Hypertension

Question 1

What is the diagnosing criteria for hypertension?

Answer 1

2 elevated readings, at 2 separate visits, at least one month apart

Question 2

What are factors that can effect blood pressure?

Answer 2

Stress, smoking, caffeine, exercise

Question 3

What work up should be done prior to initiating drug therapy for hypertension?

Answer 3

UA, lipid panel, EKG, potassium/calcium/creatine levels (effect blood pressure meds), blood glucose (diabetics should be on an ACE-I), C-reactive protein, homocysteine (protein from meat, elevated levels increase risk of heart disease)

Question 4

When should follow up from initiation of drug therapy happen?

Answer 4

2-4 weeks depending on BP reading
2 weeks for 160/100
4 weeks for 140/90

Question 5

What hypertension medications are safe for children?

Answer 5

ACE-I, ARBs, CCBs

Question 6

What is the mechanism of action for the ACE inhibitors?

Answer 6

They inhibit the ACE enzyme from converting angiotensin 1 to angiotensin 2 which promotes vasodilation and decreases peripheral resistence

Question 7

What are common side effects of ACE inhibitors?

Answer 7

Dry cough, hyperkalemia, fatigue, dizziness, headache, loss of taste

Question 8

What is a benefit of ACE-I?

Answer 8

Renal protection by decreasing aldosterone levels

Question 9

What is the ending of the ACE-I’s?

Answer 9

-pril

Question 10

Who are ACE-I contraindicated for?

Answer 10

Pregnant patients and patients of child bearing age as they have been linked to teratogenic effects

Question 11

How often can ACE-I be titrated?

Answer 11

Every 2 weeks, but every 4-6 weeks if preferred

Question 12

If a patient cannot tolerate an ACE-I, what medication can they be transitioned to?

Answer 12

Angiotensin II Receptor Binders (ARBs)

Question 13

What is the ending for the ARB’s?

Answer 13

-sartan

Question 14

What is the mechanism of action of ARBs?

Answer 14

They prevent angiotensin 2 from binding to the receptor site thus promoting vasodilation

Question 15

What are the adverse effects of ARBs?

Answer 15

Dizziness, headaches, drowsiness, N/V/D, elevated potassium

Question 16

What labs should be monitored with ARBs?

Answer 16

BUN/Cr, BMP (mainly K+)

Question 17

How often can ARBs be titrated?

Answer 17

Every 2 weeks but 4-6 is preferred

Question 18

What is the first line therapy for HTN?

Answer 18

Thiazide diuretics

Question 19

What is the mechanism of action of the thiazide diuretic?

Answer 19

They prevent reabsorption of Na/Cl in the distal tubule this promoting the excretion of Na, Cl, K+, and water, thus decreasing volume in the body and reducing blood pressure

Question 20

What are the adverse effects of thiazide diuretics?

Answer 20

Hyponatremia, Hypokalemia, dehydration, hyperglycemia (most common with diabetics), hyperuricemia, hypochloremia

Question 21

Why should thiazides be cautioned with diabetic patients?

Answer 21

The excretion of Na/Cl/K+ promotes the elevation of glucose and uric acid, thus potentially increasing glucose levels to hyperglycemic states in diabetic patients

Question 22

What should we be aware of with patients with gout on thiazide diuretics?

Answer 22

Thiazides can increase uric acid levels and potentiate gout flares

Question 23

What is a medication to use in conjunction with the thiazide diuretics to prevent hypokalemia?

Answer 23

Potassium-sparing diuretics such as spironolactone

Question 24

What are the two types of potassium-sparing diuretics?

Answer 24

Aldosterone antagonists and non-aldosterone antagonists

Question 25

What is the mechanism of action of the aldosterone antagonists?

Answer 25

They block the aldosterone receptor sites promoting the retention of potassium and the excretion of Na and fluid

Question 26

What is the mechanism of action of the non-aldosterone antagonists?

Answer 26

They inhibit the sodium/potassium exchange in the distal nephron without interfering with the action/binding of aldosterone

Question 27

What are the adverse affects of the potassium-sparing diuretics?

Answer 27

Hyperkalemia, N/V, leg cramps

Question 28

What is a side effect of spironolactone specific to men?

Answer 28

Gynecomastia

Question 29

What is a side effect of spironolactone specific to women?

Answer 29

Menstrual irregularities

Question 30

What is the mechanism of action of loop diuretics?

Answer 30

They block reabsorption of Na/Cl at the Loop of Henle

Question 31

What are adverse effects of the loop diuretics?

Answer 31

Hypokalemia, hyponatremia, hypochloremia, hypotension, dehydration, ototoxicity

Question 32

Which diuretic is most effective with promoting fluid excretion?

Answer 32

Loop diuretics

Question 33

Which HTN medication is most effective to black patients due to their genetic makeup?

Answer 33

Calcium channel blockers (CCBs)

Question 34

What are the two types of CCBs?

Answer 34

Dihydropyridine and the nondihyropridine

Question 35

What is the ending of the diphydropyridine CCBs?

Answer 35

-pine

Question 36

What is the mechanism of action of CCBs?

Answer 36

They inhibit the calcium by blocking the receptors thus preventing calcium from getting into the intracellular space thus promoting vasodilation

Question 37

Which of the CCBs classes has a large effect on cardiac smooth muscle vasodilation?

Answer 37

Nondihydropridine

Question 38

What are the adverse effects of CCBs?

Answer 38

Dizziness, flushing, orthostatic hypotension, headache, edema, reflex tachycardia

Question 39

What medication can help prevent reflex tachycardia when using CCBs?

Answer 39

Beta blockers

Question 40

When are CCBs contraindicated?

Answer 40

Heart failure patients with an EF less than 35% due to the adverse effect of edema

Question 41

What is the mechanism of action of the beta blockers?

Answer 41

Beta blockers (especially selective beta-1 blockers) block the beta receptors promoting a decrease in HR and contractility thus decreasing cardiac output

Question 42

What is an adverse affect of the non-selective beta blockers?

Answer 42

They block beta 2 receptors and promote bronchoconstriction

Question 43

Which patient population should not receive non-selective beta blockers?

Answer 43

Patients with asthma as the bronchoconstriction can induce bronchospasm and asthma attacks

Question 44

What are adverse effects of beta blockers?

Answer 44

bradycardia, orthostatic hypotension, rebound cardiac excitation, AV blocks (due to the reduction of velocity impulses through the AV node from beta blockade)

Question 45

What is a non-selective beta blocker?

Answer 45

Propanolol and Carvedilol

Question 46

What do the selective beta blockers end in?

Answer 46

-olol

Question 47

What is the mechanism of action of hydralazine?

Answer 47

Selective dilation of the arterioles thus decreasing arterial pressure and peripheral resistance thus promoting an increase in cardiac output and heart rate

Question 48

What are the adverse effects of hydralazine?

Answer 48

Reflex tachycardia, increased blood volume (edema), lupus-like reaction

Question 49

When is minoxidil used in practice?

Answer 49

When there is a need for intense vasodilation

Question 50

Who is minoxidil indicated for?

Answer 50

Patients with severe hypertension unresponsive to other treatments

Question 51

What is the mechanism of action of minoxidil?

Answer 51

Selective vasodilation of the arterioles thus decreasing arterial pressure and increasing cardiac output

Question 52

What are the adverse effects of minoxidil?

Answer 52

Reflex tachycardia, fluid and sodium retention, hypertrichosis, pericardial effusion (due to increased fluid retention)

Question 53

When should patients be referred to a HTN specialist?

Answer 53

When they need 3 or more BP medications to manage their blood pressure

Question 54

What is the most effective way to manage blood pressure according to the JNC 8?

Answer 54

The use of multi-drug therapy to help promote reduction of blood pressure through various mechanisms of action which can promote using smaller doses of medications