questions 9

Antihypertensive Therapy

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Topic updated on 12/22/16 11:30am

Introduction
  • There are a variety of different antihypertensive medications available
    • variables that determine which antihypertensive medications are appropriate include
      • degree of hypertension
        • essential hypertension
        • malignant hypertension
      • concomitant diseases
        • CHF
        • diabetes mellitus (DM)
        • pregnancy
        • COPD
        • BPH
        • post-MI
Degree of Hypertension and Indicated Antihypertensive Therapy
  • Essential hypertension
    • diuretics
    • ACEI/ARBs 
    • calcium channel blockers (CCB) 
  • Malignant hypertension
    • nitroprusside
    • fenoldopam
    • diazoxide
Concomitant Diseases and Indicated Antihypertensive Therapy
 
Disease Diuretics
ACEI/ARB  β-blocker 
 α-blocker 
CCB
Misc
CHF  Y Y Y  -  -  
DM  Y Y Y  Y  Y -
COPD/asthma  - - -  -    Y  
-
BPH  - - -  Y  - -
Post-MI  -
Y
Y
-
Y
-
 
  • CHF
    • diuretics
      • K+-sparing diuretics (e.g., spironolactone)
    • ACEI/ARBs
    • β-blockers 
      • do not use β-blockers in decompensated patients
      • decrease cardiac contractile force
      • decrease heart rate
  • DM
    • diuretics
    • ACEI/ARBs 
      • added benefit of ↓ risk of diabetic nephropathy
      • ACEIs can cause a dry, non-productive, persistent cough 
      • ACEIs can cause hyperkalemia 
    • CCBs
    • β-blockers
      • mechanism of action includes blocking catecholamine-induced renin release by the kidney 
      • use cardioselective (β1-selective) drugs to avoid bronchoconstrictive effects (e.g. metoprolol)
    • α-blockers (-zosin's)
  • Pregnancy
    • methyldopa
    • hydralazine
    • labetalol
    • contraindicated
      • do not use ACEI/ARBs due to teratogenicity
  • COPD/asthma
    • CCB
    • avoid non-selective β-blockers
    • no contraindication to selective β-blockers if indication to use (i.e., CAD, CHF)
  • BPH
    • α-blockers
      • can treat both BPH and hypertension at same time 
  • Post-MI
    • β-blockers
    • ACEI/ARB's  
    • CCB if β-blockers are contraindicated


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Qbank (7 Questions)

TAG
(M1.CV.84) A 60-year-old Caucasian female with hypertension is treated with atenolol. Which of the following is NOT a direct effect of atenolol?
Topic Review Topic

1. Decreased cardiac contractile force
2. Decreased renin levels
3. Increased peripheral vasodilation
4. Decreased heart rate
5. Decreased intraocular pressure

PREFERRED RESPONSE ▶
TAG
(M1.CV.85) A 72-year-old anthropologist with long-standing hypertension visits your office for a routine exam. You notice an abnormality on his laboratory results caused by his regimen of captopril and triamterene. What abnormality did you most likely find?
Topic Review Topic

1. Hypercalcemia
2. Hyperkalemia
3. Hypernatremia
4. Thrombocytopenia
5. Anemia

PREFERRED RESPONSE ▶
TAG
(M1.CV.90) A 67-year-old gentleman with a history of poorly controlled diabetes presents to his primary care physician for a routine examination. He is found to be hypertensive on physical exam and is started on a medication that is considered first-line therapy for his condition. What should the physician warn the patient about before the patient takes his first dose of the medication? Topic Review Topic

1. Hypertensive episodes
2. Hypotensive episodes
3. Hyperthermic episodes
4. Hypothermic episodes
5. Anuric episodes

PREFERRED RESPONSE ▶
TAG
(M1.CV.92) A 27-year-old female with no significant past medical history presents to clinic for an annual evaluation. She has no complaints. Vital signs are as follows: T 37 Celsius, HR 70, BP 159/93, RR 12, and O2 99% on room air. Her BMI is 20.1. Repeat blood pressures on two separate occasions are 157/95 and 161/91. On physical examination, you auscultate just laterally to the umbilicus and detect a low pitched "wooshing" sound on each side. In medical management of this patient's hypertension, which medication should be avoided? Topic Review Topic

1. Hydrochlorothiazide
2. Atenolol
3. Amlodipine
4. Spironolactone
5. Lisinopril

PREFERRED RESPONSE ▶
TAG
(M1.CV.93) A 67-year-old man with a history of diabetes mellitus type II and a previous myocardial infarction presents to your office for a routine examination. His blood pressure is found to be 180/100 mmHg. Which drug is the first-line choice of treatment for this patient's hypertension? Topic Review Topic

1. Amlodipine
2. Hydrochlorothiazide
3. Lisinopril
4. Prazosin
5. Isoproterenol

PREFERRED RESPONSE ▶
TAG
(M1.CV.139) A 59-year-old man presents to general medical clinic for his yearly checkup. He has no complaints except for a dry cough. He has a past medical history of type II diabetes, hypertension, hyperlipidemia, asthma, and depression. His home medications are sitagliptin/metformin, lisinopril, atorvastatin, albuterol inhaler, and citalopram. His vitals signs are stable, with blood pressure 126/79 mmHg. Hemoglobin A1C is 6.3%, and creatinine is 1.3 g/dL. The remainder of his physical exam is unremarkable. If this patient's cough is due to one of the medications he is taking, what would be the next step in management? Topic Review Topic

1. Change citalopram to escitalopram
2. Change lisinopril to metoprolol
3. Change lisinopril to amlodipine
4. Change atorvastatin to to lovastatin
5. Change lisinopril to losartan

PREFERRED RESPONSE ▶
TAG
(M1.CV.4753) A 45-year-old male with a history of diabetes and poorly controlled hypertension presents to his primary care physician for an annual check-up. He reports that he feels well and has no complaints. He takes enalapril and metformin. His temperature is 98.8°F (37.1°C), blood pressure is 155/90 mmHg, pulse is 80/min, and respirations are 16/min. His physician adds another anti-hypertensive medication to the patient’s regimen. One month later, the patient returns to the physician complaining of new onset lower extremity swelling. Which of the following medications was likely prescribed to this patient? Topic Review Topic

1. Metoprolol
2. Verapamil
3. Nifedipine
4. Hydrochlorthiazide
5. Spironolactone

PREFERRED RESPONSE ▶
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