⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
NURP 424 Exam 3 with verified solutions
Factors that Affect BP - correct answer ✔- Cardiac output
! ! ! ! ! ! ! ! !
- Peripheral resistance
! !
- Heart rate
! !
- Filling pressure
! !
- Contractility
! !
- Arteriolar tone
! !
- Blood volume
! !
- Venous tone
! !
Blood Pressure Medicine Action - correct answer ✔Reduce blood pressure by
! ! ! ! ! ! ! ! ! !
lowering cardiac output and peripheral resistance
! ! ! ! ! !
ACE Inhibitors (-prils) - correct answer ✔- Block conversion of angiotensin I to
! ! ! ! ! ! ! ! ! ! ! !
angiotensin II which inhibits aldosterone and in return lowers BP by:
! ! ! ! ! ! ! ! ! ! !
- Decreasing output of the sympathetic nervous system
! ! ! ! ! ! !
- Increasing vasodilation of vascular smooth muscle
! ! ! ! ! !
- Decreasing retention of sodium and water (by decreasing aldosterone in the
! ! ! ! ! ! ! ! ! ! !
system)
!
,⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
- Inhibit the degradation of bradykinin (anti-inflammatory mediator - the cause
! ! ! ! ! ! ! ! ! !
of the cough and angioedema) and increase the synthesis of vasodilating
! ! ! ! ! ! ! ! ! ! !
prostaglandins
!
ACE Inhibitor Indications - correct answer ✔- HTN: less SE in Caucasian decent
! ! ! ! ! ! ! ! ! ! ! ! !
- Hypertensive proteinuric diabetes: helps with renal protection and prevention
! ! ! ! ! ! ! ! !
of nephropathy
! ! !
- Angina and ischemic heart disease: decreases peripheral vascular resistance
! ! ! ! ! ! ! ! !
which decrease cardiac output; decrease the thickening of the ventricular walls
! ! ! ! ! ! ! ! ! ! !
which leads to less O2 demand
! ! ! ! ! ! !
- Post-MI: reduce morbidity and mortality by reducing myocardial injury and
! ! ! ! ! ! ! ! ! !
preventing ventricular remodeling
! ! ! !
- HF: reduce remodeling of the heart due to HTN
! ! ! ! ! ! ! ! !
ACE Inhibitor Caution & Conraindications - correct answer ✔- Avoid in bilateral
! ! ! ! ! ! ! ! ! ! !
renal artery stenosis
! ! !
- Avoid in idiopathic and hereditary angioedema
! ! ! ! ! ! !
- Avoid in pregnancy and lactation
! ! ! ! !
- Avoid concurrent use of ACE-I with ARB or aliskern
! ! ! ! ! ! ! ! ! !
,⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
- Caution in renal and hepatic impairment
! ! ! ! ! ! !
- Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
! ! ! ! ! ! ! ! ! ! ! ! ! !
ACE Inhibitor Adverse Effects - correct answer ✔- Dry cough
! ! ! ! ! ! ! ! ! !
- Hypotension
! !
- Hyperkalemia
!
- Skin rash
! !
- Altered taste
! !
- Dizziness
!
- HA !
- Fatigue !
ARBs (-sartans) - correct answer ✔- Indications: HTN, hypertensive proteinuric
! ! ! ! ! ! ! ! !
diabetes, angina and ischemic heart disease, post-MI, HF
! ! ! ! ! ! ! !
- Pharmacodynamics: block angiotensin II receptors and reduce the levels of
! ! ! ! ! ! ! ! ! !
aldosterone secretion which reduces the retention of sodium and water
! ! ! ! ! ! ! ! ! ! !
- No effect on bradykinin so less likely to develop a cough or angioedema
! ! ! ! ! ! ! ! ! ! ! ! !
ARBs Caution & Contraindications - correct answer ✔- Avoid in bilateral renal
! ! ! ! ! ! ! ! ! ! !
artery stenosis
! !
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
- Avoid in idiopathic and hereditary angioedema
! ! ! ! ! ! !
- Avoid concurrent use of ACE-I with ARB or aliskern
! ! ! ! ! ! ! ! ! !
- Caution with other medications that cause hyperkalemia
! ! ! ! ! ! ! !
- Caution in renal and hepatic impairment
! ! ! ! ! ! !
- Approved for > 6 y.o.
! ! ! ! !
ARBs Adverse Drug Effects - correct answer ✔- Dizziness
! ! ! ! ! ! ! !
- Hypotension
!
- Hyperkalemia
!
- Fatigue !
- URI !
The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower
! ! ! ! ! ! ! ! ! ! ! ! ! !
in which of these? - correct answer ✔For patients on ARBs, no change in dosage
! ! ! ! ! ! ! ! ! ! ! ! ! ! !
is required based on renal impairment; however, initial ARB doses may be lower
! ! ! ! ! ! ! ! ! ! ! ! !
for patients with impaired hepatic function. Liver function tests should be
! ! ! ! ! ! ! ! ! ! !
performed prior to initiating therapy and the dose may be increased as
! ! ! ! ! ! ! ! ! ! ! !
tolerated.
!
The action of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II
! ! ! ! ! ! ! !
receptor blockers (ARBs), and direct renin inhibitors on the renin-angiotensin-
! ! ! ! ! ! ! ! ! !
aldosterone (RAA) system lowers blood pressure and reduces the adverse effects ! ! ! ! ! ! ! ! ! !
of which disease on the kidney? - correct answer ✔The action of ACEIs, ARBs,
! ! ! ! ! ! ! ! ! ! ! ! ! !
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
NURP 424 Exam 3 with verified solutions
Factors that Affect BP - correct answer ✔- Cardiac output
! ! ! ! ! ! ! ! !
- Peripheral resistance
! !
- Heart rate
! !
- Filling pressure
! !
- Contractility
! !
- Arteriolar tone
! !
- Blood volume
! !
- Venous tone
! !
Blood Pressure Medicine Action - correct answer ✔Reduce blood pressure by
! ! ! ! ! ! ! ! ! !
lowering cardiac output and peripheral resistance
! ! ! ! ! !
ACE Inhibitors (-prils) - correct answer ✔- Block conversion of angiotensin I to
! ! ! ! ! ! ! ! ! ! ! !
angiotensin II which inhibits aldosterone and in return lowers BP by:
! ! ! ! ! ! ! ! ! ! !
- Decreasing output of the sympathetic nervous system
! ! ! ! ! ! !
- Increasing vasodilation of vascular smooth muscle
! ! ! ! ! !
- Decreasing retention of sodium and water (by decreasing aldosterone in the
! ! ! ! ! ! ! ! ! ! !
system)
!
,⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
- Inhibit the degradation of bradykinin (anti-inflammatory mediator - the cause
! ! ! ! ! ! ! ! ! !
of the cough and angioedema) and increase the synthesis of vasodilating
! ! ! ! ! ! ! ! ! ! !
prostaglandins
!
ACE Inhibitor Indications - correct answer ✔- HTN: less SE in Caucasian decent
! ! ! ! ! ! ! ! ! ! ! ! !
- Hypertensive proteinuric diabetes: helps with renal protection and prevention
! ! ! ! ! ! ! ! !
of nephropathy
! ! !
- Angina and ischemic heart disease: decreases peripheral vascular resistance
! ! ! ! ! ! ! ! !
which decrease cardiac output; decrease the thickening of the ventricular walls
! ! ! ! ! ! ! ! ! ! !
which leads to less O2 demand
! ! ! ! ! ! !
- Post-MI: reduce morbidity and mortality by reducing myocardial injury and
! ! ! ! ! ! ! ! ! !
preventing ventricular remodeling
! ! ! !
- HF: reduce remodeling of the heart due to HTN
! ! ! ! ! ! ! ! !
ACE Inhibitor Caution & Conraindications - correct answer ✔- Avoid in bilateral
! ! ! ! ! ! ! ! ! ! !
renal artery stenosis
! ! !
- Avoid in idiopathic and hereditary angioedema
! ! ! ! ! ! !
- Avoid in pregnancy and lactation
! ! ! ! !
- Avoid concurrent use of ACE-I with ARB or aliskern
! ! ! ! ! ! ! ! ! !
,⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
- Caution in renal and hepatic impairment
! ! ! ! ! ! !
- Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
! ! ! ! ! ! ! ! ! ! ! ! ! !
ACE Inhibitor Adverse Effects - correct answer ✔- Dry cough
! ! ! ! ! ! ! ! ! !
- Hypotension
! !
- Hyperkalemia
!
- Skin rash
! !
- Altered taste
! !
- Dizziness
!
- HA !
- Fatigue !
ARBs (-sartans) - correct answer ✔- Indications: HTN, hypertensive proteinuric
! ! ! ! ! ! ! ! !
diabetes, angina and ischemic heart disease, post-MI, HF
! ! ! ! ! ! ! !
- Pharmacodynamics: block angiotensin II receptors and reduce the levels of
! ! ! ! ! ! ! ! ! !
aldosterone secretion which reduces the retention of sodium and water
! ! ! ! ! ! ! ! ! ! !
- No effect on bradykinin so less likely to develop a cough or angioedema
! ! ! ! ! ! ! ! ! ! ! ! !
ARBs Caution & Contraindications - correct answer ✔- Avoid in bilateral renal
! ! ! ! ! ! ! ! ! ! !
artery stenosis
! !
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ⪛ ⪴⪴⪷⪱ ⪘⪞⪴⪸ε ΘΙΙμλΜ ιΙππππ !! !! !! !! !! !! ιΤΜΜτλμτΧ
- Avoid in idiopathic and hereditary angioedema
! ! ! ! ! ! !
- Avoid concurrent use of ACE-I with ARB or aliskern
! ! ! ! ! ! ! ! ! !
- Caution with other medications that cause hyperkalemia
! ! ! ! ! ! ! !
- Caution in renal and hepatic impairment
! ! ! ! ! ! !
- Approved for > 6 y.o.
! ! ! ! !
ARBs Adverse Drug Effects - correct answer ✔- Dizziness
! ! ! ! ! ! ! !
- Hypotension
!
- Hyperkalemia
!
- Fatigue !
- URI !
The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower
! ! ! ! ! ! ! ! ! ! ! ! ! !
in which of these? - correct answer ✔For patients on ARBs, no change in dosage
! ! ! ! ! ! ! ! ! ! ! ! ! ! !
is required based on renal impairment; however, initial ARB doses may be lower
! ! ! ! ! ! ! ! ! ! ! ! !
for patients with impaired hepatic function. Liver function tests should be
! ! ! ! ! ! ! ! ! ! !
performed prior to initiating therapy and the dose may be increased as
! ! ! ! ! ! ! ! ! ! ! !
tolerated.
!
The action of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II
! ! ! ! ! ! ! !
receptor blockers (ARBs), and direct renin inhibitors on the renin-angiotensin-
! ! ! ! ! ! ! ! ! !
aldosterone (RAA) system lowers blood pressure and reduces the adverse effects ! ! ! ! ! ! ! ! ! !
of which disease on the kidney? - correct answer ✔The action of ACEIs, ARBs,
! ! ! ! ! ! ! ! ! ! ! ! ! !
