Week 5 CARDIOVASCULAR: HTN/HEART FAILURE

Question 1

Pharmacologic treatment for HTN is indicated for primary prevention

Answer 1

No CVD, 10 year ASCVD <10%, and SBP >=140 or DBP >=90 OR NoCVD, 10 year ASCVD >=10% and SBP >=130 or DBP >=80

Question 2

First line pharmaceutical options for treatment of HTN

Answer 2

Diuretics, ACE inhibitors, ARBs, CCB

Question 3

Class of antihypertensive drug that should be used with caution in individuals with gout

Answer 3

Thiazide diuretics

Question 4

Pharmacologic agent that prevents conversion of Angiotensin 1 to Angiotensin II

Answer 4

ACE inhibitor

Question 5

Antihypertensive of choice (2) in the black population

Answer 5

Thiazide diuretics and CCB

Question 6

Antihypertensive of choice for individuals with CKD

Answer 6

ACE inhibitor (or ARB if not tolerated)

Question 7

Side effect of ACE inhibitors related to blocking of bradykinase

Answer 7

cough

Question 8

Mechanism of Action: ARB

Answer 8

Blocks access of angiotensin II

Question 9

Mechanism of Action: CCB

Answer 9

Blocks calcium influx resulting in vasodilation

Question 10

Block only Beta receptors in heart and kidneys

Answer 10

Cardio-selective Beta Blocker

Question 11

Class of antihypertensive that should be used cautiously in individuals with lung disease

Answer 11

Non selective beta blocker

Question 12

Class of antihypertensive that has a common side effect of orthostatic hypotension

Answer 12

Alpha blockers

Question 13

Hypertension caused by a co-morbid condition or drug

Answer 13

Secondary Hypertension

Question 14

Cornerstone of treatment of HF

Answer 14

Ace inhibitors and beta blockers

Question 15

Drugs routinely used in addition to ACEI and Beta blockers in HFREF (Stage C)

Answer 15

Diuretics (loop) and Aldosterone antagonist (spironolactone)

Question 16

Goal in dosing ACE inhibitors in HF

Answer 16

Maximal dose tolerated

Question 17

Medication class that minimizes cardiac remodeling

Answer 17

ACE inhibitors

Question 18

Goals of treatment of HF (Stage A)

Answer 18

Healthy lifestyle, prevent vascular/coronary disease, prevent LV structural abnormalities

Question 19

Class of diuretic most commonly used to treat HF

Answer 19

Loop diuretics (e.g. furosemide, bumetanide)

Question 20

Common OTC analgesic that interacts with loop diuretic

Answer 20

NSAIDS

Question 21

Drug recommended for treatment of HF and SVT or atrial fibrillation

Answer 21

Digoxin

Question 22

Effect of combination of isosorbide dinitrate and hydralazine

Answer 22

Decrease preload and afterload

Question 23

Major adverse effect of aldosterone antagonists / Mineralcorticoid receptor antagonists

Answer 23

Hyperkalemia and renal failure

Question 24

Mechanism of action of Mineralcorticoid receptor antagonists

Answer 24

Inhibit aldosterone to produce a mild diuretic effect and potassium sparing

Question 25

Medication used to treat HF that may have endocrine side effect profile such as gynecomastia in men and menstrual irregularity in women

Answer 25

Sprinolactone

Question 26

Effect of digoxin

Answer 26

Positive inotrope (increase contractility)

Question 27

Blanche, 46 years old, presents for her annual Well exam. Her BP today is 136/84 with a repeat of 139/88. She brings in her blood pressure reading from the health fair at work which is 138/80. Blanche is considered to have: A) stage 1 HTN B) Accelerated HTN C) Hypertensive crisis D) Normal

Answer 27

A) stage 1 hypertension

Question 28

Which of the following is NOT a first line option for pharmacologic treatment of hypertension: A) Thiazide diuretic B) Beta Blocker C) ACE inhibitor D) ARB therapy

Answer 28

B) Beta blocker

Question 29

The best first choice for treating hypertension in individuals with CKD: A) Beta Blocker B) Thiazide diuretic C) ACE inhibitor D) Calcium Channel Blocker

Answer 29

C) ACE inhibitor

Question 30

Frank, a black male, age 56 is diagnosed with Stage 1 HTN. His ASCVD risk is 15%. He has no CKD. The NP chooses which medication as the best first choice to treat his hypertension? A) Furosemide B) Amlodipine C) Metoprolol D) HCTZ

Answer 30

B) Amlodipine

Question 31

Adverse drug reactions associated with the dihydropyridine calcium channel blockers include all of the following EXCEPT: A) Diarrhea B) Hypotension C) Edema D) Gingival Hyperplasia

Answer 31

A) diarrhea

Question 32

Stage 1 HTN

Answer 32

130-139 SBP OR 80-89 DBP

Question 33

Stage 2 HTN

Answer 33

>= 140 SBP OR >= 90 DBP

Question 34

Elevated BP

Answer 34

120-129 SBP and < 80 DBP

Question 35

Pharmacologic treatment with one first line agent

Answer 35

Stage 1 HTN and ASCVD risk >10% | or known CVD, DM or CKD

Question 36

Pharmacologic treatment with two first line agents is the protocol for which stage of HTN?

Answer 36

Stage 2 HTN

Question 37

Hypertensive Urgency

Answer 37

SBP >=180 or DBP >=120 and no target end organ damage evident

Question 38

Preferred first line medication for patients with CKD or DM with microalumuria

Answer 38

ACE inhibitor

Question 39

Preferred first line treatment for black population with no CKD

Answer 39

Calcium channel blocker or thiazide diuretic

Question 40

Preferred thiazide diuretic due to duration of action

Answer 40

Chlorthalidone

Question 41

Drug used in individuals who do not tolerate ACE inhibitors due to cough

Answer 41

Angiotensin receptor blocker

Question 42

Recommended management and follow up if Stage 1 HTN and clinical ASCVD < 10%

Answer 42

Lifestyle changes and FU in 3 -6 months

Question 43

Recommended management and follow up if Stage 1 HTN and clinical ASCVD >= 10% or known CKD, DM, or CVD

Answer 43

Lifestyle changes, a single pharmaceutical agent and FU in 1 month

Question 44

Recommended management and follow up if Stage 2 HTN

Answer 44

Lifestyle changes, two pharmaceutical agents and FU in 1 month

Question 45

Most common cause of secondary HTN

Answer 45

Obstructive Sleep Apnea

Question 46

Compelling use for this medication if history of MI

Answer 46

Beta blocker or CCA

Question 47

BP Threshold for treatment if no CVD and 10 year ASCVD risk <10%

Answer 47

>= 140/90

Question 48

Overweight / Obesity

Answer 48

Modifiable risk factor

Question 49

Low socioeconomic status

Answer 49

Relatively fixed risk factor

Question 50

Reduction in BP for each 1 Kg of weight loss

Answer 50

1 mm Hg

Question 51

Accounts for up to 95% of HTN

Answer 51

Primary (essential) HTN

Question 52

What are the first choice of Thiazide diuretics in mild HF, corticosteroid and estrogen therapy, premenstrual syndrome and limited renal dysfunction? A) furosemide and hydrochlorothiazide B) spironolactone and chlorthalidone C) hydrochlorothiazide and chlorothalidone D) metolazone and hydrochlorothiazide

Answer 52

Answer= C Rationale A) furosemide is a loop diuretic and not a thiazide B) spironolactone is a potassium sparing diuretic, not a thiazide C) see page 331, second paragraph of Edema Associated with... D) Both metolazone and HCTZ are classified under thiazide diuretics, but metolazone is not the preferred thiazide in this situation.