Hypertension

Question 1

maximum blood pressure during contraction of ventricles is called _______

Answer 1

systolic pressure

Question 2

minimum pressure recorded just prior to next contraction is called _________

Answer 2

diastolic pressure

Question 3

define stage 1 HTN

Answer 3

systolic BP from 140-159

diastolic BP in 90s

Question 4

define stage 2 HTN

Answer 4

systolic BP from 160-179

diastolic BP in 100-109 range

Question 5

define stage 3 HTN

Answer 5

systolic BP >180
diastolic BP >110
aka malignant HTN

Question 6

what outcomes can you expect to improve by treating elevated BP

Answer 6

atherosclerosis –> MI & stroke
HF
renal damage

Question 7

non-pharmacologic tx to HTN

Answer 7

sodium restriction
weight loss
smoking cessation
stress management

Question 8

four categories of antihypertensive drugs

Answer 8

Diuretics
Beta blockers
CCB
ACE/ARB

Question 9

2014 BP guidelines, which 3 or 4 are recommended in general non-black population?

Answer 9

Diuretic, ACE/ARB, CCB

Question 10

at which site do loop diuretics act?

Answer 10

thick ascending loop of henle

Question 11

at which site to thiazides act?

Answer 11

distal convoluted tubule

Question 12

name the 4 common thiazide diruetics

Answer 12

Chlorothiazide (prototype)
Hydrochlorothiazide
Chlorthalidone
Metolazone

Question 13

what is the MOA of thiazide diuretics

Answer 13

inhibit Na and Cl transportere in distal convoluted tubule
increase NA and Cl excretion
increase K/Mg excretion
decrease Ca excretion
natriuretic effect on Na reduces circulating blood vol. and relaxes vascular SM in wall of arteries

Question 14

Side effects of thiazide diuretics

Answer 14

*****hypokalemia (order CMP after 6 mo use)

hyponatremia

Question 15

name the 4 loop diuretics

Answer 15

Furosemide (prototype)
Bumetanide
Torsemide
Ethacrynic acid

Question 16

MOA loop diuretics

Answer 16

inhibits apical Na-K-Cl transporter in thick ascending loop of henle (these drugs really make you pee)
competes with Cl binding sites
enhances passive Mg and Ca excretion
inhibits reabsorption of 25% of glomerular filtrate

Question 17

which diuretic is preferred in patients with moderate-severe chronic kidney dz

Answer 17

loop

Question 18

side effect of loop diuretics

Answer 18

increase lithium toxicity
hypokalemia**
hyponatremia

Question 19

what are the best tolerated antihypertensives?

Answer 19

RAS: ACE/ARB*****

Question 20

T/F: dual RAS blockade either with an ACE-Iplus an ARB or with aliskiren plush ACE-I or ARB is contraindicated

Answer 20

true

Question 21

how do ACE-I, ARBs and aliskiren work?

Answer 21

blocking conversion of angiotensin I into angiotensin II and thus reducing effects of angiotensin II on blood vessels
they are basically vasodilators

Question 22

name the 4 ACE-I’s

Answer 22

Lisinopril
Enalapril
Catopril
Ramipril

Question 23

name the 4 ARBs

Answer 23

Losartan
Irbesartan
Valsartan
Candesartan

Question 24

what are the side effects of RAS

Answer 24

contraindicated in pregnancy --> birth defects
mc is dry cough
angioedema (mc in ACE-I)
hyperkalemia
small reductions in kidney function

Question 25

Three classes of CCB

Answer 25

Phenylalkylamines (Verapamil) Benzothiazepines (Diltiazem) 1, 4-Dihydropyridines (nifedipine)

Question 26

which CCBs work thru decreasing CO

Answer 26

Phenylalkylamines and Benzothiazepines

Question 27

which CCB is a vasodilator

Answer 27

1,4-Dihydropyridines

Question 28

what is the principal side effect of dihydropyridines

Answer 28

ankle edema | can also cause gingival hyperplasia

Question 29

side effect of verapamil and diltiazem

Answer 29

impairment of cardiac conduction (esp. in older pts)

Question 30

Beta-1

Answer 30

tachycardia increased lipolysis increased myocardial contractility = increased cardiac output

Question 31

Beta-2

Answer 31

vasodilation slightly decreased peripheral resistance bronchodilation

Question 32

MOA beta blockers

Answer 32

all are competitive antagonists | antagonize effects of catecholamines on heart

Question 33

cardioselective BBs

Answer 33

``` metoprolol esmolol acebutolol atenolol (markedly hydrophilic --> can penetrate tissue less well, making it preferred in practice) betaxolol ```

Question 34

non-cardioselective BBs

Answer 34

carvedilol

Question 35

what BB is contraindicated in pts with lung dz

Answer 35

carvedilol

Question 36

adverse side effects Beta blockers

Answer 36

CNS effects (sedation, depression, hallucinations) precipitation or worsening of HF hypoglycemia unawareness in diabetes worsening of impotence