CV & Renal: HTN

Question 1

What are the four classes of drugs used in treating HTN?

Answer 1

Diuretics, vasodilators, SNS drugs, RAAS Inhibitors

Question 2

Compelling indications for which HTN drug?

> 65 yo
Black
Stroke prophylaxis
Osteoporosis

Answer 2

diuretics

Question 3

Compelling indications for which HTN drug?

> 65 yo
stroke prophylaxis
CKD
T2DM
Asthma

Answer 3

ACE/ARB

Question 4

Compelling indications for which HTN drug?

> 65 yo
Black
Angina
T2DM
Asthma
Migraines

Answer 4

CCBs

Question 5

HTN drugs useful in pregnancy…

Answer 5

labetalol, methyldopa, nifedipine (L, M, N)

Question 6

Compelling indications for which HTN drug?

BPH

Answer 6

alpha blockers

Question 7

Compelling indications for HTN tx with Migraines

Angina

Answer 7

beta blockers

Question 8

Which drug class is avoided in Asthma?

Answer 8

beta blockers

Question 9

Which HTN drugs are avoided in patients over 65?

Answer 9

central alpha agonists

Question 10

Which HTN drugs are avoided in black patients?

Answer 10

beta blockers

Question 11

Which HTN drugs are avoided in pregnancy?

Answer 11

ACE/ARB

Question 12

Which HTN drugs are avoided in angina patients?

Answer 12

hydralazine, minoxidil

Question 13

This HTN drug class works directly on the heart.

Answer 13

propranolol and other beta blockers

Question 14

The following drugs exert effects on what tissue type?

ARBs, Alpha Blockers, Vasodilators, CCBs, fenoldopam

Answer 14

Vessels

Question 15

Describe the dose of thiazides for HTN vs diuresis

Answer 15

lower in HTN

Question 16

which diuretics are DOC for HTN?

Answer 16

thiazides

Question 17

What is the short term mechanism for treating HTN with thiazides?

Answer 17

↓ Na+, blood volume, CO

Question 18

The below describes the long term mechanism for treating HTN with which drug?

↓ Na+ in smooth muscle, K+ activation, ↓ muscle sensitivity to vasopressors, ↓ peripheral resistance

Answer 18

thiazides

Question 19

This drug has the following indications:

Mild to moderate HTN, esp. in black patients

Monotherapy ↓ BP 40-60% of pts by 10-15 mmHg

Combo: ↑ efficacy of other drugs

Direct Vasodilation

Answer 19

indapamide (thiazide)

Question 20

Wha can be done to reduce the adverse effects of thiazide diuretics w/ HTN

Answer 20

lower dose

Question 21

When can loop diuretics be considered in HTN?

Answer 21

severe cases

Question 22

When should potassium sparing diuretics be considered in HTN treatment?

Answer 22

combo w/ thiazide

Question 23

The following are common adverse effects to what drug class?

Reflex Tachy → Palpitations

↑ myocardial contraction

↑ Renin → fluid retention

↑ vasodilation → HA, Flushing, Dizziness

Answer 23

Vasodilators

Question 24

What are three vasodilators used in HTN tx?

Answer 24

hydralazine, sodium nitroprusside, fenoldopam

Question 25

Which vasodilators achieve their effects via NO?

Answer 25

Hydralazine and Sodium Nitroprusside

Question 26

This vasodilator has the following indications... severe, refractory HTN in combo therapy HTN emergency in pregnancy

Answer 26

hydralazine

Question 27

Which drug can lead to SLE in slow acetylators?

Answer 27

hydralazine (HIP drug)

Question 28

This drug can lead to cyanide accumulation. Its effects are rapid and short lived

Answer 28

sodium nitroprusside

Question 29

When should sodium nitroprusside be considered?

Answer 29

HTN emergency

Question 30

sodium nitroprusside is converted to what by the liver?

Answer 30

thiocyanate

Question 31

Which vasodilator achieves its action through dopamine?

Answer 31

Fenoldopam

Question 32

Describe the half-life of fenaldopam?

Answer 32

5 min

Question 33

What 4 drugs are considered CCBs?

Answer 33

nifedipine, amlodipine, diltiazem, verapamil

Question 34

Rank the affinity of CCBs to cardiac muscle and incidence of depressed SA/AV node function...

Answer 34

Verapamil > Diltiazem > nifedipine

Question 35

Rank the affinity of CCBs to vascular smooth muscle and occurrence of reflex tachycardia.

Answer 35

Nifedipine > diltiazem > verapamil

Question 36

What are the three major effects of CCBs on the heart?

Answer 36

negative inotropic, chronotropic, dromotropic

Question 37

The below describes the major mechanism of which drugs? binds L-type Ca channels leading to relaxation of all calcium dependent smooth muscle

Answer 37

CCBs

Question 38

What two benefits does slow release formulation of CCB have?

Answer 38

less reflex tachy | QD dosing

Question 39

Which CCBs are dihydropyridines?

Answer 39

nifedipine, amlodipine

Question 40

Dihydropyridines have what SFx?

Answer 40

vascular SFx | gingival hyperplasia

Question 41

Which CCBs are contraindicated in the following: - SA/AV node abnormality - HF - Use with beta blockers

Answer 41

verapamil and diltiazem

Question 42

Dihydropyridines are used with caution in what condition?

Answer 42

HTN with HF

Question 43

Which two ACE-Is are used in HTN?

Answer 43

Enlapril and Lisinopril

Question 44

ACE-Is can reduce BP without compromising which three tissue types?

Answer 44

brain, heart, kidney

Question 45

Do ACE-Is cause SNS activation or reflex tachy?

Answer 45

no

Question 46

ACE-Is are DOC in what conditions?

Answer 46

HTN + T2DM, CKD, HFrEF CKD and Diabetic Nephropathy

Question 47

ACE-Is have a synergistic effect with which drug class?

Answer 47

diuretics

Question 48

The following adverse effects describe which drug class? ↑ Bradykinin → Dry Cough & Angioneurotic edema Allergic skin rashes Orthostatic hypotension & Dizziness Acute renal failure if bilateral renal artery stenosis

Answer 48

ACE-I

Question 49

Why do ACE-Is cause acute renal failure in bilateral renal artery stenosis?

Answer 49

inhibited RAAS leads to further decreased GFR

Question 50

ACE-Is are contraindicated in what 3 conditions?

Answer 50

pregnancy Use with K-sparing diuretics and use with NSAIDs

Question 51

ARBs are analogous to ACE-Is, except they don't cause...

Answer 51

cough or angioedema