| Question | Answer |
| Beta blocker: MOA | Blockade of parts of the sympathetic NS (reduce PVR); Lowers HR; Initially lowers cardiac output; Reduces circulating renin |
| Pt just started on ACEI develops weakness. What test (lab, UA, CT, US) is most specific to dx pt? | Renal US |
| Peripheral presynaptic adrenergic release inhibitors (anti-adrenergic meds) MOA | prevent norepinephrine release from peripheral nerve terminals (eg, in heart) -> block alpha-1 receptors (eg, prazosin) |
| HTN Tx in CVD | BB |
| DHP CCBs (amlodipine, nifedipine): AEs | Ankle edema; Flushing; HA; Increased HR |
| JNC8: tx of uncomplicated HTN for most (non-AA) patients | Firstline: ACEI, ARB, CCB, thiazide diuretics |
| Secondary indications of anti-adrenergic meds | Central: nicotine/heroin W/D; Ppx for migraine, glaucoma, DM-assoc diarrhea. Peripheral: BPH; asthma (relax smooth mx); meds lower LDL & inc HDL |
| HTN Compelling Indications: High Coronary Dz Risk | Beta; ACEI; CCB; Diuretic |
| 1stline (&2nd & 3rd) tx for uncomplicated isolated systolic HTN (elderly) | 1) HCTZ; 2) Atenolol; 3) captopril or verapamil |
| Thiazide diuretics AEs = | Volume depletion, low K+ & Na, hyperglycemia / insulin resistance; hyperuricemia/gout, photosensitivity, decreased placental flow. May increase serum cholesterol & digoxin |
| BB used to reduce IOP in glaucoma = | nadolol |
| Tx osteoporosis (w/HTN med): | HCTZ |
| Presynaptic adrenergic release inhibitors: 2 types | central and peripheral |
| CCBs are contraindicated in: | CHF, LV dysfunction, AV block, sick sinus syndrome |
| HTN tx if BP >20/10 over goal: | 2 meds |
| ACEI AEs | Cough; Angioedema; Hyperkalemia & hyponatremia (2/2 low aldosterone); Rash. CI in pregnancy, and use cautiously in renal artery stenosis (RAS) |
| 1stline HTN tx in pregnancy | 1 Methyldopa; 2 hydralazine |
| BBs (2) used for migraine, SVT, V-tach, tremors, EtOH W/D = | Inderal (propranolol) and atenolol |
| Hypertensive emergency tx | nitroprusside (CI in PG) or labetolol; to 110 over several hours |
| BBs are contraindicated in: | 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 increasing O2 demand |
| JNC 8: in patients <60, start tx at: | 140/90 (same used in pts >18 yo with either CKD or DM) |
| First Line Tx for HTN | *Thiazide*; beta; ACEI; ARB; other diuretics; CCB |
| For pts with DM regardless of race), HTN tx should include: | ACEI or ARB |
| Beta-1 stimulation causes (a), and beta-2 stimulation causes (b) | (a) tachycardia; (b) bronchodilation |
| Thiazide diuretics MOA = | HCTZ & chlorthalidone: inhibit K+ & Na+ reabsorption in TAL. Decrease plasma volume, increase Na excretion |
| Central presynaptic adrenergic release inhibitors (anti-adrenergic meds) MOA | prevent adrenergic outflow from the brain, by stimulating inhibitory alpha-2 receptors (eg, clonidine) |
| Tx for pre-op HTN | Atenolol |
| Sudden DC of anti-adrenergic meds can cause: | rebound HTN |
| Non-DHP CCBs (diltiazem, verapamil): AEs | Bradycardia, constipation, hotn, edema, CHF, AV node block |
| HTN lifestyle mods | Wt reduction (BMI 18.5 - 25) (biggest fx on bp); ETOH; aerobic activity 30 min; Na+ to 2.4 mg/day; K+; DASH diet |
| ARBs: MOA | Act to block Angiotensin II from binding points; same effect as ACEI, without some of the AEs |
| Nitrates MOA | 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 supply & decrease O2 demand) |
| HTN Compelling Indications: DM | 1 ACEI; 2 Beta (for DM2); 3 Verapamil or clonidine |
| ACEI work less well in AA popultion bc of: | lower blood renin levels |
| ARBs AEs | Hyperkalemia; Angioedema (rare, 10% cross-over); CI in PG; Cautious use in RAS |
| JNC 8: in patients >60, start tx at: | SBP >150 or DBP >90 |
| Hypertensive Emergency: tx | 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 cardiac ischemia |
| HTN Compelling Indications: CHF | 1st: ACE plus diuretic (HCTZ / Lasix); 2) Beta blocker (atenolol); 3) clonidine. Also ARB |
| Firstline & 2ndline HTN tx in pregnant patient = | 1st: methyldopa (Aldomet). 2nd: hydralazine |
| HTN Tx in DM | ARB |
| CCBs: Dihydropyridines (DHPs) vs nonDHPs | DHPs more vascular selective (fewer cardiac conduction fx): tx HTN/angina. NonDHPs more cardio-selective with more inhibitory fx on SA/AV node (CAUTION in CHF) |
| HTN Compelling Indications: Post-MI | 1 Beta; 2 ACEI; CCB |
| Most single HTN meds lower BP: | at most 20/10 mm Hg (so most pts on more than 1 drug) |
| Tx for migraine (w/HTN meds): | 1 atenolol; 2 verapamil |
| HTN Compelling Indications: CKD | 1 ACE; 2 BB (atenolol) or verapamil or HCTZ; 3 clonidine |
| Rx of choice for DM nephropathy | ACEI (increase blood flow to kidneys -> promote renal repair); act synergistically with a diuretic |
| Tx for BPH | Prazosin +/- tamsulosin |
| HTN Compelling Indications: Recurrent Stroke Prevention | ACEI; Diuretic |
| Most potent type of diuretics & MOA = | loop (furosemide): inhibit Cl reabsorption in TAL -> Na follows Cl and H2) follows Na&Cl. Results in high K+ losses. |
| Cushing Syndrome: tx for HTN | HTN is reversible if cause is eliminated (ie, pituitary adenoma, corticosteroid Rx) |
| Nitrates AEs | hotn, rebound tachycardia, facial flushing, HA |
| CCBs: MOA | Inhibit Ca+ influx -> block vascular smooth mx contractility -> vasodilatation & afterload reduction (aoso preload). Also coronary vasodilatation: CCBs are used in coronary artery spasm (Prinzmetal, Raynaud) |
| JNC 8: essential HTN tx for AA patients | CCBs and thiazide diuretics |
| Firstline tx in HTN: MOA (eg, diuretics, BB) | decrease vascular volume, decrease afterload and systolic BP |
| ACEI MOA: | Inhibit ACE in lung -> block formation of angiotensin II -> increased vasodilatation and Na+ loss |
| Alternate to ACEI if CHF or other intolerance | ARB |
