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1
Q

What is a NORMAL BP

A

120/80

2
Q

What is pre-HTN?

A

120-139 systolic

80-89 diastolic

3
Q

What is stage I HTN?

A

140-159 systolic

90-99 diastolic

4
Q

What is stage II HTN?

A

Greater than 160 systolic

Greater than 100 diastolic

5
Q

What classifies a blood pressure as a hypertensive emergency?

A

DBP greater than 120mmHg

6
Q

What are the 4 types of diuretics?

A

Thiazide
Thiazide-like
K+ sparing
“Loop diuretics”

7
Q

What is the site of action of diuretics?

A

Renal nephron

8
Q

Increases urinary Na+ and H2O excretion, decreases extracellular fluid and/or plasma volume which causes a decrease in TPR

A

Method of action of diuretics

9
Q

What is the most commonly used medication for mild to moderate hypertension?

A

Diuretics

10
Q

How do you dose diuretics?

A

Start with low potency, monitor for tolerance

11
Q

What kind of diet do you recommend to a person on diuretics?

A

Low in Na+, high in K+

12
Q

What should you warn your patient about when they take a diuretic?

A

Hypokalemia
Hypovalemia - low blood plasma
Dehydration

13
Q

What do beta blockers do?

A

Decrease heart rate, decrease stroke volume, decrease TPR via decreasing renin and angiotensin II

14
Q

What is the site of action of beta blockers?

A

Heart and kidney

15
Q

Who should you caution use of beta blockers in?

A

Patients with pulmonary disease

16
Q

What is the benefit of beta blockers post MI?

A

Cardio protective

17
Q

What are some other uses for beta blockers?

A
Stage fright
Anxiety
Headache prevention/treatment
PTSD
Panic disorders
18
Q

What should you monitor in a patient with renal insufficiency if they are taking an ACEI?

A

Monitor creatinine closely

19
Q

If your patient is receiving hemodialysis and you want to start them on an ACEI, what should you do?

A

Communicate with nephrologist because increased incidence of negative effects

20
Q

If your patient on an ACEI experiences edema, what should you do?

A

Take them off medication and do not try again! Once experienced they are always at risk and it can be life threatening

21
Q

What vitamin should you keep an eye on if your patient is taking an ACEI?

A

K+

22
Q

What is the site of action for an ACEI?

A

Renal (Renin-angiotensin system)

23
Q

What do ACEIs do?

A

Inhibit conversion of Angiotensin I to angiotensin II

24
Q

ACEIs _____ arteriolar resistance, _____ venous capacity, _____ cardiac output, and _______ vascular volume, and ______ renovascular resistance

A

Lower

Increase

Increase

Increase

Lower

25
Q

Site of action of ARBs?

A

Smooth muscle of blood vessels

26
Q

What do ARBs do?

A

Block angiotensin from binding to angiotensin receptors

Relaxes and dilates blood vessels

27
Q

Site of action of direct renin inhibitor?

A

Renal

28
Q

What do direct renin inhibitors do?

A

Inhibit renin which diminishes production of angiotensin

Dilates vessels, lowers TPR, lowers BP

29
Q

Site of action of DCCB and NDCCB?

A

Vascular smooth muscle, SA and AV nodal conduction, myocardium

30
Q

What may cause a positive ANA and a direct Coombs test?

A

Nifedipine

31
Q

Why should a patient not take a CCB with grapefruit juice or grapefruit?

A

Could increase serum concentration of CCB

32
Q

What type of health maintenance should you include in your patient education when your patient is on a beta blocker?

A

Dental - gingival hypertrophy and inflammation may occur

33
Q

Site of action of Hydralazine?

A

Vascular smooth muscle

34
Q

What drug can cause Lupus?

A

Hydralazine

35
Q

Which drug may caused increased hair production?

A

Hydralazine

36
Q

What is the drug of choice for treatment of a hypertensive emergency in women?

A

Hydralazine

37
Q

What is the site of action of alpha blockers?

A

Peripheral arterioles, veins, and smooth muscle

38
Q

What drug should patients taking an alpha blocker avoid?

A

Cialis - hypotension

39
Q

What is the site of action of a centrally acting A2 agonist?

A

CNS/Brain

40
Q

What does prolonged use of a centrally acting A2 agonist cause?

A

H2O retention

41
Q

What can occur to BP in response to starting a patient on a centrally acting A2 agonist?

A

Rebound increase in BP

42
Q

What is commonly used in detox protocols for ETOH withdrawal?

A

Centrally acting A2 agonist

43
Q

What is one mood altering affect of centrally acting A2 agonists?

A

Depression

44
Q

How do antihypertensives work to control BP?

A

They all reduce cardiac output and/or TPR to lower BP!

45
Q

What is the rule about prescribing multiple hypertensives ?

A

Don’t combine two drugs from the same class

46
Q

What drug regimen is recommended for patients with heart failure?

A

ACEI, diuretics

47
Q

What drug regimen is recommended for patients with diabetes?

A

Avoid Beta blockers!! use an ACEI

48
Q

What drug regimen is recommended for patients with myocardial infarction?

A

Beta blocker, ACEI

49
Q

What drug regimen is recommended for patients with renal insufficiency?

A

ACEI

50
Q

What drug regimen is recommended for patients with angina?

A

Beta blocker, CCB

51
Q

What drug regimen is recommended for patients with asthma?

A

Avoid non selective beta blocker

USE CCB!!

52
Q

What drug regimen is recommended for patients with isolated systolic HTN (older patients)?

A

Diuretics, CCB

53
Q

Which anti-arrhythmics are in Class 1a

A

Procainamide, quinidine

54
Q

Which anti-arrhythmic is in class 1B

A

Lidocaine

55
Q

Which anti-arrhythmic is in class 1C

A

Flecainide

56
Q

Which anti-arrhythmic is in class 2

A

Propranolol

57
Q

Which anti-arrhythmic is in class 3

A

Amiodarone

58
Q

Which anti-arrhythmic is in class 4

A

Verapamil, diltiazem

59
Q

Which anti-arrhythmic is in the “miscellaneous category”?

A

Adenosine, ivabrodine

60
Q

Prolongs APD, intermediate dissociation kinetics

A

Class 1a

61
Q

Shortens APD ion selective tissues, rapid dissociation kinetics

A

Class 1b

62
Q

Minimal APD impact, slow dissociation kinetics

A

Class 1c

63
Q

Sympatholytic action

A

Class 2

64
Q

Prolongation of APD

A

Class 3

65
Q

Blockade of calcium current

A

Class 4

66
Q

What is primary prevention of hyperlipidemia?

A

High LDL levels with family history or diabetes

High global risk score (over 7.5%)

67
Q

What is secondary prevention of hyperlipidemia?

A

History of heart disease or stroke

68
Q

What are the guidelines for treating a patient for hyperlipidemia?

A

Don’t treat to target LDL but use intensity of statin therapy as rubric

69
Q

High intensity statins reduce LDL by ?

A

50%

70
Q

Moderate intensity statins reduce LDL by?

A

30-49%

71
Q

Which HMG-CoA reductase drug should you avoid in patients with decreased renal function (GFR under 30)

A

Lovastatin

72
Q

Which HMG-CoA reductase drug should you use w patients who have hepatic dysfunction because it is not CYP450 metabolized?

A

Pravastatin

73
Q

Which HMG-CoA reductase drug should you avoid in patients with renal or hepatic dysfunction because it is the second most potent combination for LDL/Trig reduction?

A

Rosuvastatin (crestor)

74
Q

Which HMG-CoA reductase drug should you avoid in patents with renal dysfunction?

A

Simvastatin

75
Q

What are the thresholds for treatment for HTN?

A

SBP greater than 140mmHg in patients less than 60

SBP greater than 150mmHg in patients older than 60

76
Q

If your patients BP is 160/100, what should you do?

A

Start then on two drugs, but be cautious in elderly