NURP-424- Exam 3 UPDATED ACTUAL
Exam Questions and CORRECT Answers
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)
- 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
- 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
- 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, and direct renin inhibitors on the
RAA system lowers blood pressure and reduces the adverse effects of diabetes on the kidney.
Calcium Channel Blockers (Dihydropyridines) - CORRECT ANSWER - - Nifedipine
(Procardia) or Amlodipine (Norvasc)
- Indications: HTN and angina
- Pharmacodynamics: inhibit calcium ions from crossing the cell membrane, resulting in a
marked decrease in transmembrane calcium content and prolonged vascular smooth muscle
relaxation
- Increase myocardial oxygen supply and decrease peripheral vascular resistance
- More potent vasodilator and do not suppress the conduction of the SA or AV node
- More beneficial to the African American community
Calcium Channel Blockers (Dihydropyridines) - Caution and Contraindications - CORRECT
ANSWER - - Avoid in patients with significant peripheral edema
- Avoid in unstable angina
Exam Questions and CORRECT Answers
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)
- 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
- 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
- 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, and direct renin inhibitors on the
RAA system lowers blood pressure and reduces the adverse effects of diabetes on the kidney.
Calcium Channel Blockers (Dihydropyridines) - CORRECT ANSWER - - Nifedipine
(Procardia) or Amlodipine (Norvasc)
- Indications: HTN and angina
- Pharmacodynamics: inhibit calcium ions from crossing the cell membrane, resulting in a
marked decrease in transmembrane calcium content and prolonged vascular smooth muscle
relaxation
- Increase myocardial oxygen supply and decrease peripheral vascular resistance
- More potent vasodilator and do not suppress the conduction of the SA or AV node
- More beneficial to the African American community
Calcium Channel Blockers (Dihydropyridines) - Caution and Contraindications - CORRECT
ANSWER - - Avoid in patients with significant peripheral edema
- Avoid in unstable angina
