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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: Firstline tx in HTN: MOA (eg, , BB)Answer: decrease volume, decrease afterload and systolic BP Question: Most type of diuretics & MOA = Answer: loop (furosemide): inhibit Cl reabsorption in TAL -> Na Cl and H2) follows Na&Cl. Results in high K+ losses. Question: diuretics MOA =Answer: HCTZ & : inhibit K+ & Na+ reabsorption in TAL. Decrease plasma volume, increase Na excretion Question: Thiazide AEs =Answer: Volume depletion, low K+ & Na, / insulin resistance; hyperuricemia/gout, photosensitivity, decreased placental flow. May increase serum cholesterol & digoxin Question: Hypertensive : txAnswer: Controlled, gradual lowering of BP; 10% decrease in first hour, then 15% over next 3–12 hrs to BP of no less than 160/110; rapid correction of BP to normal levels puts pt at high risk for worsening cerebral, renal or ischemia Question: Syndrome: tx for HTN Answer: HTN is reversible if cause is eliminated (ie, adenoma, corticosteroid Rx) Question: Beta : MOAAnswer: Blockade of parts of the NS (reduce PVR); Lowers HR; Initially lowers cardiac output; Reduces circulating renin Question: ACEI AEs Answer: Cough; Angioedema; Hyperkalemia & hyponatremia (2/2 low aldosterone); Rash. CI in , and use cautiously in renal artery stenosis (RAS) Question: ARBs: Answer: Act to block Angiotensin II from binding points; same effect as ACEI, without some of the Question: ARBs AEs Answer: Hyperkalemia; Angioedema (rare, 10% cross-over); CI in PG; Cautious use in Question: CCBs: MOA Answer: Inhibit Ca+ -> block vascular smooth mx contractility -> vasodilatation & afterload reduction (aoso preload). Also coronary vasodilatation: CCBs are used in coronary artery spasm (Prinzmetal, Raynaud) Question: CCBs: Dihydropyridines (DHPs) vs Answer: DHPs more vascular selective (fewer cardiac conduction fx): tx HTN/angina. more cardio-selective with more inhibitory fx on SA/AV node (CAUTION in CHF) Question: DHP CCBs (amlodipine, ): AEs Answer: Ankle ; Flushing; HA; Increased HR Question: Non-DHP CCBs (diltiazem, ): AEs Answer: Bradycardia, constipation, hotn, edema, CHF, AV node Question: HTN lifestyle Answer: Wt reduction (BMI 18.5 - 25) (biggest fx on bp); ETOH; activity 30 min; Na+ to 2.4 mg/day; K+; DASH diet Question: Most single HTN meds BP:Answer: at most 20/10 mm Hg (so most pts on more than 1 drug) Question: Beta-1 stimulation causes (a), and beta-2 causes (b)Answer: (a) tachycardia; (b) Question: BBs (2) used for migraine, SVT, V-tach, , EtOH W/D =Answer: Inderal (propranolol) and Question: BB used to reduce IOP in = Answer: nadolol Question: BBs are in:Answer: any resp dz (asthma, COPD, DF); type 1 DM. Also pt may have W/D and increase in CP (2/2 CAD) bc of increased HR & thus O2 demand Question: CCBs are in:Answer: CHF, LV dysfunction, AV block, sick syndrome Question: Line Tx for HTN Answer: *Thiazide*; beta; ACEI; ARB; diuretics; CCB Question: ACEI MOA:Answer: Inhibit ACE in lung -> block formation of angiotensin II -> vasodilatation and Na+ loss Question: ACEI work less well in AA bc of:Answer: blood renin levels Question: Rx of for DM nephropathyAnswer: ACEI (increase blood flow to kidneys -> promote renal ); act synergistically with a diuretic Question: Presynaptic adrenergic release inhibitors: 2 Answer: central and Question: Central presynaptic release inhibitors (anti-adrenergic meds) MOAAnswer: prevent adrenergic outflow from the brain, by stimulating alpha-2 receptors (eg, clonidine) Question: presynaptic adrenergic release inhibitors (anti-adrenergic meds) MOA Answer: norepinephrine release from peripheral nerve terminals (eg, in heart) -> block alpha-1 receptors (eg, prazosin) Question: Sudden DC of anti-adrenergic meds can :Answer: HTN Question: Firstline & 2ndline HTN tx in patient =Answer: 1st: methyldopa (Aldomet). 2nd: Question: indications of anti-adrenergic meds Answer: Central: nicotine/heroin W/D; Ppx for , glaucoma, DM-assoc diarrhea. Peripheral: BPH; asthma (relax smooth mx); meds lower LDL & inc HDL Question: Nitrates Answer: 1) dilate large myocardial arteries -> increase blood flow to heart; 2) reduce venous tone -> blood pooling in periphery -> reduces preload -> reduces cardiac work (so: increase O2 & decrease O2 demand) Question: AEsAnswer: hotn, rebound tachycardia, flushing, HA Question: JNC8: tx of uncomplicated HTN for most (non-AA) Answer: Firstline: ACEI, ARB, CCB, diuretics Question: JNC 8: HTN tx for AA patientsAnswer: CCBs and diuretics Question: For pts with DM regardless of race), HTN tx include:Answer: ACEI or Question: Hypertensive txAnswer: nitroprusside (CI in PG) or labetolol; to 110 over hours Question: HTN Compelling Indications: Answer: 1st: ACE plus diuretic (HCTZ / Lasix); 2) Beta (atenolol); 3) clonidine. Also ARB Question: HTN Compelling Indications: High Dz Risk Answer: Beta; ACEI; CCB; Question: HTN Indications: Post-MI Answer: 1 Beta; 2 ACEI; CCB Question: HTN Compelling Indications: Answer: 1 ACEI; 2 Beta (for DM2); 3 Verapamil or Question: HTN Indications: Recurrent Stroke Prevention Answer: ACEI; Question: JNC 8: in >60, start tx at:Answer: SBP >150 or DBP >90 Question: JNC 8: in <60, start tx at:Answer: 140/90 (same used in pts >18 yo with CKD or DM) Question: (&2nd & 3rd) tx for uncomplicated isolated systolic HTN (elderly)Answer: 1) HCTZ; 2) ; 3) captopril or verapamil Question: HTN Indications: CKDAnswer: 1 ACE; 2 BB (atenolol) or or HCTZ; 3 clonidine Question: Tx for Answer: Prazosin +/- Question: Tx for (w/HTN meds):Answer: 1 atenolol; 2 Question: Tx (w/HTN med):Answer: Question: Tx for pre-op Answer: Question: 1stline HTN tx in Answer: 1 ; 2 hydralazine Question: Pt just started on ACEI develops weakness. What test (lab, UA, CT, US) is most to dx pt?Answer: Renal Question: HTN Tx in Answer: Question: HTN Tx in Answer: Question: Alternate to ACEI if CHF or other Answer: ARB Question: HTN tx if BP >20/10 over goal:Answer: 2 |
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