hypertension part 1 meds

Question 1

risk for HTN

Answer 1

race ( black pt htn is more severe)
cigarette smoking
obesity
diabetes mellitus
physical inactivity

Question 2

essential primary hypertension

Answer 2

over 90%
hereditary

Question 3

secondary hypertension common causes

Answer 3

<10%

chronic kidney disease

med induced

Question 4

first line tx options

Answer 4

thiazides, ccbs, ACE and ARB

Question 5

in patients that are black what medication can u use?

Answer 5

thiazides , or calcium channel blockers
(amlodipine, felodipine, nifedipine)

Question 6

nonpharmacological tx option

Answer 6

smoke cessation
dash diet
weight loss, in overweight/obesity pt
limit alcohol intake
increase physical activity

Question 7

for diabetes or chronic kidney disease what med will you use:?

Answer 7

ace or arb

not together

Question 8

why not do ace and arb together

Answer 8

can cause hyperkalemia

Question 9

thiazide diuretics include what meds ?

Answer 9

chlorthalidone, metolzaone, HCTZ

Question 10

electrolyte abnormalities with thiazides

Answer 10

increase in uric acid, increased hyperglycemia, calcium

decrease in sodium, and potassium

Question 11

pt that is a 44 year old, no other medical condition, bp 155/90 what meds could u use?

Answer 11

ccb, thiazide, ace/arb

Question 12

if pt has hyponatremia, or hypokalemia what med will you not want to use
- ace/arb
-ccb
- thiazide

Answer 12

thiazide (HCTZ, chlorthalidone, metolzoane

Question 13

thiazide diuretics should be avoided in what patients

Answer 13

avoid in gout
pts taking lithium
sulfa allergy pts

Question 14

a 65 year old pt with 4 year history of hypertension, past reading, of 170/90, pt has type 2 dm, ckd, and angina. on hydrocholorothiazide, what is your next step?

Answer 14

DO NOT discontinue, add losartan 50 mg, maintain hydrochlorothalidone

Question 15

what lifestyle modifocation has greatest effect on blood pressure

Answer 15

weight loss

Question 16

furosemide is what diuretic? and why is it used in some times vs thiazides?

Answer 16

loop diuretic

used in times where a stronger med is required. in cases of CHF (where you need to remove excess volume faster)

Question 17

loop diuretics used for

Answer 17

pulmonary. edema,
chf (preferred)
htn

Question 18

adverse effects of loop diuretic

bumex, bumetanide
furosemide (lasix)

Answer 18

decrease in potassium, sodium, and calcium, magnesium
increase uric acid

dehydration
ototoxicity
increase in serum creatinine

Question 19

if creatine clearence is low want to use thiazides, or loop diuretics

Answer 19

**loop diuretics

no thiazides

loop diuretic work in loop of henle, inhibiting transport of sodium, and

Question 20

which meds can cause hyperkalemia

Answer 20

ace and arb

pril, and sartan

Question 21

dry cough due to what med?

Answer 21

ace (quinapril)

use arb
(. start irbesartan

Question 22

beta 1 selective beta blocker

Answer 22

bisoprolol, metoprolol, atenolol, esmolol, betaxolol
AMEBBA

Question 23

alpha 1 and beta 1 beta blocker

Answer 23

carvedilol

Question 24

acute renal failure, present with uti, blood panel reveals 1.4 creatine cl, home med is lisinopril, how would you manage bp?

Answer 24

cant keep ace,
cant do arb
no thiazide

use ccb, amlodipine
hydralizine

Question 25

aldosterone receptor blockers includes

Answer 25

spironolactone eplernone compete with **aldosterone** and prevent sodium reabsorption

Question 26

aldosterone receptor blockers work how

Answer 26

compete with aldosterone and prevent sodium reabsorption and potassium excretion

Question 27

potassium sparing drugs include diuretic

Answer 27

triamterene amiloride | good in a pt with hypokalema triampteren must be used tho in combinatio

Question 28

potassium sparing diuretics, aldosterone receptor blocker including spironolactone used for _________

Answer 28

reduced ejection fraction heart failure

Question 29

spironolactone adverse effects include

Answer 29

gynecomastia menstrual irregularities | **eplerone**, other aldosterone blocker, less se, bcuz more selective

Question 30

potassium sparing diuretics general adverse effect

Answer 30

hyperkalemia | triampterene or spirnolactone for pt at risk with hypokalemia/ avoid

Question 31

ace inhibitors include

Answer 31

lisinopril captopril moexipril quinapril enalipril

Question 32

ace inhibitor work how

Answer 32

inhibit ace to block production of angiotensin II

Question 33

ace inhibitor is a ____ line med for ckd

Answer 33

first

Question 34

adverse effect with ace inhibitor

Answer 34

cough angioedema hyperkalemia

Question 35

ACE inhibitors are contraindicated in

Answer 35

pregnancy angioedema with other ace inhibitor renal artery stenosis

Question 36

drug interactions with ace inhibitor include

Answer 36

potassium supplement, potassium sparing diuretics, nsaid

Question 37

captopril is dosed ____ to ___ times per day

Answer 37

twice to three

Question 38

captopril absorption is decreased with _____

Answer 38

captopril

Question 39

arbs inhibit ______ at its receptor site

Answer 39

angiotensin II

Question 40

arbs do not inhibit the breakdown of _____

Answer 40

bradykinin

Question 41

what are arbs

Answer 41

losartan olmesartan valsartan

Question 42

arbs are ____ for ckd (with ace)

Answer 42

first line

Question 43

ARBs monitoring include _____, _____

Answer 43

angioedema, potassium

Question 44

first oral agent that directly inhibit renin

Answer 44

aliskiren

Question 45

two. categories of calcium channel blocker

Answer 45

1. non dhp ccb - diltiazem - verampiril 2. dhp ccb - amlodipine - nifedipine

Question 46

ccb mechanism of action

Answer 46

inhibit calcium influx, to prevent muscle contraction

Question 47

verampiril and diltiazem inhibit calcium influx, into _______ smooth muscle

Answer 47

cardiac decrease rate and force of contraction

Question 48

calcium channel blocker: dihydropyridines, amlodipine, felodipine, nifedipine, all inhibit calcium influx into ______ smooth muscle

Answer 48

vascular peripheral vasodilation

Question 49

in clinical practice, ccb ___ is preffered over ______ for htn

Answer 49

dhp over non dhp (verampiril, diltiazem)

Question 50

non dhp adverse reaction

Answer 50

constipation (verapamil) bradycardia heart block

Question 51

adverse effect of all ccb

Answer 51

hypotension

Question 52

adverse effect of ccb, dihydropyradine

Answer 52

peripheral edema, worst with nifedipine (amlodipine, felodipine, ok in pt with chf) reflex tachycardia flushing headache

Question 53

ccb dihydropyridines useful in pts with ______ ______

Answer 53

systolic hypertension elderly

Question 54

ccb clevidipine contraindicated in ___ or ___ allergy

Answer 54

eggs, or soy

Question 55

ace and arb beware what drug interaction

Answer 55

potassium supplement, sal substitue, nsaids

Question 56

You have a patient with severe renal failure with chf, you are considering a med, also to reduce bp, which med would you choose? - Hydrochlourothide, thiazide class OR Furosemide

Answer 56

use furosemide more potent, but watch for electrolyte abnormalities decrease in magnesium, calcium, sodium, and potassium

Question 57

What electrolyte abnormality would u likely see with a patient on furosemide - Magnesium decreased - Calcium increase - Sodium increase

Answer 57

magnesium will be decreased (also calcium, sodium and potassium will also be decreased)

Question 58

loop diuretic mechansim of action

Answer 58

inhibit the active transport of sodium, chlouride, and potassium in the loop of henle

Question 59

peripheral edema worse with what ccb dihydropyridine

Answer 59

nifedipine amlodipine, ok in pt with CHF

Question 60

dihydropyridine side effect non dihydropyridine

Answer 60

headache/ peripheral edema constipation, and bradycardia

Question 61

triampteren is ____ sparing but most be used in combo why? and wht clinical scenario is it helpful in?

Answer 61

potassium weak if pt has hypokalemia cannot do regular thalizide, and loop

Question 62

loop used in pt with reduced ___ and in chi

Answer 62

gfr, (kidney disease)

Question 63

captopril is not ideal why

Answer 63

frequent dosing short half life that is cap to take it

Question 64

enalapril is used in what clinical scenario

Answer 64

pt needs immediate blood pressure reduction and is in the hospital

Question 65

loop diuretic precaution _____ toxicity and _____ allergy pts

Answer 65

nephrotoxicity sulfa allergy pts

Question 66

enalapril is ___ drug and is ____

Answer 66

pro only one available IV