Hypertension

Question 1

Alpha-2 receptors inhibit….

Answer 1

Norepinephrine release

Question 2

Stimulation of alpha-1 receptors located on arterioles and venules causes….

Answer 2

Vasoconstriction

Question 3

Activation of beta-2 receptors causes….

Answer 3

Vasodilation

Question 4

Beta-1 receptors are located on

Answer 4

The heart and kidneys

Question 5

Beta-1 receptors regulate…

Answer 5

HR and contractility impacting cardiac output

Question 6

Blocking beta-1 receptors….

Answer 6

Decreases CO, peripheral resistance and BP

Question 7

BP rises as a result of

Answer 7

Sodium and water elimination by kidney,
In turn plasma volume, CO and BP decrease

Dysfunction of this raises BP and plasma volume

Question 8

Renin is released in response to….

Answer 8

Changes in BP, caused by reduced renal perfusion, decreased intravascular volume or increased circulation of catecholamines

Question 9

Angiotensin I is converted into

Answer 9

The vasoconstrictor angiotensin II by angiotensin-converting enzyme (ACE)

Question 10

Angiotensin II causes

Answer 10

Vasoconstriction and stimulation of the sympathetic nervous system and the release of aldosterone from the adrenal gland resulting in water and salt retention

Question 11

Thiazides

Mechanism of action

Answer 11

Increasing urinary excretion of sodium and chloride in equal amounts and inhibit reabsorption

Question 12

Thiazides

Contraindications

Answer 12

Not recommended in pts with creatinine clearance of <30mL/min
Renal decompensation
Hypersensitive to thiazides or Sulfonamides

Question 13

Thiazides

Adverse events

Answer 13

Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hyperglycemia 
GI upset
Tinnitus
Paresthesia

Question 14

K+ sparing diuretics have the potential for causing ….

Answer 14

Hyperkalemia and hyponatremia, especially in pts with renal insufficiency or diabetes. Pts with concurrent tx with an acei, nsaids, or k+ supplements

Question 15

Beta-1 receptors (heart and kidneys) regulate….

Answer 15

Heart rate
Renin release
Cardiac contractility

Question 16

Beta-2 receptors (lungs, liver, pancreas, and arteriolar smooth muscle) regulate ….

Answer 16

Bronchodilation and vasodilation

Question 17

Beta-blockers reduce BP by….

Answer 17

Blocking central and peripheral beta receptors, resulting in decreased CO and sympathetic outflow

Question 18

Beta-1 receptors are referred to as..,,,

Answer 18

Cardioselective because they do not significantly block beta-2 receptors

Better for asthmatics, CPOD, and peripheral vascular disease

Question 19

BB that possess sympathomimetic activity (ISA)

Answer 19

Partial beta-receptor agonist that reduce HR and contractility during excessive sympathetic outflow

Question 20

In diabetics, BB ….

Answer 20

Can mask all symptoms of hypoglycemia with the exception of sweating

Question 21

ACE

Mechanism of action

Answer 21

Inhibiting ACE enzyme, converting angiotensin I to angiotensin II a potent vasoconstrictor
CHF, post MI, systolic dysfunction

Question 22

ACE

Contraindications

Answer 22

Avoid with renal issues
Don’t use with ARBs
Past angioedema during pregnancy

Question 23

ACE

Adverse Events

Answer 23

Chronic dry cough
Rashes
Dizziness 
Angioedema is rare most frequently in blacks, reversible with discontinuation 
Laryngeal edema 
Hyperkalemia

Question 24

ARBs mechanism of action

Answer 24

Block vasoconstriction and aldosterone-secreting effects

Indicated for HTN, nephropathy in type II diabetes, HF and those that can’t tolerate ACE

Question 25

ARBs more effective

Answer 25

Losartan more effective than atenolol in reducing cardiovascular morbidity and mortality in DM with HTN and LVH

Question 26

ARBs and cough and hyperkalemia....

Answer 26

Lower than with ACEs

Question 27

Angioedema with ARBS vs ACEs

Answer 27

ARBs less common

Question 28

CCB | Mechanism of action

Answer 28

Inhibit the movement of Ca+ ions across the cell membranes Relaxing and vasodilation, decreases HR and slows cardiac conduction at the AV node Effective with black pts Tx HTN associated with ischemic heart disease Recommended for Prinzmetal angina

Question 29

CCB | Contraindications

Answer 29

Not first line for HF Dilt and verapamil should be avoided in HB and with EF <45% Causes reflex tachycardia

Question 30

CCB | Adverse Events

Answer 30

``` Produce symptoms of vasodilation, such as headaches, flushing, palpitations, and peripheral edema Dizziness Gingival hyperplasia Mood changes GI upset Peripheral edema Bradycardia AV block CHF Verapimil causes constipation in elderly ```

Question 31

Peripheral Alpha-1 receptor blockers

Answer 31

Cadura or minipress Effective in pts with benign prostatic hypertrophy Dilate both arterioles and veins, causing relaxation of smooth muscle

Question 32

Diuretics work by.....

Answer 32

Increasing urine output therefore decreasing fluid volume

Question 33

Beta blockers work by.....

Answer 33

Blocking the SNS and inhibit HR

Question 34

CCB work by....

Answer 34

Causing vasodilation, affect preload and afterload

Question 35

ACE inhibitors work by....

Answer 35

Stopping conversion of angiotensin I to angiotensin II in RAAS

Question 36

ARBs work by.....

Answer 36

Blocking the action of angiotensin II in RAAS

Question 37

Adrenergic inhibitors....

Answer 37

Cause vasodilation, centrally acting

Question 38

Vasodilators work by....

Answer 38

Causing vasodilation

Question 39

JNC 8 algorithm | All ages CKD present with or without DM

Answer 39

Initiate ACEI or ARB alone or in combo with another drug class

Question 40

JNC 8 algorithms All ages DM present no CKD Black

Answer 40

Initiate thiazide type diuretic or CCB, alone or in combination

Question 41

JNC 8 algorithms All ages DM present no CKD Nonblack

Answer 41

Initiate thiazide type diuretic or ACEI or ARB or CCB, alone or in combination