1st line medications
ACE inhibitors have which suffix?
-pril
you should measure bp in both arms
true, esp. on first visit
which medication can NOT be combined with nondihydropyridine calcium channel blockers?
beta blockers!!!
normal bp range
119/79 or below
pt presents with average bp of 135/80 across several visits. they have hx of DM and 10-year CVD irsk of 7.5%. what are your recommendations?
start HTN medications and reduce CVD risk if SBP 130+ or DBP 80+
dihydropyridines are different from nondihydropyridines because
DHP = 1st line HTN , NDHP is NOT first line. NDHP = more effect on HR and contractility. DHP = inc vasodilation and less effect on heart.
DHP helpful in raynauds/migraines, ok to use in pregnancy.
NDHP mainly used for arrythmias
Lisinopril and losartan can safely be prescribed together, as their side effect profiles are different
false! two ACE inhibitors together = bad
ACE + RAS inhibitor = bad
which medication is LAST LINE due to adverse effects of severe postural hypotension, rebound severe HTN if stopped abruptly, and sedation/depression?
i'll accept drug name(s) or class of drug
central alpha 2 agonists such as clonididine and methyldopa
stage 2 HTN SBP
140+
stage 1 is 130-139
patient has average bp of 130/80 across several visits. What are your recommendations, if any?
lifestyle intervention 3-6 months
if bp is still 130+/80+ at that point, start HTN meds
which medication has a MOA that blocks NCC in distal convoluted tubule, leading to dec.d Na+ & K+ and dec.d Ca & uric acid
thiazide
ACE inhibitors are better tolerated than ARBs
false! opposite; Antiotensin receptor blockers are better tolerated than ACE inhibitors
which of the following is the most common side effect of alpha 1 blockers?
1. worsen Raynaud phenomenon
2. hyperkalemia
3. orthostatic hypotension
4. reflex tachycardia
3, orthostatic hypotension is specifically listed
(based on pharm, reflex tachycardia could also be correct but it's not specifically listed in clin med, and it's not as strong of a. side effect in a1 blockers as it is in direct vasodilators)
if pt has a 2nd or 3rd degree block, which medication drug classes would be contraindicated to prescribe for tx of HTN?
CCB dihydropyridines
beta blockers
patient presents with bp of 129/70 at their first office visit and 122/78 on their second visit. what are your recommendations, if any, and when will you see them next?
lifestyle intervention and f/u in 3-6 months
category : elevated bp 120-129/ <80
everyone gets lifestyle recommendations!
which of the first line HTN medications should NOT be used in a patient with a sulfa allergy?
thiazide
If a patient is asymptomatic but has a blood pressure of 160/100, we would use an IV medication
false
we WILL start them on anti-HTN medication as outpatient, but there's no need to use IV if they are asymptomatic
a1 blockade will lead to
vasodilation
what drug class ends in -sartan
ARB
1st line htn and CKD
pt has an average bp over several visits of 140/90. what are the next steps, if any?
start on 2 HTN medications to lower risk for CVD
2 first line agents from DIFFERENT classes, ideally a single pill combination
which drug is a first line anti-HTN medication as well as a first line in chornic kidney disease and why?
ACE inhibitors -- they slow the CKD decline so they're very beneficial in renal disease
if a pt is having a hypertensive emergency, our goal is to decrease their systolic blood pressure by 30% in the first hour
false
DO NOT dec. SBP by more than 25% in the first hour
name a drug that is approved for tx of HTN in pregnancy, and when you should avoid that drug in a pregnant patient
1. labetalol (avoid w/ asthma/block/slow HR)
2. nifedipine (avoid w/ tachycardia)
3. methyldopa (limited w/ side effects of depression, sedation, dizziness)
4. HCTZ (2nd/3rd line)
SBP and DBP for hypertensive emergency
>180 systolic
> 120 diastolic
a 42 year old F presents for routine f/u and is complaining of severe HA. Her bp is 200/110. You quickly identify this as a hypertensive emergency. What is the goal of tx over the next 6 hours, and 48 hours?
do not dec SBP >25% in 1st hour. goal is 160/100 in 2-6 hours, normalize bp in 24-48 hours