Therapeutics of HTN pt. 3

Question 1

Angiotensin converting enzyme inhibitors (ACEi) moa

Answer 1

Inhibits conversion for angiotensin I to angiotensin II

Question 2

Angiotensin II receptor blockers (ARBs) moa

Answer 2

Block effects of angiotensin II by binding to target receptors

Question 3

Renin inhibitors moa

Answer 3

Inhibits conversion of angiotensinogen to angiotensin I

Question 4

What is ACEi

Answer 4

first line tx option for HTN

Question 5

ACEi have additional benefit in pts with history of:

Answer 5

pts with DM w/ proteinuria, HF, post MI, CKD

Question 6

what is the only ACEi that has frequency of 2 or 3 /day

Answer 6

Captopril

Question 7

what is the ACEi that has frequency of 1 or 2 /day

Answer 7

Benazepril, Enalapril, Ramipril, Moexipril, Quinapril,

Question 8

which ACE inhibitors have frequency of 1/day

Answer 8

Fosinopril, Lisinopril, Perindopril, Trandolapril

Question 9

ACEi AEs

Answer 9

angioedema, cough (up to 20%), hyperkalemia, acute renal failure w/ severe bilateral renal artery stenosis

Question 10

ACEi CIs

Answer 10

• history of angioedema on an ACEi
• concomitant use of aliskiren in pts w/ DM
• pregnancy/breastfeeding

Question 11

what is ARBs

Answer 11

first line tx option for HTN

Question 12

when are ARBs used

Answer 12

often “back up” if an ACEi isn’t tolerated for other indications

Question 13

why are ARBs often a back up to ACEi

Answer 13

• doesn’t block bradykinin breakdown -> less cough than ACEi
• can use with hx of angioedema due to ACEi

Question 14

why are ARBs a good option for PM dosing

Answer 14

ensures BP dipping overnight

Question 15

which are the only ARBs have a frequency of 1 or 2 /day

Answer 15

Eprosartan, Losartan

Question 16

ARBs AEs

Answer 16

angioedema, hyperkalemia, acute renal failure w/ severe bilateral renal artery stenosis

Question 17

ARBs CIs

Answer 17

• history of angioedema on ARB
• concomitant use of aliskiren in pts w/ DM
• pregnancy/breastfeeding

Question 18

ACEi/ARB monitoring

Answer 18

Question 19

when should ACEi/ARBs doses be possibly held or reduced

Answer 19

if K >5.5 mEq/L or SCr increase >30%

Question 20

what is the direct renin inhibitor agent

Answer 20

aliskiren

Question 21

is aliskiren a first line tx option for HTN

Answer 21

No

Question 22

why does aliskiren produce less cough than ACEi

Answer 22

doesn’t block bradykinin breakdown

Question 23

aliskiren CIs

Answer 23

• pregnant pts
• concomitant use with an ACEi or ARB contraindicated in pts w/ DM

Question 24

aliskiren frequency

Answer 24

1/day

Question 25

what labs should be monitored in pts using aliskiren

Answer 25

K, BUN, SCr

Question 26

aliskiren AEs

Answer 26

diarrhea, musculoskeletal effects, dizziness, headache, hyperkalemia, renal insufficiency, orthostatic hypotension

Question 27

CCBs moa

Answer 27

Inhibit influx of calcium across cardiac and smooth muscle cell membranes -> coronary and peripheral vasodilation

Question 28

CCBs subclasses and effects

Answer 28

- Dihydropyridines - more vasodilation - Nondihydropyridines - more negative ionotropic effects - Overall similar effect on BP

Question 29

Are CCBs first line for HTN

Answer 29

Yes

Question 30

what pt populations do dihydropyridine CCBs provide additional benefit

Answer 30

Pts with: - Reynaud's syndrome - elderly pts w/ isolated systolic HTN

Question 31

what dihydropyridines should be avoided

Answer 31

short-acting (IR nifedipine/nicardipine)

Question 32

how does dihydropyridine CCBs cause vasodilation

Answer 32

through baroreceptor-mediated tachycardia

Question 33

what does dihydropyridine CCBs not have an effect on

Answer 33

no effect on atrioventricular node conduction

Question 34

which dihydropyridine CCBs have a frequency of 2/day

Answer 34

Isradipine, Nicardipine SR

Question 35

dihydropyridine CCBs AEs

Answer 35

reflex tachycardia, flushing, dizziness, headache, peripheral edema (dose related), gingival hyperplasia

Question 36

dihydropyridine CCBs warning

Answer 36

increased risk of angina/MI in pts with obstructive coronary disease due to reflex tachycardia

Question 37

dihydropyridine CCBs drug interactions

Answer 37

- grapefruit juice - CYP3A4 enzyme inducers/inhibitors

Question 38

what pt populations do nondihydropyridine CCBs provide additional benefit

Answer 38

pts with: - supraventricular tachyarrhythmias (Afib) - pts w angina who can not tolerate a B blocker

Question 39

why do nondihydropyridine CCBs have negative ionotropic effects

Answer 39

slows AV node conduction and decreases HR

Question 40

what nondihydropyridine CCBs formulations are preferred for HTN

Answer 40

extended release formulations

Question 41

what is frequency of nondihydropyridine CCBs

Answer 41

1 or 2 /day

Question 42

what are the nondihydropyridine CCBs agents

Answer 42

Diltiazem ER, Verapamil ER

Question 43

why are nondihydropyridine CCBs not interchangeable

Answer 43

due to differences in release mechanisms and bioavailability

Question 44

nondihydropyridine CCBs AEs

Answer 44

bradycardia, headache, dizziness, AV node block, systolic HF, gingival hyperplasia, constipation (verapamil>diltiazem)

Question 45

nondihydropyridine CCBs drug interactions

Answer 45

- concomitant use of B blockers - increases risk of heart block - grapefruit juice - CYP3A4 enzyme inducers/inhibitors

Question 46

nondihydropyridine CCBs CIs

Answer 46

- heart block - left ventricular dysfunction

Question 47

are routine lab monitoring required for CCBs

Answer 47

No

Question 48

what CCB is preferred in the setting of HF

Answer 48

amlodipine

Question 49

are B blockers first line for HTN

Answer 49

NOT first line unless a compelling indication is present

Question 50

what pt populations get additional benefit from B blockers

Answer 50

Pts with: - tachyarrhythmias - tremors - migraines - thyrotoxicosis

Question 51

what cardioselective B blocker has a frequency of 2/day

Answer 51

Metoprolol tartrate

Question 52

what nonselective B blocker has a frequency of 2/day

Answer 52

Propranolol IR

Question 53

what are the intrinsic sympathomimetic activity (ISA) B blockers

Answer 53

- Acebutolol (frequency of 2/day) - Penbutolol (frequency of 1/day) - Pindolol (frequency of 2/day)

Question 54

what are the mixed alpha/beta B blockers

Answer 54

- Carvedilol (frequency of 2/day) - Labetalol (frequency of 2/day)

Question 55

B blockers AEs

Answer 55

Bronchospasms, bradycardia, fatigue, exercise intolerance, depression

Question 56

what is problem with B blockers

Answer 56

can mask signs/Sx of hypoglycemia

Question 57

use B blockers with caution in pts with:

Answer 57

- peripheral artery disease - reactive airway disease

Question 58

what B blocker is preferred in pts with peripheral artery disease

Answer 58

carvedilol

Question 59

what B blocker is preferred in pts with reactive airway disease

Answer 59

selective B blockers

Question 60

B blockers CIs

Answer 60

- second or third degree heart block - decompensated HF - post MI (ISA B blockers only) - severe bradycardia - sick sinus syndrome