Hypertension Pharmacology

Question 1

When a patient has hypertension, what medication is our first go to?

Answer 1

Thiazide

You can add an ACE too

Question 2

What are some examples of ACE inhibitors?

Answer 2

Lisinopril, Captopril, and Fosinopril

Question 3

Why do we go to an ACE inhibitor first to treat hypertension?

Answer 3

Lowers BP by decreasing peripheral resistance and inhibiting sodium and water retention. They also help increase venous capacity, cardiac output, and vascular volume.

Question 4

What is the main mechanism of ACE inhibitors that allows them to do so much?

Answer 4

Inhibit the conversion of angiotensin I to angiotensin II – thereby vasodilating.

Question 5

Besides hypertension, what are the other indications for ACE inhibitors?

Answer 5

Heart Failure, left ventricular dysfunction after an MI, and diabetic neuropathy.

Question 6

When thinking about heart failure, what do ACE inhibitors do?

Answer 6

Slow heart/muscle remodeling

Question 7

What are the main side effects of ACE inhibitors?

Answer 7

They can cause a cough, hyperkalemia, and angioedema.

Question 8

What if a patient can’t handle the cough the ACE inhibitor has caused?

Answer 8

You can switch them to losartan

Question 9

What type of medication is losartan?

Answer 9

Angiotensin receptor blocker (ARB)

Question 10

How does Losartan work?

Answer 10

It competitively blocks angiotensin 1 (1000x greater than ACE) and II. Therefore relaxing and dilating blood vessels = decreased BP

Question 11

When we give a patient an ACE inhibitor what must we tell them about the first dose?

Answer 11

The first dose can cause hypotension

Question 12

If a patient has renal insufficiency, can you give them an ACE inhibitor?

Answer 12

you can, but you must monitor creatinine closely

Question 13

What are the absolute contraindications for ACE’s?

Answer 13

Bilateral renal artery stenosis, angioedema, and pregnancy

Question 14

What lab work is especially important to watch with ACE inhibitors?

Answer 14

Potassium levels & liver function

Question 15

In patients over the age of 50, what BP is our target goal?

Answer 15

140/90

Question 16

What blood pressure reading is an emergency?

Answer 16

A diastolic pressure that is greater than 120

Question 17

What can you NOT do while on an ACE inhibitor?

Answer 17

get pregnant

Question 18

If a patient is a diabetic and has hypertension, what do we need to treat them with?

Answer 18

ACE inhibitor + Diuretic

Question 19

In a patient with hypertension, what are the most common diuretics we would use?

Answer 19

Hydrochlorothiazide or Chlorothalidone

Question 20

Between Hydrochlorothiazide and Chlorothalidone, which is more potent?

Answer 20

Chlorothalidone – 2x the potency

Question 21

In general, how to the diuretics work in the body? What is the goal?

Answer 21

They increase urinary sodium and water excretion, which decreases extracellular fluid and plasma volume which helps us reach the goal of decreasing total peripheral resistance.

Question 22

: How do the thiazide diuretics work?

Answer 22

They inhibit the sodium-chloride symporter, increasing sodium and chloride excretion.

Question 23

Are there any side effects to be concerned about with Thiazides?

Answer 23

QT prolongation, photosensitivity, nausea, and hypokalemia

Question 24

If a patient has an allergy to sulfa, can they take a thiazide? If not, what is the alternative?

Answer 24

Nope, Ethacrinic acid

Question 25

If a patient has an eGFR that is less than 30 what happens to the thiazides?

Answer 25

the effectiveness decreases

Question 26

If a patient has renal failure, can you use a thiazide?

Answer 26

Nope, change to a loop

Question 27

What happens if a patient is on a beta blocker and a thiazide?

Answer 27

It increases the risk of hyperglycemia

Question 28

Can you ever take an NSAID with a diuretic?

Answer 28

No

Question 29

When you prescribe a thiazide, what should you educate patient’s about?

Answer 29

Low sodium diets, add more potassium rich foods, and the warning signs for potassium depletion are hypovalemia.

Question 30

What medication can you add to a thiazide if your patient is experiencing hypokalemia?

Answer 30

Potassium sparing adjunct = Triamterene

Question 31

What over the counter medication can cause hypertension?

Answer 31

Ibuprofen

Question 32

How does ibuprofen cause hypertension?

Answer 32

Inhibits prostaglandins therefore causing vasoconstriction

Question 33

Say your patient is African American and hypertension, what medication would you start with and if it still didn’t control hypertension, what medication would you add?

Answer 33

``` Start with Hydrochlorothiazide (diuretic) Then add (NOT AN ACE) a Calcium Channel Blocker ```

Question 34

What are calcium channel blockers? What are the major categories?

Answer 34

They are vasodilators. Either nondihydropyradines or dihydropyradines.

Question 35

What medications are our dihydropyradines?

Answer 35

Amlodipine & Nifedipine

Question 36

What medications are our nondihydropyradines?

Answer 36

Diltiazem & Verapamil

Question 37

What medications block calcium channels and dilate smooth muscle of the myocardium?

Answer 37

Dihydropyradines

Question 38

What medications dilate the coronary arteries and decrease myocardial oxygen demands?

Answer 38

Nondihydropyradines

Question 39

What are the nondihydropyradine medications used for?

Answer 39

angina, hypertension, afib, aflutter, and PSVT

Question 40

When can you never use nondihydropyradines?

Answer 40

can’t use them with beta blockers or heart failure

Question 41

What are the dihydropyradine medications used for?

Answer 41

angina & hypertension. It can also be used for heart failure (mainly Amlodipine)

Question 42

What medications are contraindicated with grapefruit juice?

Answer 42

Calcium channel blockers

Question 43

What medication would you use for urgent to emergent elevated BP?

Answer 43

Hydralazine

Question 44

What medications are our selective Beta-1 adrenergic receptors?

Answer 44

Metoprolol & Atenolol

Question 45

What medications are non-selective beta blockers? Which one blocks alpha receptors?

Answer 45

Propranolol, Prazosin, & Carvedilol | Carvedilol & Prazosin blocks alpha receptors

Question 46

What is different about propranolol than any other beta blocker?

Answer 46

It can cause sedation & fatigue more than any of the others

Question 47

What is propranolol mainly used for?

Answer 47

Migraine prophylaxis

Question 48

What is the function of non-selective beta/alpha blockers?

Answer 48

vascular smooth muscle vasodilation and decrease total peripheral resistance

Question 49

What can Prazosin cause, more-so than the other non-selective beta/alpha blockers?

Answer 49

Can decrease peripheral resistance so much that it causes postural hypotension

Question 50

In general what are beta blockers used to treat?

Answer 50

angina, hypertension, and post-MI

Question 51

: Is there a beta blocker that can also be used for heart failure?

Answer 51

carvedilol

Question 52

What is key about prescribing beta blockers?

Answer 52

You must start low, titrate up, and down titrate

Question 53

Which form of metoprolol is longer acting?

Answer 53

Metoprolol Succinate

Question 54

What is special about Atenolol?

Answer 54

You cannot use it in hypertension. It can also cause peripheral edema

Question 55

What medications do we need to avoid if our patient has hypertension and asthma?

Answer 55

Propranolol & Carvediolol

Question 56

In treating hypertension, what are the 1st, 2nd, 3rd, 4th, order medications?

Answer 56

Start with an ACE (can combo with a diuretic), then try a beta blocker (skip if African American), then try a calcium channel blocker.

Question 57

What is the one medication we can use for hypertension in a pregnant woman? What is its class?

Answer 57

- Methyldopa | - Centrally acting alpha2 adrenergic agonist.

Question 58

In general, how do the centrally acting alpha2 agonists work?

Answer 58

Decrease the release of norepinephrine, which increases vasodilation, decreasing total peripheral resistance.

Question 59

What other centrally acting alpha2 agonist can be used to treat hypertension, narcotic addiction, and ADHD?

Answer 59

Clonidine

Question 60

we go to take a patient off of clonidine, what must we be careful of?

Answer 60

You cannot stop it abruptly, it will cause rebound hypertension

Question 61

What medication is out direct renin inhibitor?

Answer 61

Aliskerin