HTN

Question 1

What are the first-line agents for treating HTN?

Answer 1

ACE, ARB, thiazide, or CCB

Question 2

Which HTN medications put patients at a higher risk for orthostasis?

Answer 2

thiazides, loops, central alpha agonists, alpha antagonists, beta blockers, and short acting CCBs

Question 3

Which HTN medications have a low risk for orthostasis?

Answer 3

ACE, ARB, and CCBs

Question 4

What are the three major side effects of thiazide diuretics?

Answer 4

hyperglycemia, hyperuricemia, and dyslipidemia

Question 5

Which thiazide is used in advanced kidney disease and why?

Answer 5

metolazone because it doesn’t have a renal cutoff like the other thiazides

Question 6

What are the two ways that thiazides decrease blood pressure?

Answer 6

they decrease blood volume and decrease peripheral vascular resistance

Question 7

At what CrCl do thiazides lose efficacy?

Answer 7

CrCL < 30

Question 8

Why are elderly patients at a higher risk for orthostasis with thiazides?

Answer 8

Dehydration

Question 9

What is the other major risk when using thiazides in the elderly population, besides orthostasis?

Answer 9

electrolyte abnormalities and arrhythmias

Question 10

What are the major side effects with ACE inhibitors?

Answer 10

Hyperkalemia, acute kidney injury, and angioedema (usually in AA patients)

Question 11

What are the major side effects of ARBs?

Answer 11

hyperkalemia, AKI, and cancer related recalls

Question 12

What are the major side effects of DHP-CCBs?

Answer 12

peripheral edema and headache

Question 13

What short acting CCB is on the BEERs list for orthostasis and myocardial ischemia?

Answer 13

nifedipine IR

Question 14

What are the major side effects of Non-DHP CCBs?

Answer 14

constipation, bradycardia, and heart block

Question 15

What are the major side effects of beta-blockers?

Answer 15

bradycardia, heart block, and fatigue/depression

Question 16

What are the negatives to using beta-blockers in the elderly?

Answer 16

decreased beta receptor sensitivity, weak data, and interactions with respiratory conditions and inhalers

Question 17

What are the major side effects of the central alpha agonists?

Answer 17

drowsiness, headache, fatigue, and dry mouth

Question 18

What are the central alpha agonists effective for?

Answer 18

resistant hypertension

Question 19

What is another benefit to the central alpha agonists?

Answer 19

there is a clonidine patch

Question 20

What are the downsides to alpha-agonists?

Answer 20

frequent dosing, skin reactions, orthostasis, rebound HTN if missed dose, and BEERS list

Question 21

What are the alpha 1 blockers?

Answer 21

doxazosin, terazosin, and prazosin

Question 22

Which alpha 1 blocker can be used in PTSD nightmares?

Answer 22

prazosin

Question 23

What are the most common side effects of alpha 1 blockers?

Answer 23

dizziness, fatigue, and headache

Question 24

What are the alpha 1a blockers?

Answer 24

tamsulosin, alfuzosin, and sildosin

Question 25

What is the biggest side effect of the alpha 1a blockers?

Answer 25

retrograde ejaculation

Question 26

What class of medications is known to interact with the alpha 1a blockers?

Answer 26

PDE-5 inhibitors

Question 27

What are the components of ASCVD?

Answer 27

coronary heart disease, cerebrovascular disease, peripheral artery disease, and aortic atherosclerosis

Question 28

Who all should be screened for ASCVD?

Answer 28

all patients 20-79 (after age 79 use risk/benefit assessment)

Question 29

What are the traditional risk factors for CVD?

Answer 29

HTN, smoking, DM, family hx, CKD, and obesity

Question 30

What 3 components make up primary prevention of ASCVD?

Answer 30

1. lifestyle changes 2. statin 3. aspirin

Question 31

What is the management plan for those up to age 79 for primary prevention?

Answer 31

If 10 year ASCVD risk is less than 5%, test their 30 year ASCVD risk. If it is greater than 39%, initiate primary prevention. If 10 year ASCVD risk is between 5 and 7.5%, test their 30 year ASCVD risk. If it is greater than 39%, initiate primary prevention. If 10 year ASCVD risk is greater than 7.5%, initiate primary prevention

Question 32

What is the management plan for primary prevention in people over the age of 79?

Answer 32

If they are already on prevention, don't stop it. If they aren't on ay prevention, and they don't have any risk factors or history, don't have to start it.

Question 33

What is the ASCEND trial?

Answer 33

aspirin 100 mg in low-moderate risk patients with diabetes showed a decrease in vascular events, but the benefit was balanced by bleeding events

Question 34

What is the ARRIVE trial?

Answer 34

no mortality benefit in patients with moderate ASCVD risk with aspirin 100 mg daily

Question 35

What is the ASPREE trial?

Answer 35

nearly 20,000 subjects age 70 or older without CVD, dementia or disability. Aspirin 100 mg was given daily and all cause mortality went up! BEERs list age dropped from 80 to 70!