Hypertension Pharmacology I and II

Question 1

Define Stage I HTN

Answer 1

BP: 140-159/90-99

Question 2

Define Stage II HTN

Answer 2

Systolic BP >160; or diastolic BP >100

Question 3

What is essential HTN

Answer 3

no known secondary cause for HTN; accounts for 95% of cases

Question 4

Causes of Secondary HTN

Answer 4

Renal disease, drugs (EtOH, oral contraceptives, NSAIDS, MAOIs), Endocrine (pheochromocytoma, Cushings, hyperaldosteronism, hyper/hypothyroidism), Pulmonary (Obstructive Sleep Apnea)

Question 5

Clinical Features of Secondary HTN

Answer 5

Severe/resistant HTN, onset before puberty, onset before 30 with no fam history or obesity, electrolyte disturbances

Question 6

Modifiable Risk Factors for HTN

Answer 6

sodium intake, obesity, EtOH intake, meds, sedentary lifestyle, stress

Question 7

Risk factors for aggressive treatment of HTN

Answer 7

young age at onset, hyperlipidemia, diabetes, smoking, family history of vascular disease

Question 8

What is end-organ disease related to?

Answer 8

extent of BP elevation and duration of HTN

Question 9

What are some manifestations of end-organ disease?

Answer 9

stroke, CAD, LV hypertrophy, atherosclerosis, nephrosclerosis, aneurysms

Question 10

Who is more likely to benefit from lowering BP: a 45 y/o male with obesity and BP 145/95, or a 45 y/o female smoker with obesity, diabetes, LV hypertrophy, and BP 145/95

Answer 10

45 y/o female-the benefit of lowering BP increases in the setting of end-organ disease

Question 11

General MOA: Diuretics

Answer 11

decrease intravascular volume

Question 12

General MOA: Angiotensin Blockers

Answer 12

inhibit production/action of angiotenisin II->decrease PVR

Question 13

General MOA: Direct Vasodilators

Answer 13

relax smooth muscle to decrease PVR

Question 14

General MOA: Sympathoplegic agents

Answer 14

decrease sympathetic tone -> decrease PVR (ex. beta blockers, alpha blockers)

Question 15

Which drug classes have no effect on heart rate and cardiac output (5)

Answer 15

diuretics, ISA beta blockers, ACEI, ARB, renin inhibitors

Question 16

Which drug classes have no effect on plasma volume (3)

Answer 16

ACEI, ARB, Renin inhibitors

Question 17

Which type of diuretic is high potency and what is its MOA

Answer 17

Loop diuretic; competitively inhibit Na-K-Cl transporter in proximal ascending tubule

Question 18

Which type of diuretic is medium potency and what is its MOA

Answer 18

Thiazides; inhibits exchange of Na-Cl in the distal ascending loop

Question 19

Which type of diuretic is low potency and what is its MOA

Answer 19

Potassium sparing; inhibits Na reabsorption in the distal tubule

Question 20

When would you use a loop diuretic

Answer 20

severe HTN, CHF, cirrhosis, renal insufficiency (GFR < 30-40 ml/min)

Question 21

Side effects of loop and thiazide diuretics

Answer 21

hypokalemia, hypomagnesemia, impaired glucose tolerance, increased lipids, increased uric acid, erectile dysfunction, volume depletion

Question 22

Side effects of potassium sparing drugs

Answer 22

gynecomastia, menstrual irregularities, hyperkalemia

Question 23

Most famous loop diuretic

Answer 23

Furosemide

Question 24

MOA of ARBs

Answer 24

competitive receptor binding of angiotensin II to vascular endothelium

Question 25

Ending associated with ACEIs

Answer 25

-pril (ex. lisinopril)

Question 26

Ending associated with ARBs

Answer 26

-sartan (ex. losartan)

Question 27

Short acting ACEI

Answer 27

captopril

Question 28

Unique side effect to ACEIs

Answer 28

cough

Question 29

Contraindications to ACEIs and ARBs

Answer 29

renal artery stenosis, hyperkalemia, pregnancy

Question 30

ACEIs/ARBs benefit:

Answer 30

chronic kidney disease and proteinuria, CHF, LV remodeling post-MI, LV hypertrophy

Question 31

Calcium Channel Blockers

Answer 31

Dihydropyridines: Amlopidine, nifedipine | Non-dihydropyridines: Verapamil, diltiazem

Question 32

Which class of Calcium channel blockers has anti-anginal effects

Answer 32

non-dihydropyridines

Question 33

Calcium channel blocker MOA

Answer 33

inhibits contraction of smooth muscle by blocking entry of calcium into cell->decreases PVR

Question 34

Side effects of CCBs

Answer 34

heart failure, block, bradycardia for non-dihydropyridines. reflex tachycardia and angina for dihydropyirdines

Question 35

How do you minimize the side effects of CCBs

Answer 35

use a long-lasting CCB

Question 36

How do beta blockers decrease BP

Answer 36

reduce CO

Question 37

Which beta blocker is used for a hypertensive emergency in the ICU setting

Answer 37

labetolol

Question 38

Which beta blocker is used for acute coronary syndromes or CHF

Answer 38

carvedilol

Question 39

Which beta blocker is administered IV and has a short half life used for AV nodal blocking in unstable patients

Answer 39

Esmolol

Question 40

Ending associated with alpha 1 antagonists

Answer 40

-azosin (terazosin) (doxazosin)

Question 41

Vasodilators (2)

Answer 41

hydralazine, minoxidil

Question 42

Central acting sympathoplegic drugs MOA

Answer 42

stimulate alpha 2 receptors to reduce sympathetic output

Question 43

Only alpha 2 agonist routinely used

Answer 43

clonidine

Question 44

ganglion blocking agents (2) + MOA

Answer 44

Guanethidine: blocks release of NE from post-ganglionic nerve terminals Reserpine: depletes NE, DA, and serotonin; decreases CO and PVR