripheral vascular resistance
(Probably FYI: by decreasing Na content in smooth muslce cells and activating K+ channels, the muscles are less sensitive to vasopressors)

Question 3

What kind of drugs are clonidine and Methyldopa

Answer 3

Centrally acting sympatholytics

Question 4

Where do clonidine and methyldopa act

Answer 4

On the brain

Question 5

Will we see reflex tachycardia with clonidine or methyldopa?

Answer 5

NO! They act on the CV center in the brain!

Question 6

When do we use methyldopa most

Answer 6

Pregancy

Question 7

What are the adverse effects of clonidine and methyldopa

Answer 7

DRY MOUTH

Sedation (and other CNS effects)

Methyldopa can cause hemolytic anemia if they have a positive Coombs test and you give it to them

Question 8

What is the MOA of clonidine and methyldopa?

Answer 8

They stimulate a2 receptors in the brain, which decreases NE release!

Question 9

If a patient has a positive ________test, you should NOT give Methyldopa

Answer 9

Coombs

Will cause hemolytic anemia

Question 10

Which drugs are the a1 blockers

Answer 10

Prazosin

Terazosin

Doxazosin

Question 11

Who is the ideal patient for a1 blockers

Answer 11

Old man with BPH and HTN

Can help with urine flow

Question 12

Do we see reflex tachycardia with a1 blockers

Answer 12

Yes

Question 13

What class of drug has the first dose phenomonon

Answer 13

a1 blockers

Make sure patient takes first dose before bed since postural hypotension will be intense at first

Question 14

Do a1 blockers affect lipids or glucose?

Answer 14

No

Question 15

Can you use B blockers for vasodilation

Answer 15

NO NO NO NONONO a thousand times NOOOOOOOOOOOOOOO

They are NOT direct vasodilators!!!!!!!!!!!!!!

Question 16

Do you need to know everything about b blockers

Answer 16

Yes

Question 17

What are the HIP drugs and what do they do?

Answer 17

Hydralazine**

Isoniazid

Procainamide

They cause drug-induced SLE in slow acetylators

Question 18

What is the MOA of Fenoldopam

Answer 18

Is stimulates D1 receptors to relax arteriolar smooth muscle

Question 19

When do we use fenoldopam

Answer 19

Emergency hypertensive situations

IV only

Question 20

What is the MOA of Minoxidil?

Answer 20

It opens K+ channels to stabilize membranes and dilate ARTERIOLES

Question 21

Minoxidil dilates (arterioles/veins)

Answer 21

Arterioles

Question 22

What is an interesting adverse effect of minoxidil

Answer 22

Hair growth!

Topical minoxidil= Rogaine

Question 23

Why do vasodilators threaten coronary perfusion?

Answer 23

They TANK your diastolic BP, PLUS your HR goes up so there’s less time between beats =less blood flow and less time between beats for heart to get perfused

Question 24

Do ACE inhibitors cause reflex tachycardia?

Answer 24

NO!!!!!!! They lower BP but they ALSO reset the baroreceptors so there is no reflex tachycardia

Question 25

Will ACEs and ARBs cause water and sodium retention?

Answer 25

No! Becasue they inhibit the angiotensin II activation of aldosterone synthesis

Question 26

Which drug classes should NOT be combined with digoxin due to the risk of causing arrhytmias? Why not?

Answer 26

Thiazides and loops. Cause hypokalemia

Question 27

Can B-blockers cause atherosclerosis?

Answer 27

Yes, becasue they increase LDL and reduce glucose tolerance

Question 28

What is the DOC for HTN in type II diabetics

Answer 28

ACEs and ARBs

Question 29

Are thiazides good for diabetics

Answer 29

NO!!! They have an inhibitory effect on insulin release

Question 30

What is the least preferred drug for people with: High physical activity African heritage Diabetes Peripheral vascular disease

Answer 30

Beta blockers!

Question 31

When do we use Hydralazine?

Answer 31

Severe hypertension (last resort drug) Hypertensive emergencies in pregnancy

Question 32

When do we use sodium nitroprusside?

Answer 32

Emergencies ONLY - IV only**

Question 33

Why is sodium nitroprusside only used in emergencies?

Answer 33

Rapid onset Effect disappears in minutes Metabolized by liver to thiocyanate (cyanide!)**

Question 34

What is a side effect of the dihydropyridine CCBs

Answer 34

Gingival hyperplasia 🦷

Question 35

What is the most common side effect of verapamil

Answer 35

Constipation

Question 36

What is the DOC for HTN in diabetics

Answer 36

ACE/ARB- prevents nephropathy

Question 37

What is the drug of choice for CKD even when they don’t have HTN?

Answer 37

ACE/ARB

Question 38

If your patient is showing even the slightest sign of diabetic nephropathy, what drug do you need to give them

Answer 38

ACE/ARB

Question 39

What drug class is not ok for patients with bilateral renal artery stenosis?

Answer 39

ACE/ARBs Their GFR is already too low, they need Angiotensin and aldosterone to keep it up.

Question 40

Which drugs can cause hemolytic anemia if the pt has a positve Coombs test

Answer 40

Methyldopa

Question 41

What do sympatholytics (other than clonidine and methyldopa) do to Na+ and H2O retention

Answer 41

They increase it! Due to activating the baroreflex. These drugs are best combined with a diuretic