HTN

Question 1

Are the majority of HTN cases primary or secondary cases?

Answer 1

90% primary

Question 2

How do large arteries change during HTN?

Answer 2

decreases elasticity and increases wall thickness

Question 3

Does low or high K+ put you at risk for HTN?

Answer 3

Low K+
Recall: spironolactone puts you at risk for hyperK+, but it also lowers BP

Question 4

Will at home BP readings with an automatic BP cuff be higher or lower than auscultory BP readings in a Dr’s office?

Answer 4

automatic readings are 5-10mmhg lower

Question 5

Lifestyle changes to lower BP

Answer 5

Wt loss
DASH Diet
Lower Na+ intake
Incr K+
Exercise
Drink less (men 2 drinks/day; women 1 drink/day)

Question 6

Which patients are at highest risk for HTN? what should their BP goal be?

Answer 6

ASCVD
Heart failure
CKD
Diabetes

BP Goal: 125-130/<80

Question 7

Exaples of Secondary causes of HTN

Answer 7

Renal Dysfn
Phenochromocytoma (rare benign adrenal gland tumor)
cushing’s Dz

Question 8

1st line trmnt for HTN

Answer 8

ACE-I or ARBs
CCBs (DHP)
Thiazides

Question 9

2nd line trmnts for HTN

Answer 9

CCBS (NON-DHP)
BBs
Central Alpha Antagonists
Direct vasodilators
Alpha Antagonists

Question 10

Diuretics used for HTN

Answer 10

Loop diuretics
K+ Sparing Antag
Carbonic Anhydrase inhibitors (CAI)

Question 11

Meds used in HTN emergencies

Answer 11

Fenoldopam
Nitroglycerin
Nitroprusside

Question 12

Pt is already on an ACE-I or ARB. Should you add on a CCB or Thiazide?

Answer 12

CCB
ACE-I or ARB + CCB is better than ACE-I or ARB + Thiazide

Question 13

When are BBs 1st line for HTN?

Answer 13

Pregnancy
use Labetolol or nifedipine 1st line

Question 14

African Americans should be given ___ for HTN
However, if Diabetic AA -> give _______ bc their the only ones that have enough research

Answer 14

AA -> CCBs and Thiazides
Diabetic AA -> ACE-I

Question 15

Diabetics can get ____ for HTN

Answer 15

ACE-I/ARB, CCBs, Diuretics

Question 16

give a pt with CKD _____ for HTN

Answer 16

ACE-I/ARB

Question 17

1st line trmnt for Child with HTN

Answer 17

ACE-I/ARB

Question 18

1st line trmnt for elderly person with HTN

Answer 18

DHP CCB (amlodipine) or ACE-I

Question 19

Which drug class gives cough, rash, and angioedema

Answer 19

ACE_I “-pril”

Question 20

A pt with HTN and CAD is already on Lisinopril (ACE-I) , Amlodipine (CCB), and hydrochlorothiazide (diuretic) but BP is still not controlled. What else should be added?

A. ARB (Losartan
B. Hydralazine
C. Alpha Agonist (Clonidine)
D. BB (Carvedilol)

Answer 20

D. BB (Carvedilol)

A. pt is already on an ACE-I (you have to pick b/w ACE-I or ARB)
B. Hydralazine is used in HTN emergency. this is not an emergency
C. Alpha Agonists are lower in the rank of 2nd line options
D. Correct answer

Question 21

DHP vs Non-DHP CCBs

Answer 21

DHP lower BP
Non-DHP lower HR (negative chronotropic effect)

Question 22

Do ACE-I result in constriction or dilation of the efferent arteriole? Does this increase or decreased GFR?

Answer 22

ACE-I result in efferent arteriole vasodilation. This decreases GFR and pressure in the glomerulus

Question 23

Pt just started taking ACE-I, what changes to you expect to see in serum creatinine and proteinuria levels

Answer 23

increased serum creatinine
Decreased Proteinuria
ACE-I result in efferent arteriole vasodilation, decr GFR/glomerular pressure; less if filtered out

Question 24

Olmesartan concerning SE

Answer 24

Enteropathy (chronic irritation to small intestine) -> severe, chronic diarrhea
It can happen months/years later after stopping med

Question 25

Pt can't remember if they were on a ACE-I or ARB but report enteropathy like SE with severe, chronic diarrhea

Answer 25

Pt was likely taking an ARB (olmesartan MC)