HTN Path and Mgmt

Question 1

What is HTN (give me a number)?

Answer 1

at least 140/90

Question 2

Should a hypertensive person lift weights?

Answer 2

No, it raises BP

Question 3

Where is renin released? What does it do?

Answer 3

Kidneys: Juxtaglomerular apparatus
Stimulated formation of angiotensin
Stimulates release of aldosterone from adrenal cortex

Question 4

PreHTN

Answer 4

120-139/80-89

Question 5

Stage 1 HTN

Answer 5

140-159/90-99

Question 6

Stage 2 HTN

Answer 6

> 160 / >100

Question 7

Most common adverse affect of diuretics?

Answer 7

Hypokalemia

Question 8

Hydrochlorothiazide (HCTZ)

Answer 8

Inhibits NaCl absorption in the DCT of the nephron.
May precipitate hyponatremia
Generally first-line
Ineffective if creatanine in >2.5
Patients allergic to sulfa may be allergic

Question 9

Loop diuretics

Answer 9

Selectively inhibit NaCl absorption in the ascending thick loop of henle.
Used when renal fxn declines
Stronger incidence of hypokalemia
Reserve for patients with chronic renal dz

Question 10

Loop diuretic types

Answer 10

Furosemide (Lasix)
Torsemide (Demedex)
Bumetanide (Bumex)
Metolazone (Zaroxolyn)

Question 11

K+ Sparing Diuretics

Answer 11

Antagonize the effects of aldosterone at the late distal and cortical collecting tubule in the nephron.
Weak when used alone

Question 12

K+ sparing diuretic types

Answer 12

Aldactone (Spironolactone)
Midamor (Amiloride)
Dyrenium (Triamterene)
All can be combined with HCTZ

Question 13

Beta Blockers

Answer 13

Effect is on the ANS
Reduced HR and CO
Antagonize catecholamine at Beta receptors
Decrease renin release
Cardioprotective

Question 14

What does cardioprotective mean?

Answer 14

Negative inotropic effect (Decreased squeeze, man)

Negative chronotropic effect (lower rate)

Question 15

Beta blocker SE

Answer 15

Bradycardia
Heart failure
Bronchospasm
Impotence
Depression
Sedation/fatigue
Cold extremities
Hypotension

Question 16

Do not use Beta blockers with…

Answer 16

NSAIDS
Epi
CCB

Question 17

ACE Inhibitors

Answer 17

Block the conversion of angiotensin I to angiotensin II.
Leads to dilation, decreased cardiac workload
Renal Protective
Cardioprotective

Question 18

Types of ACE Inhibitors

Answer 18

Captopril
Lisinopril (Zestril)
Enalapril
Others

Question 19

When are ACE inhibitors first-line?

Answer 19

Diabetics
CHF
Chronic kidney failure
MI

Question 20

ACE inhibitor SE

Answer 20

Cough
Acute renal failure (bilateral renal artery stenosis)
Angioedema
Hypotension
Rash
Hyperkalemia
***Contraindicated in pregnancy***

Question 21

Angiotensin II Receptor Blockade (ARB’s)

Answer 21

Alternative to AVE inhibitors
Block angiotensin II receotirs
Same profile as ACE
DOes no cause cough

Question 22

ARB types

Answer 22

Irbesartan (Avapro)
Candesartan (Atacand)
Losartan (Cozaar)

Question 23

Calcium Channel Blockers (CCB’s)

Answer 23

Dilate peripheral arterioles by blocking calcium influx into smooth muscle cells.
Decrease contractile force
Reduce cardiac work load
Good in combo w/ diuretics for black pts

Question 24

Dihydropyridine CCB’s

Answer 24

Highly vascular selective
end in dipine
Amlodipine (norvasc)
Felodipine (Plendil)
Nifedipine (Procardia)

Question 25

Dihydropyridine SE

Answer 25

``` Reflex tachycardia flushing HA Hypotension Edema ```

Question 26

Non-dihydropyridine CCB's

Answer 26

Verapamil | DIltiazem

Question 27

Non-dihydropyridine SE

Answer 27

Excessive bradycardia Impaired electrical conduction depressed contractility concern with beta blockers

Question 28

Alpha 1 Blockers

Answer 28

Block alpha receptors in small arterioles and venules Lower peripheral vascular resistance May cause orthostatic hypotension Used for men with prostate issues

Question 29

Alpha 1 blocker types

Answer 29

Prazosin (minipress) Terazosin (Hytrin) Doxazosin (cardura)

Question 30

Alpha 2 Receptor Agonists

Answer 30

Stimulate alpha 2 receptors in brain Decreased sympathetic outflow from vasomotor center Causes decreased vasoconstriction May cause fluid retention

Question 31

Alpha 2 Receptor Agonist Types

Answer 31

Clonidine (Catapres) 2nd or 3rd line | Methyldopa (Aldomet) Frequently used in pregnancy

Question 32

Vasodilators

Answer 32

Causes direct arteriolar smooth muscle relaxation by increasing cGMP Have to take along side another antihypertensive agent long-term

Question 33

Vasodilator types

Answer 33

Hydralazine Minoxadil Reserpine

Question 34

Moderate HTN emergency Tx

Answer 34

Captopril oral | Amlodipine

Question 35

Severe HTN Mgmt

Answer 35

Admission Nitroprusside IV drip Nitroglycerine IV drip

Question 36

Nitroprusside

Answer 36

``` IV only Short 1/2 life Immediate onset of action ICU only Start slow, go slow ```

Question 37

Which type of therapy should be used for a BP above 160/100?

Answer 37

2 drug therapy

Question 38

Average BP at birth?

Answer 38

78 systolic

Question 39

Which group is HTN more common in?

Answer 39

African Americans Around 35% of the pop has it Also women over the age of 60

Question 40

BP Circadian Rhythm

Answer 40

Lowest in the morning and midday Highest at end of the day Also higher in cold weather

Question 41

HTN Eye damage

Answer 41

``` Hard exudates Flame hemorrhage Cotton wool spots AV nipping Copper wiring ```

Question 42

Oral contraceptives cause?

Answer 42

HTN

Question 43

Most common cause of secondary HTN

Answer 43

Renovascular HTN

Question 44

Which meds are contraindicated for renovascular dz?

Answer 44

ACE and ARB's. | Make the renal failure worse.

Question 45

Alpha 1 blockers end in?

Answer 45

Zosin

Question 46

Which med is used in pregnancy?

Answer 46

Methyldopa: Alpha 2 Blocker

Question 47

Spironolactone causes what?

Answer 47

Gynecomastia in males | K+ sparing diuretic

Question 48

Why shouldn't ACE inhibitors be used in women of child bearing age?

Answer 48

Pregnancy category X

Question 49

Which meds cause angioedema?

Answer 49

ACE and ARB

Question 50

ARB's end in?

Answer 50

Sartan

Question 51

Dihydropyridines are highly _______ selective.

Answer 51

Vascular

Question 52

Dihydropyridine CCB's all end in

Answer 52

ipine

Question 53

CCB's are contraindicated in?

Answer 53

CHF

Question 54

Which med should be used in pregnancy?

Answer 54

Methyldopa: Alpha 2 antagonist

Question 55

What do you need to watch for with nitroprusside?

Answer 55

Cyanide Toxicity