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1

What is a NORMAL BP

120/80

2

What is pre-HTN?

120-139 systolic
80-89 diastolic

3

What is stage I HTN?

140-159 systolic
90-99 diastolic

4

What is stage II HTN?

Greater than 160 systolic
Greater than 100 diastolic

5

What classifies a blood pressure as a hypertensive emergency?

DBP greater than 120mmHg

6

What are the 4 types of diuretics?

Thiazide
Thiazide-like
K+ sparing
"Loop diuretics"

7

What is the site of action of diuretics?

Renal nephron

8

Increases urinary Na+ and H2O excretion, decreases extracellular fluid and/or plasma volume which causes a decrease in TPR

Method of action of diuretics

9

What is the most commonly used medication for mild to moderate hypertension?

Diuretics

10

How do you dose diuretics?

Start with low potency, monitor for tolerance

11

What kind of diet do you recommend to a person on diuretics?

Low in Na+, high in K+

12

What should you warn your patient about when they take a diuretic?

Hypokalemia
Hypovalemia - low blood plasma
Dehydration

13

What do beta blockers do?

Decrease heart rate, decrease stroke volume, decrease TPR via decreasing renin and angiotensin II

14

What is the site of action of beta blockers?

Heart and kidney

15

Who should you caution use of beta blockers in?

Patients with pulmonary disease

16

What is the benefit of beta blockers post MI?

Cardio protective

17

What are some other uses for beta blockers?

Stage fright
Anxiety
Headache prevention/treatment
PTSD
Panic disorders

18

What should you monitor in a patient with renal insufficiency if they are taking an ACEI?

Monitor creatinine closely

19

If your patient is receiving hemodialysis and you want to start them on an ACEI, what should you do?

Communicate with nephrologist because increased incidence of negative effects

20

If your patient on an ACEI experiences edema, what should you do?

Take them off medication and do not try again! Once experienced they are always at risk and it can be life threatening

21

What vitamin should you keep an eye on if your patient is taking an ACEI?

K+

22

What is the site of action for an ACEI?

Renal (Renin-angiotensin system)

23

What do ACEIs do?

Inhibit conversion of Angiotensin I to angiotensin II

24

ACEIs _____ arteriolar resistance, _____ venous capacity, _____ cardiac output, and _______ vascular volume, and ______ renovascular resistance

Lower

Increase

Increase

Increase

Lower

25

Site of action of ARBs?

Smooth muscle of blood vessels

26

What do ARBs do?

Block angiotensin from binding to angiotensin receptors

Relaxes and dilates blood vessels

27

Site of action of direct renin inhibitor?

Renal

28

What do direct renin inhibitors do?

Inhibit renin which diminishes production of angiotensin

Dilates vessels, lowers TPR, lowers BP

29

Site of action of DCCB and NDCCB?

Vascular smooth muscle, SA and AV nodal conduction, myocardium

30

What may cause a positive ANA and a direct Coombs test?

Nifedipine

31

Why should a patient not take a CCB with grapefruit juice or grapefruit?

Could increase serum concentration of CCB

32

What type of health maintenance should you include in your patient education when your patient is on a beta blocker?

Dental - gingival hypertrophy and inflammation may occur

33

Site of action of Hydralazine?

Vascular smooth muscle

34

What drug can cause Lupus?

Hydralazine

35

Which drug may caused increased hair production?

Hydralazine

36

What is the drug of choice for treatment of a hypertensive emergency in women?

Hydralazine

37

What is the site of action of alpha blockers?

Peripheral arterioles, veins, and smooth muscle

38

What drug should patients taking an alpha blocker avoid?

Cialis - hypotension

39

What is the site of action of a centrally acting A2 agonist?

CNS/Brain

40

What does prolonged use of a centrally acting A2 agonist cause?

H2O retention

41

What can occur to BP in response to starting a patient on a centrally acting A2 agonist?

Rebound increase in BP

42

What is commonly used in detox protocols for ETOH withdrawal?

Centrally acting A2 agonist

43

What is one mood altering affect of centrally acting A2 agonists?

Depression

44

How do antihypertensives work to control BP?

They all reduce cardiac output and/or TPR to lower BP!

45

What is the rule about prescribing multiple hypertensives ?

Don't combine two drugs from the same class

46

What drug regimen is recommended for patients with heart failure?

ACEI, diuretics

47

What drug regimen is recommended for patients with diabetes?

Avoid Beta blockers!! use an ACEI

48

What drug regimen is recommended for patients with myocardial infarction?

Beta blocker, ACEI

49

What drug regimen is recommended for patients with renal insufficiency?

ACEI

50

What drug regimen is recommended for patients with angina?

Beta blocker, CCB

51

What drug regimen is recommended for patients with asthma?

Avoid non selective beta blocker
USE CCB!!

52

What drug regimen is recommended for patients with isolated systolic HTN (older patients)?

Diuretics, CCB

53

Which anti-arrhythmics are in Class 1a

Procainamide, quinidine

54

Which anti-arrhythmic is in class 1B

Lidocaine

55

Which anti-arrhythmic is in class 1C

Flecainide

56

Which anti-arrhythmic is in class 2

Propranolol

57

Which anti-arrhythmic is in class 3

Amiodarone

58

Which anti-arrhythmic is in class 4

Verapamil, diltiazem

59

Which anti-arrhythmic is in the "miscellaneous category"?

Adenosine, ivabrodine

60

Prolongs APD, intermediate dissociation kinetics

Class 1a

61

Shortens APD ion selective tissues, rapid dissociation kinetics

Class 1b

62

Minimal APD impact, slow dissociation kinetics

Class 1c

63

Sympatholytic action

Class 2

64

Prolongation of APD

Class 3

65

Blockade of calcium current

Class 4

66

What is primary prevention of hyperlipidemia?

High LDL levels with family history or diabetes
High global risk score (over 7.5%)

67

What is secondary prevention of hyperlipidemia?

History of heart disease or stroke

68

What are the guidelines for treating a patient for hyperlipidemia?

Don't treat to target LDL but use intensity of statin therapy as rubric

69

High intensity statins reduce LDL by ?

50%

70

Moderate intensity statins reduce LDL by?

30-49%

71

Which HMG-CoA reductase drug should you avoid in patients with decreased renal function (GFR under 30)

Lovastatin

72

Which HMG-CoA reductase drug should you use w patients who have hepatic dysfunction because it is not CYP450 metabolized?

Pravastatin

73

Which HMG-CoA reductase drug should you avoid in patients with renal or hepatic dysfunction because it is the second most potent combination for LDL/Trig reduction?

Rosuvastatin (crestor)

74

Which HMG-CoA reductase drug should you avoid in patents with renal dysfunction?

Simvastatin

75

What are the thresholds for treatment for HTN?

SBP greater than 140mmHg in patients less than 60
SBP greater than 150mmHg in patients older than 60

76

If your patients BP is 160/100, what should you do?

Start then on two drugs, but be cautious in elderly