Hypertension

Question 1

Define secondary HTN

Answer 1

caused by renal disease (CKD) adrenal disease (exces aldosterone secretion), OSA, or drugs. There is increased activity of the sympathetic nervous system (SNS) and the RAAS, leading to increased levels of neurohormones (NE, ANG 2, aldosterone) that can increase BP

Question 2

BP equation

Answer 2

SVR x CO

Question 3

CO equation

Answer 3

Stroke volume x HR

Question 4

normal BP

Answer 4

> 120/<80

Question 5

elevated BP

Answer 5

120-129/<80

Question 6

Stage 1 HTN

Answer 6

SBP 130-139 or DBP 80-89

Question 7

Stage 2 HTN

Answer 7

SBP > 140 or DBP > 90

Question 8

Drugs that can inc. BP (7)

Answer 8

ADHD drugs
cocaine
Decongestants
ESA
Immunosuppressants
NSAIDs
Systemic steroids

Question 9

BP goals

Answer 9

<130/80 for all patients

Question 10

initial drug selection for non-black (4)

Answer 10

thiazide
ccv
acei
arb

Question 11

initial drug selection for black (2)

Answer 11

thiazide

ccb

Question 12

initial drug selection for CKD

Answer 12

acei

arb

Question 13

initial drug selection for DM with albuminuria

Answer 13

acei

arb

Question 14

BP meds CI in pregnancy

Answer 14

ACEi
ARB
DRI: aliskiren

Question 15

Drugs of choice for HTN in pregnancy (3)

Answer 15

labetalol
nifedipine
ER methyldopa

Question 16

When to treat HTN in pregnancy

Answer 16

if SBP > 160 or DBP > 105

Question 17

Thiazide diuretic MOA

Answer 17

inhibit Na reabsorption in the DCT causing increased excretion of Na, Cl, H20, and K

Question 18

Major allergy CI with thiazides

Answer 18

sulfonamide hypersensitivty

Question 19

At what CrCl are thiazides not effective

Answer 19

CrCl < 30

Question 20

List DHP CCB

Answer 20

amlodipine
nifedipine
nicardipine

Question 21

List Non-DHP CCB

Answer 21

diltiazem

verapamil

Question 22

DHP CCB MOA

Answer 22

inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation (which dec. SVR and BP) and coronary artery vasodilation.

Question 23

Common SE in DHP CCB (4)

Answer 23

reflex tachycardia
HA
flushing
peripheral edema

Question 24

DHP CCB to use in pregnancy

Answer 24

nifedipine ER

Question 25

Clevidipine is a lipid emulsion and provides how many kcal/mL

Answer 25

2 kcal/mL

Question 26

which CCB is preferred for HTN

Answer 26

DHP

Question 27

Non-DHP CCB indication

Answer 27

control HR in certain arrhythmias sometimes HTN sometimes angina

Question 28

Non-DHP CCB MOA

Answer 28

inhibit Ca ions from entering vascular smooth muscle and are myocardial cells, but they are more selective for the myocardium

Question 29

ACEi MOA

Answer 29

block the conversion of antiotensin 1 to 2 resulting in decreased vasoconstriction and dec. aldosterone secretion and block the degration of brady kinin

Question 30

ARB MOA

Answer 30

block Ang 2 from binding to the angiotensin 2 type-1 receptor on vascular smooth muscle preventing vasoconstriction

Question 31

Caution with entresto and ACEi

Answer 31

36 washout period required

Question 32

List K-sparing diuretics (4)

Answer 32

traimterene-Na channel inhibitor amiloride-Na channel inhibitor spironolactone-aldosterone antagonist eplerenone-aldosterone antagonist

Question 33

preferred add on treatment for patients with resistant HTN

Answer 33

spironolactone | epleronone

Question 34

resistant HTN

Answer 34

uncontrolled BP despite max tolerated dose of CCB + thiazide +ACEi/ARB

Question 35

difference b/w spironolactone and epleronone

Answer 35

``` spironolactone -non-selective -also blocks androgen epleronone -selective -no endocrine SE ```

Question 36

K-sparing diuretic MOA

Answer 36

compete with aldosterone at receptor sites in the DCT and CD, increasing Na and H2O excretion and conserving K

Question 37

Major SE of spironolactone

Answer 37

gynecomastia breast tenderness impotence

Question 38

BB MOA

Answer 38

competitively blocking beta-1 and/or beta-2 adrenergic receptors resulting indecreases in HR nad myocardial contracility

Question 39

major BB that are beta-1 selective (3)

Answer 39

atenolol esmolol metoprolol

Question 40

caution with BB in DM

Answer 40

can worsen hyperglycemia or hypoglycemia and mask hypoglycemic symtpoms

Question 41

alpha-2 agonist MOA

Answer 41

decrease BP by stimulating alpha-2 receptors in the brain and reducing sympathetic outflow of norepinephrine, which decreases SVR and HR

Question 42

List Alpha-2 agonist

Answer 42

clonidine guanfacine methyldopa

Question 43

caution with d/c a-2 agonists aburptly

Answer 43

rebound hypertension

Question 44

List vaodilators (2)

Answer 44

hydralzine | minoxidil

Question 45

define HTN crisis

Answer 45

BP > 180/120 2 types -HTN emergency: acute target organ damage (encephalopathy, stroke, AKI, ACS) -HTN urgency: no acute organ damage