HTN

Question 1

Stage 1 HTN reading

Answer 1

130-139/ 80-89

Question 2

What is the pathophysiology of HTN

Answer 2

An increase in after load affects stroke volume which in turn raises the blood pressure

Question 3

digoxin and nifedipine (procardia xl) together interacts how together

Answer 3

Nifedipine affects the absorption of digoxin and can increase the risk of digoxin toxicity.

Question 4

Decrease sympathetic impulses from the CNS to the heart and arterioles, causing vasodilation. Is the mechanism of action of what drugs

Answer 4

Alpha, agonists

Question 5

Drugs whose mechanism of action
Inhibit sympathetic activation in arterioles, causing vasodilation are called what

Answer 5

Alpha, blockers

Question 6

Drugs with a mechanism of action that
Act on the smooth muscle of arterioles, causing vasodilation are called what

Answer 6

Direct vasodilators

Question 7

Drugs with a mechanism of action that
Decreaso the heart rate and myocardial contractility.
reducing cardiac output are called what?

Answer 7

Beta blockers

Question 8

Drugs with a mechanism of action that
Block calcium ion channeis in artorial
smooth muscie
causing
vasodilation are called what?

Answer 8

Calcium channel blockers

Question 9

Drugs with a mechanism of action that
Prevents angiotensin
Il from reaching its receptors, causing vasodilation are called what

Answer 9

Angiotensin receptor blockers

Question 10

Drugs with a mechanism of action that
Block formation of angiotensin Il, causing vasodilation, and block aldosterone secretion, decreasing fluid volume. Are called what?

Answer 10

ACE inhibitors

Question 11

Drugs that increase urine output and decrease fluid volume are called what

Answer 11

Diuretics.

Question 12

Elevated blood pressure level

Answer 12

120-129/ less than 80

Question 13

Htn stage 2 levels

Answer 13

140 and above/ 90 and above

Question 14

First line drugs for hypertension

Answer 14

ACE inhibitors
Angiotensin receptor blockers (arbs)
Calcium channel blockers
Thiazide diuretics

Question 15

Second line drugs for hypertension

Answer 15

Alpha 1- adrenergic blocker
Aloha2- adrenergic agonists
Beta-adrenergic blockers
Centrally acting alpha and beta blockers
Direct-acting vasodilators
Direct renin inhibitors
Peripherally acting adrenergic neuron blockers

Question 16

What herbal hypertension remedy should be discontinued if patient is taking an anticoagulant drug.

Answer 16

Grape seed extract
Increased risk of bleeding

Question 17

Common adverse effect of ACE inhibitors that is usually minor

Answer 17

Persistent cough
From accumulation of bradykinin.

Question 18

Most serious adverse effect of ACE inhibitors that usually would develop within hours or days after beginning treatment with drug. (Although late onset has been reported months or years after therapy starts)

Answer 18

Angioedema
Swelling around the lips, eyes, throat and other body regions.

Question 19

Concurrent use of ACE inhibitor, ARB, or renin inhibitor is or is not recommended for HTN patients

Answer 19

Not. It can be harmful and low effectiveness

Question 20

Losartan (cozaar)
Is what type of drug
- pregnancy category?

Answer 20

Angiotensin 2 receptor blocker (ARB)
- pregnancy category D (do not use)

Question 21

Nifedipine (adalat cc, procardia xl) is what class do drug
- what special administration alert needs to be considered with this drug

Answer 21

Calcium channel blocker
- do not administer immediate release formulations if an impending MI is suspected or within 2 weeks following a confirmed MI.

Question 22

What drug drug interaction needs to be monitored if a patient is taking nifedipine

Answer 22

Digoxin toxicity

Question 23

Beta blockers should be used with caution in what kind of patients and why?

Answer 23

Asthma or HF because it slows heart rate and causes brochoconstriction

Question 24

Alpha1 adrenergic blockers main side effects

Answer 24

Orthostatic hypotension, dizziness, nausea, nervousness and fatigue.

Question 25

Doxazosin is what kind of drug

Answer 25

Alpha 1- adrenergic blocker

Question 26

To prevent the adverse effect of reflex tachycardia when administering a direct vasodilator, what can be done?

Answer 26

Concurrent administration of a beta adrenergic blocker like propranolol

Question 27

Hydralazine is what class of drug And has what contraindications

Answer 27

Direct acting vasodilator. Contraindications for: Patients with angina, or rheumatic mitral valve heart disease. Patients with lupus as it worsens symptoms

Question 28

What is the BP level of a hypertensive emergency

Answer 28

Greater than 180/ greater than 120

Question 29

What are the 3 primary factors controlling blood pressure

Answer 29

Cardiac output, peripheral resistance, and blood volume

Question 30

Heart failure can be caused or accelerated by what conditions

Answer 30

Coronary artery disease Mitral stenosis Myocardial infarction Chronic htn Diabetes mellitus Dyslipidemia Thyroid disorders

Question 31

What is an inotropic effect?

Answer 31

A change in contractility of the heart

Question 32

Drugs that increase contractility are called what Examples?

Answer 32

Positive inotropic agents Epinephrine, norepinephrine, thyroid hormone, dopamine.

Question 33

Drugs that decrease contractility are called what? Examples

Answer 33

Negative inotropic agents Quinidine, beta adrenergic atangonists (propranolol)

Question 34

A patient is at high risk for developing HF but without structural heart disease or symptoms. What stage is this and how to treat

Answer 34

Stage A Lifestyle modifications Comorbidities treated. (Diabetes, htn, dislipidemia)

Question 35

A patient has structural evidence of heart disease (such as previous MI or valvular disease) but no symptoms. What stage is this and how to treat.

Answer 35

Stage B Continued lifestyle modifications and treat comorbidities. Treat with ACE or ARB. Added beta blockers for patients with prior HF symptoms or MI hx.

Question 36

Patient has structural evidence of heart disease with symptoms of fatigue, fluid retention or Dyspnea. What stage and how to treat.

Answer 36

Stage C Lifestyle mods ACE or ARBs Add a beta blocker to control symptoms or isosorbide, dinitrate with hydralazine, digoxin, aldosterone antagonists. Diuretics if fluid retention is evident.

Question 37

Patient has structural evidence of heart disease with symptoms at rest or during minimal exertion despite optimal medical therapy. What stage. How to treat.

Answer 37

Stage D, Continue lifestyle mods Tx may include ivabradine, IV diuretics, dopamine, dobutamine, I’v nitroglycerins, nitroprusside, nesiritide, or phosphodiesterase inhibitors.

Question 38

What drug Decreases cardiac workload by slowing the heart rate (B1) and decreasing blood pressure (a1) (Example: carvedilol)

Answer 38

Adrenergic blockers

Question 39

What drugs Increase cardiac output by increasing the force of myocardial contraction (Example: digoxin)

Answer 39

Cardiac glycosides

Question 40

What drugs Increase cardiac output by increasing the force of myocardial contraction (Example: milrinone)

Answer 40

Phosphodliesterase inhibitors

Question 41

What drugs Increase cardiac output by lowering blood pressure and decreasing blood volume (Example: lisinopril)

Answer 41

ACE inhibitors and angiotensin receptor blockers.

Question 42

What drugs Decrease cardiac workload by dilating vessels and reducing preload (Example: isosorbide dinitrate with hydralazine)

Answer 42

Vasodilators

Question 43

What drugs Increase cardiac output by reducing fluid volume and decreasing blood pressure (Example: furosemide)

Answer 43

Diuretics.

Question 44

All patients with HF and those at high risk for HF should receive what drug

Answer 44

ACE inhibitor

Question 45

Lisinopril (prinivil, zestril) is what class of drug Black box warning?

Answer 45

Ace inhibitor Fetal injury or death. Pregnancy contraindication

Question 46

A patient prescribed Lisinopril is discussing how they plan on using salt substitutes to help with their HF. What patient education do you need to address

Answer 46

Lisinopril can cause hyperkalemia which is a serious electrolyte imbalance and salt substitutes are generally potassium based, so they should be avoided while taking this med.

Question 47

What is the one potassium sparing diuretic that is useful in the treatment of heart failure

Answer 47

Spironolactone

Question 48

What 3 beta blockers are approved for treatment of HF

Answer 48

Bisoprolol (Zebeta) Carvedilol (coreg) Metoprolol extended release (toprol xl)

Question 49

How are beta blockers administered for HF And why do we not start give too fast or too much

Answer 49

Low initial doses 1/10-1/20 of target dose. Then doubled every 2-4 weeks until optimal dose is reached. They can worsen HF if too fast or too much

Question 50

What does Ivabradine (corlanor) do

Answer 50

It slows ion currents across the sa node which slows heart rate, reducing myocardial oxygen demand.

Question 51

What class of drug is Metoprolol What black box warning

Answer 51

Beta-1 adrenergic blocker Abrupt withdrawal may exacerbate angina or cause mi.