Cardiovascular Conditions: Hypertension

Question 1

Primary vs secondary HTN?

Answer 1

Primary = cause unknown, combo of risk factors
Secondary = can be caused by renal or adrenal disease, sleep apnea

Question 2

Stages of HTN

Answer 2

Normal = SBP < 120, DBP < 80
Elevated = SBP 120-129, DBP < 80

Stage 1: SBP 130 - 139, DBP 80-89
Stage 2: SBP > 140, DBP > 90

Question 3

Proven lifestyle interventions

Answer 3

Weight loss
Heart Healthy Diet = DASH
Sodium intake < 1,500mg
Exercise
Stop smoking
Limit alcohol smoking

Question 4

ACC/AHA treatment principles

Answer 4

Lifestyle modifications
QD regimen preferred
4 drug classes preferred (ACE, ARB,DHP CCBs, Thiazide diuretics)

most req combo, dont add second until max dose of 1st. Dont use ACE/ARBs together

Question 5

Which HTNsion drugs have boxed warnings in pregnancy

Answer 5

ACE
ARB
PSCK9i

Question 6

First line txm for HTN in pregnancy

Answer 6

labetalol
nifedipine ER
Metyhldopa less effective but an optionW

Question 7

When to start txm for HTN?

Answer 7

Start stage 2
Stage 1 + CVD, ASCVD > 10%, dont drop BP after 6 month of life changes

Goal = <130/80

Question 8

Where do thiazide diuretics work?

Answer 8

Inhibit sodium reabsorption in DCT< inc excretion of sodium, Cl, H20, potassium

Question 9

Thiazide CI

Answer 9

cross hypersensitivity with sulfonamide-derived drugs

Question 10

Thiazide side effects

Answer 10

dec K/Mg/Na
Inc Ca/UA/LDL/TG/BG
Photo sensitivity

Question 11

Thiazides are not effective when

Answer 11

CrCl < 30 mL/minT

Question 12

Thiazide notes

Answer 12

take during day to avoid nocturia
Chlorothiazide only one you can get IV

Question 13

Dont use thiazides in combo with drugs that inc sodium/water retention such as…

Answer 13

NSAID

Question 14

Two types of CCB

Answer 14

DHP
Non-DHP

Question 15

DHP CCBs

Answer 15

Nifedipine
Amlodipine

Question 16

Non-DHP CCBs

Answer 16

diltiazem
Verapamil

Question 17

DHP CCB warnings

Answer 17

Hypotension
** Nifedipine IR: dont use for chronic HTN or acute BP reduction in non-pre adults **

Question 18

DHP CCB side effects

Answer 18

Peripheral edema
Headache
flushing
palpitations
reflex tachycardia
gingival hyperplasia (more w/ non DHP)

Question 19

Safest CCB to use in HFrEF?

Answer 19

Amlodipine

Question 20

Which DHP is drug of choice in pregnancy

Answer 20

Nifedipine ER

Question 21

Clevidipine CI

Answer 21

allergy to soybeans, products or eggs

Question 22

Clevidipine warnings

Answer 22

Hypotension
reflex achy
infections

Question 23

Clevidipine side effects

Answer 23

Hypertriglyceridemia

Question 24

DHP CCB work by

Answer 24

inhibit Ca ions form entering vascular smooth muscle and myocardial cells, causing peripheral arterial vasodilation (dec SVR/BP)

Question 25

Non-DHP CCB work by

Answer 25

inhibit Ca ions from entering vascular smooth muscle and myocardial cells (more selective for myocardium than DHP) decrease in BP due to negative inotropic and chronotropic effects

Question 26

Non-DHP CCBs CI

Answer 26

AV block or sick sinus syndrome acute MI and pulmonary congestion

Question 27

Non-DHP CCBs warnings

Answer 27

May worsen HF symptoms bradycardia

Question 28

Non-DHP CCBs side effects

Answer 28

Edema constipation (more w/ verapamil) gingival hyperplasia

Question 29

All CCBs should not be used with....

Answer 29

grapefruit juice

Question 30

Pts on diltiazem and verapamil who are taking statins should....

Answer 30

lower doses of simvastatin or lovastatin

Question 31

Angioedema is more common with...

Answer 31

ACEi than ARBs or aliskiren black patients higher risk if pts develops it with any RAASi, other RAASi should be avoided

Question 32

ACEi mechanism of action

Answer 32

block conversion of angiotensin I to angiotensin II, leading to dec vasoconstriction and aldosterone secretion

Question 33

ACEi side effects

Answer 33

dry cough** hyperkalemia (inc potassium) inc SCr

Question 34

ACEi boxed warnings

Answer 34

D/c if pregnancy detected

Question 35

ACEi CI

Answer 35

Dont use w/ history of angioedema Dont use within 36hrs of entresto dont use w/ aliskiren in diabetes

Question 36

ACEi warnings

Answer 36

angioedema hyperkalemia renal impairment

Question 37

ARBs mechanism of action

Answer 37

Block Angiotensin II form binding to receptor

Question 38

ARBs safety/side effects

Answer 38

Less cough Less angioedema No washout period required w/ Entresto

Question 39

ACEi/ARBs effect in lithium?

Answer 39

Can decrease lithium renal clearance and inc risk of lithium toxicity

Question 40

Potassium-sparing diuretics

Answer 40

Triamterene and amiloride

Question 41

Potassium-sparing diuretics used often in....

Answer 41

combo with HCTZ to counteract mild potassium lossess

Question 42

Preferred add-on drugs in resistant HTN are

Answer 42

aldosterone receptor antagonists spironolactone & eplerenone

Question 43

Spironolactone vs eplerenone

Answer 43

Spironolactone = non-selective Eplerenone = selective, doesnt exhibit endocrine side effects

Question 44

Boxed warnings for Amiloride and triamterene

Answer 44

K > 5.5

Question 45

Spironolactone SE and CI

Answer 45

CI: dont sue in hyperkalemia, severe renal impairment or Addison's disease SE: Gyno, breast tenderness, impotence

Question 46

Beta-1 Selective Blockers : AMEBBA

Answer 46

Atenolol Metoprolol tartrate/succinate Esmolol Bisoprolol Betaxolol Acebutolol

Question 47

Beta blockers boxed warnings

Answer 47

Down stop abruptly, taper slowly over 1-2 weeks

Question 48

Beta blocker warnings

Answer 48

caution pts with diabetes, can mask hypoglycemia caution in COPD/asthma caution Reynaud's

Question 49

Beta blocker side effects

Answer 49

Bradycardia Fatigue hypotension dizziness depression impotence

Question 50

Metoprolol notes

Answer 50

tartrate IV:PO ratio 1:2.5 should be taken with food, but other ones dont need to

Question 51

Nebivolol CI

Answer 51

severe liver impairment Child-Pugh B or C

Question 52

Beta blockers used in portal hypertension?

Answer 52

Non-selective Propranolol, nadolol, pindolol, timolol

Question 53

All forms of carvedilol should be taken with....

Answer 53

food, to dec rate of absorption and risk of orthostatic hypertension

Question 54

Which beta blocker is drug of choice in pregnancy?

Answer 54

Labetolol

Question 55

Clondine is usually used for....

Answer 55

resistant hypertension

Question 56

Methyldopa CI

Answer 56

concurrent use with MAOi and acute liver disease

Question 57

Clonidine warning

Answer 57

Dont d/c abrupt y, can cause rebound hypertension and should taper

Question 58

Clondine side effects

Answer 58

dry mouth somnolence fatigue dizziness constipation dec HR Hypotension impotence ** remove patch before MRI**

Question 59

Methyldopa Side effects

Answer 59

DILE edema or weight gain inc prolactin lvls ** can use in pregnancy **

Question 60

Direct vasodilators mechanism of action

Answer 60

Hydralazine Minoxidil

Question 61

Hydralazine warnings & SE

Answer 61

warnings: DILE SE: peripheral edema Headache flushing palpitations reflex tachy

Question 62

Minoxidil Boxed warning, CI, SE

Answer 62

Boxed warning: potent antihypertensive, with with Beta-blocker n loop diuretic CI: Pheochromocytoma SE: Fluid retention, tachycardia, hair growth

Question 63

Alpha blockers not recommended for HTN but may be used in men with....

Answer 63

HTN and benign prosaic hyperplasia

Question 64

Alpha blockers

Answer 64

Doxazosin prazosin terazosin

Question 65

Hypertensive crisis

Answer 65

BP > 180/120 2 types, emergency or urgency

Question 66

Hypertensive emergency

Answer 66

patient has acute target organ damage that may be life threatening Treat with IV meds, decrease BP by no more than 25% in 1st hour

Question 67

Hypertensive urgency

Answer 67

no evidence of acute target organ damage Use short acting oral med, gradually decrease BP over 24-48hrs