HTN

Question 1

what is secondary HTN

Answer 1

caused by renal disease, sleep apnea, or adrenal disease

Question 2

what is primary or essential HTN

Answer 2

what most people have

cause is unknown but attributed to risk factors

Question 3

which systems have increased activity in HTN

Answer 3

sympathetic nervous system

Renin-angiotensin-aldosterone system

Question 4

Describe how the RAAS system increases blood pressure

Answer 4

low blood pressure signals the liver to release angiotensinogen and renin which converts to angiotensin I. ACE then converts this to Angiotensin II which causes aldosterone secretion and vasoconstriction. aldosterone prompts increase Na and water reabsorption increasing blood volume.

Question 5

how does an ACE inhibitor affect blood pressure

Answer 5

it prevents ACE from inactivating bradykinin (which causes vasodilation) and prevents the conversion of angiotensin I to angiotensin II

Question 6

how does the sympathetic nervous system cause increased blood pressure

Answer 6

low blood pressure signals the brain to release Norepi which causes vasoconstriction by activating the alpha-1 receptors as well as increased HR and contractility by activating the beta 1 receptors

Question 7

What do DHP CCBs affect?

Answer 7

SVR (systemic ventricular resistance)

Question 8

what do non-dhp ccbs affect

Answer 8

contractility and heart rate

Question 9

Normal blood pressure

Answer 9

<120/<80

Question 10

top or bottom number: systolic

Answer 10

top

Question 11

top or bottom number diastoli

Answer 11

bottom

Question 12

HTN values

Answer 12

> /= 130/ >/= 80

Question 13

what should sodium intake be reduced to for HTN management?

Answer 13

<1500mg/daily

Question 14

when to start drug treatment

Answer 14

stage 2 HTN (>140/>90)
or
stage 1 HTN + ASCVD risk >/=10% or clinical CVD

Question 15

First-line agents: non-black patients

Answer 15

thiazide, CCB, ACE inhibitor, ARB

Question 16

First-line agents: black patient

Answer 16

thiazide or CCB

Question 17

First-line agents: CKD (all races)

Answer 17

ACEi or ARB

Question 18

First-line agents: diabetes with albuminuria

Answer 18

acei or arb

Question 19

First-line agents: stage 2 HTN with readings >150/90

Answer 19

start 2 first-line agents

Question 20

which first line agents should not be used in combo

Answer 20

acei and arbs

Question 21

can you add a second agent before the first one is titrated to max?

Answer 21

Yes! actually works better and can prevent side effects

Question 22

which htn drugs have a boxed warning for fetal toxicity when used in pregnancy

Answer 22

acei, arbs, and aliskiren

Question 23

what is recommened in patients with a high risk of preclampsia

Answer 23

low dose aspirin daily after first trimester

Question 24

when to treat chronic htn in a pregnant patient

Answer 24

if >/= 160/105

Question 25

First-line agents: pregnant patient

Answer 25

labetalol and nifedipine ER

Question 26

MOA thiazide diuretics

Answer 26

inhibit sodium reabsorption in the distal convoluted tubules, increasing excretion of sodium, cl, water, and K

Question 27

thiazides CI

Answer 27

sulfonamide allergy

Question 28

at what Crcl should thiazides not be used

Answer 28

CrCl < 30

Question 29

which thiazide is available IV

Answer 29

chlorothiazide

Question 30

which drug should not be used with thiazides due to increased risk of toxicity

Answer 30

lithium

Question 31

List of DHP CCBs

Answer 31

"-pine"

Question 32

MOA DHP CCBs

Answer 32

inhibit Ca from entering vascular smooth muscle and myocardial cells, causes peripheral arterial vasodilation

Question 33

Which side effects occur with CCBs due to peripheral vasodilation

Answer 33

reflex tachycardia/palpitations headache flushing peripheral edema!

Question 34

Which CCB is preferred in HF

Answer 34

amlodipine

Question 35

CI Nicardipine

Answer 35

advanced aortic stenosis

Question 36

Non-DHP CCBs indication

Answer 36

control HR/arrhythmias | Afib

Question 37

MOA non-DHP CCBs

Answer 37

negative inotropic and chronotropic effects (decrease force of ventricular contractions and decrease HR)

Question 38

Side effects with non-DHP CCBs

Answer 38

edema, constipation, gingival hyperplasia

Question 39

CYP considerations with CCBs

Answer 39

CYP3A4 substrates

Question 40

If a patient experiences angioedema with an ACEi or ARB, can you try the other class?

Answer 40

NO

Question 41

ACEi/ARBs safe in pregnancy?

Answer 41

NO! Boxed warning

Question 42

hypo or hyperkallemia with ACEi?

Answer 42

hyperkalemia!

Question 43

why are K+ sparing diuretics used in combo with thiazides?

Answer 43

to combat K+ loss

Question 44

Which K+ sparing is non-selective?

Answer 44

spironolactone - also blocks androgen

Question 45

When are beta blockers recommended first line?

Answer 45

post-MI ischemic heart disease heart failure

Question 46

Which beta blockers are preferred in heart failure

Answer 46

metoprolol succinate bisoprolol carvedilol

Question 47

beta 1 selective beta blockers

Answer 47

atenolol esmolol metoprolol nebivolol

Question 48

Non-selective beta blockers

Answer 48

propranolol nadolol carvediolol labetalol

Question 49

CI beta blockers

Answer 49

hepatic impairment

Question 50

What type of beta blockers are preferred in bronchospastic disease

Answer 50

selective

Question 51

Why do we have to be cautious in diabetic patients on beta blockers

Answer 51

beta blockers can mask hypoglycemia

Question 52

metoprolol tartrate IV:PO dosing

Answer 52

1:2.5

Question 53

why does propranolol have more CNS effects

Answer 53

high lipid solubility = crosses BBB

Question 54

what can help with orthostatic hypotension in carvedilol

Answer 54

taking with food!

Question 55

alpha 2 adrenergic agonists list

Answer 55

clonidine | guanfacine

Question 56

MOA alpha 2 adreergics

Answer 56

stimulating these receptors reduces outflow of norepi which causes decreased SVR and HR

Question 57

which alpha 2 comes in a patch?

Answer 57

clonidine | *good for patients who can't swallow

Question 58

which alpha 2 is commonly used in resistant HTn

Answer 58

clonidine

Question 59

which alpha 2 can be used in pregnancy

Answer 59

methyldopa

Question 60

methyldopa warnings

Answer 60

hemolytic anemia | hepatic necrosis

Question 61

list of direct vasodilators

Answer 61

hydralazine

Question 62

hydralazine CIs

Answer 62

mitral valvular rheumatic HD | CAD

Question 63

Alpha blocker list

Answer 63

-zosin

Question 64

role of alpha blockers

Answer 64

can be used in men with HTN and BPH

Question 65

HTN emergency or urgency - organ damage

Answer 65

emergency

Question 66

HTN emergency or urgency which one needs IV treatment

Answer 66

emergency

Question 67

How quickly do we need to decrease BP in emergency

Answer 67

NO MORE than 25% in first hour

Question 68

IV meds for HTN

Answer 68

``` chlorothiazide diltiazem enalaprilat esmolol hydralazine labetalol metoprolol nicadipine propranolol verapamil ```