HTN lecture important stuff

Question 1

True or false: Amphetamines can cause secondary HTN

(important)

Answer 1

True

Question 2

What determines BP classification?

(very important)

Answer 2

2 or more properly measured seated BP values from 2 or more clinical encounters.
-Out of office measurements should be used to confirm Dx
-If systolic and diastolic measurements are in different classes, use the highest category

Question 3

RAAS: Where do the following act?
1) Renin
2) ACEis
3) ARBs
4) Beta blockers

(important)

Answer 3

1) Converts angiotensinogen
2) Angiotensin I
3) Angiotensin II
4) Heart (after angiotensin II), effects contractility and CO

Question 4

This is a test question
Stage 2 HTN:
1) What is the BP of this stage?
2) What is the Tx?
3) What is the next step? (2 options)
4) When should you reassess after the initiation of medication?

Answer 4

1) >/= 140/90 mmHg
2) Lifestyle management and meds
3) ACEi or ARB with CCB
or
ACEi or ARB with thiazide
4) 1 month

Question 5

Test question pt 1
List the most appropriate first-line medications for the following:
1) HF with reduced HF/EF
2) HF with preserved HF/EF

Answer 5

1) ACEi or ARB, then add beta blocker; diuretic if edema
2) Same as above

Question 6

Test question pt 2/2
List the most appropriate first-line medications for the following:
1) Stable ischemic heart disease
2) DM
3) CKD
4) Secondary stroke prevention

Answer 6

1) Beta blocker, then add ACEi or ARB
2) ACEi, ARB, CCB, or thiazide
3) ACEi or ARB
4) Thiazide or thiazide with ACEi

Question 7

Chronic HTN in pregnancy:
1) What 3 things are recommended as a first-line agents due to favorable safety profiles?
2) What 3 things are known teratogens and are absolutely contraindicated?

Answer 7

1) Labetalol, long-acting nifedipine, or methyldopa
2) ACEi, an ARB, and a direct renin inhibitors

Question 8

Chronic HTN in pregnancy:
1) Instant-release nifedipine and atenolol are not acceptable agents due to what 2 things?
2) May see instant release ____________ use for acute hypertensive emergencies

Answer 8

1) Teratogenicity (ie, animal studies) and intrauterine growth retardation
2) nifedipine

Question 9

What is a big SE of ACEis? Why?

Answer 9

1) Cough: May develop in up to 20% of patients
a) ACEi blocks degradation of bradykinin
b) Increased bradykinin enhances the BP-lowering effects of an ACEi,

Question 10

When should you take diuretics?

Answer 10

In the morning

Question 11

What is special abt methyldopa?

Answer 11

Used for pregnancy-induced HTN

Question 12

What is a last-line Tx for HTN?

Answer 12

Direct arterial vasodilators (Hydralazine + minoxodil)

Question 13

RAAS: Where do the following act?
1) Ca+ channel blockers (2 places)
2) Thiazides (2 places)
3) Mineralocorticoids

Answer 13

1) Heart (effects contractility and CO) and vasoconstriction (increasing total peripheral resistance)
-Both are after angiotensin II
2) Directly increase total peripheral resistance + directly encourages sodium/ water reabsorption (^blood vol.)
3) Directly increases aldosterone synthesis (encouraging sodium/ water reabsorption)