Misc. Pharmacotherapy

Question 1

Which classes of drugs are used to treat hypertension? (hint: there are 12!)

Answer 1

ACEI, ARBs, Direct Renin Inhibitors, Beta-blockers, thiazides, loop diuretics, potassium sparing diuretics, CCBs, alpha 1 blockers, Aldosterone receptor blockers, central alpha2 agonists, vasodilators

Question 2

List all of the ACEIs

Answer 2

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril, Prinivil), Ramipril (Altace), Trandolapril (Mavik)

Question 3

Indications to use ACEI as first line

Answer 3

1. Non- AA, 2. DM, 3. CKD, 4. HF or LVEF <40%, 5. CAD, 6. Recurrent stroke prevention

Question 4

Which ACEIs are available as $4 generics?

Answer 4

Captopril, Enalapril, Lisinopril

Question 5

Which ACEI has the highest incidence of cough?

Answer 5

Captopril

Question 6

T or F: Tekturna is safe for pts with renal insufficiency.

Answer 6

False. Tekturna has not been studied in patients with renal insufficiency.

Question 7

Which class of B-blocker is preferred in HTN, and give an example.

Answer 7

Beta-1 selective (Atenolol, Metoprolol, bisoprolol)

Question 8

With Beta blockers, an increase in lipid solubility increases which side effect?

Answer 8

Fatigue. (Atenolol is most lipid soluble and therefore causes the most fatigue).

Question 9

Which class of beta blockers should you NEVER use in HTN? give an example

Answer 9

those with Intrinsic Sympathomimetic Activity (ISA) Ex: Acebutolol and Pindolol

Question 10

Thiazides are ineffective for patients with a GFR less than ___________

Answer 10

30 mL/Minute

Question 11

When using a diuretic for HTN which 3 labs should you monitor in 7-10 days after initiation or titration?

Answer 11

SCr, Na and K

Question 12

Which Beta blockers have alpha1 blocking activity?

Answer 12

Carvedilol and labetalol

Question 13

Which has more risk of hypokalemia, HCTZ or Chlorthalidone?

Answer 13

Chlorthalidone

Question 14

which loop diuretics have a $4 generic available?

Answer 14

HCTZ and Indapamide

Question 15

(T or F) Bumetanide is available as a $4 generic?

Answer 15

True.

Question 16

You should avoid using K+ sparing diuretics in pts with a CrCl of less than ________

Answer 16

10 mL/Min

Question 17

Which diuretic is used to treat Liddle’s Syndrome?

Answer 17

Amiloride (Bonus: Liddle’s syndrome is an autosomal dominant disorder characterized by HTN, hypokalemia and low levels of aldosterone.)

Question 18

Should you use the immediate or sustained release versions of Nicardipine and nifedipine for treatment of HTN?

Answer 18

ONLY use the sustained release dosage forms.

Question 19

(T or F) You should generally use the sustained release form of Nifedipine, but it is ok to use the immediate release form in hypertensive emergencies and urgencies.

Answer 19

FALSE. “use of immediate release nifedipine (sublingually or orally) in hypertensive emergencies and urgencies is neither safe nor effective”

Question 20

(T or F) Non- DHP CCBs are often used as 1st line therapy in combination with beta blockers.

Answer 20

False. They are usually reserved for patients with concomitant conditions (such as afib or angina) and should be used with caution in pts on beta blockers.

Question 21

Should you use the immediate release version or the sustained release version of Diltiazem and Verapamil in HTN?

Answer 21

Sustained release.

Question 22

In what patient do we most often see Alpha 1 blockers used?

Answer 22

the hypertensive male patient with concomitant BPH. It is generally a 4th or 5th line agent.

Question 23

(T of F) Aldosterone Receptor Blockers should NEVER be used as a single agent for HTN.

Answer 23

True.

Question 24

What 2 labs should you moniter 7-10 days after starting or titrating an aldosterone receptor blocker?

Answer 24

SCr and K

Question 25

What drug can be used for HTN with HF and hyperaldosteronism?

Answer 25

Spironolactone

Question 26

Which class of drugs are beneficial in hypertensive urgencies, but should be avoided in HF?

Answer 26

Central alpha 2 agonists.

Question 27

What is the most commonly used anti-HTN agent in pregnancy?

Answer 27

Methyldopa

Question 28

Which hypertension drug is also used in ADHD?

Answer 28

Guanfacine

Question 29

Which class of HTN drugs is useful for resistant HTN and for patients with HF?

Answer 29

Vasodilators (Hydralazine)

Question 30

Vasodilators should always be used with what other class of HTN drugs?

Answer 30

Loop diuretics.