What assessments should be made before prescribing any
antihypertensive agent? - ANSWER BP, RF, and head to toe assessment.
Assess diet, sodium intake, electrolytes, and potassium levels. Prior to
prescribing any antihypertensives, creatinine and BUN level s should be
evaluated. Confirmation of elevated BP at 3 different times. Children
over 3 years old should be assessed at least once at every visit-preferred
method for children is by auscultation, the correct measurement
requires using a cuff that is appropriate to the child's upper arm. 12 lead
EKG. UA, albumin, albumin/creatinine ratio. Diabetics or those with
renal disease should have the albumin/creatinine ratio annually. The
presence of albuminuria, micro albuminuria even in the setting of
normal GFR is associated with increased cardiovascular risk. Blood sugar,
hct, serum calcium, and lipid profile.
Why are ACE inhibitors the drug of choice in diabetic patients with
hypertension? - ANSWER ACE-Is will improve insulin sensitivity, as well
as reduce the effects of DM on the kidneys. Protect the kidneys, watch
for renal function, any creatinine >2.5 requires dose reduction. Prevents
diabetic nephropathy or slow its progression. Reduce albuminuria and
BP. ACEIs and ARBs should be used to treat the HTN. Renal protection,
reduces the conversion of AT II and improve the insulin sensitivity.
What is the drug of choice to improve symptoms for patients taking
propranolol? - ANSWER Ipratropium
,What is the most common adverse effect of an ACE inhibitor? - ANSWER
Dry, hacking cough in some patients. Can switch to an angiotensin
blocker which won't cause cough. Reduce dose with either of these if Cr
>2.5. Most are associated with hypotension, dizzi ness, HA, fatigue,
orthostatic hypotension, tachyphylaxis.
What is the action of an ACE inhibitor? - ANSWER Decreases angiotensin
II and aldosterone. Vasodilatation on the venous and arterial sides of the
heart. Blocks the RAAS system leads to rennin acts on angiotensinogen
to angiotensin I to angiotensin II through ACE. Angiotensin II stimulates
aldosterone causing sodium and water while losing potassium via the
kidney. ACE is also involved in the inactivation of bradykinin a
vasodilator. Bradykin is what causes the cough (irritating the lungs).
What is the action of an Angiotensin Receptor Blocker? - ANSWER Blocks
the angiotensin II receptor to leading to increasing vascular tone and
stimulating vascular smooth muscle contraction. One of the greatest
advantages: doesn't produce the dry, hacking cough that ACE-Is do.
Similar to ACE-I except to bradykinin activity (no cough), lowers BP,
decreases vascular resistance, decreases pulmonary cap wedge pressure,
decreases HR, increases cardiac index.
What ethnic background should not be prescribed long-acting beta-
agonists? - ANSWER African Americans, increased incidence of death in
this population
What is tiotropium used to treat? - ANSWER COPD, after patient stops
smoking, this medication slow the progression of COPD.
,What is the action of a Calcium Channel Blocker? - ANSWER Decrease
the amount of calcium inside the cell to control blood pressure.
Dihydropyridine CCB: inhibits transmembrane influx of extracellular
calcium ions across myocardial and vascular smooth muscl e cell
membranes without changing serum calcium concentrations. This results
in inhibition of cardiac and vascular smooth muscle contraction, thereby
dilating main coronary and systemic arteries. Vasodilatation with
decreased peripheral resistance and increased heart rate.
Nondihydropyridine CCB: inhibits extracellular calcium ion influx across
membranes of myocardial cells and vascular smooth muscle cells.
Resulting in inhibition of cardiac and vascular smooth muscle
contraction and thereby dilating main coronary and systemic arteries. No
effect on serum calcium contractions. Substantial inhibitory effects on
cardiac conduction system, acting principally at AV node, with some
effects at sinus node.
What are the adverse effects of a dihydropyridine-type calcium channel
blocker? - ANSWER Causes edema of the feet and hands, especially feet.
Amlodipine and nifedipine. Type 2 (dihydropyridine=vessel loving) =
peripheral edema. Type 1 (non-dihydropyridine=heart
loving)=bradycardia, dizziness, hypotension.
A 70-year-old patient is admitted with peripheral edema. He is taking a
calcium channel blocker and metformin. What is the cause of his
peripheral edema? - ANSWER The edema is not related to metformin.
Type 1 CCB more commonly exhibit peripheral edema. Pts report
swelling of the hands, feet, ankles, and decreased urine output.
, What special populations should not be prescribed pseudoephedrine? -
ANSWER Children under the age of 4, first line treatment for coughs and
colds is increased fluids and symptomatic management. Schedule III -
addictive personalities, HTN, CAD. Children under 4= Infants cause
sudden death, not recommended for children under 4. Anytime thinking
of cough and cold medications you should always think of the elderly,
very young and HTN.
How is amlodipine metabolized? - ANSWER All CCBs are metabolized by
the liver in the CYP 3A4. Avoid, don't administer CCB with grapefruit
juice, it will increase amlodipine level. Has a half life of 30 -50 hours
(56hr in hepatic impairment), eliminated via urine.
A patient is prescribed amlodipine. She develops reflex tachycardia.
What is the reason for the development of bradycardia? - ANSWER It
increases the myocardial oxygen delivery in patients with angina. Sub -
peripheral vasodilatation causes such a dramatic drop in BP that
baroreceptor reflex is triggered. The baroreceptors are in the aortic
arch. The baroreceptor causes sympathetic stimulation of the heart. It
increases pulse, it increases contractile force. Peripheral or facial edema
can result. Hypotension is a common adverse effect of CCB. A beta
blocker can be administered to prevent the reflex tachycardia. When
prescribing CCB you always start low and progress slow. Older patients
should be started at half the regular dose. Decrease in SA and AV node
conduction velocity occurs.
What drug should be prescribed for a patient with nasal congestion with
hypertension? - ANSWER Nasal oxymetazoline or nasal azelastine.
Cromolyn sodium, ipratropium bromide, or corticosteroids by inhalation
can be used safely for nasal congestion by patients with HTN.
antihypertensive agent? - ANSWER BP, RF, and head to toe assessment.
Assess diet, sodium intake, electrolytes, and potassium levels. Prior to
prescribing any antihypertensives, creatinine and BUN level s should be
evaluated. Confirmation of elevated BP at 3 different times. Children
over 3 years old should be assessed at least once at every visit-preferred
method for children is by auscultation, the correct measurement
requires using a cuff that is appropriate to the child's upper arm. 12 lead
EKG. UA, albumin, albumin/creatinine ratio. Diabetics or those with
renal disease should have the albumin/creatinine ratio annually. The
presence of albuminuria, micro albuminuria even in the setting of
normal GFR is associated with increased cardiovascular risk. Blood sugar,
hct, serum calcium, and lipid profile.
Why are ACE inhibitors the drug of choice in diabetic patients with
hypertension? - ANSWER ACE-Is will improve insulin sensitivity, as well
as reduce the effects of DM on the kidneys. Protect the kidneys, watch
for renal function, any creatinine >2.5 requires dose reduction. Prevents
diabetic nephropathy or slow its progression. Reduce albuminuria and
BP. ACEIs and ARBs should be used to treat the HTN. Renal protection,
reduces the conversion of AT II and improve the insulin sensitivity.
What is the drug of choice to improve symptoms for patients taking
propranolol? - ANSWER Ipratropium
,What is the most common adverse effect of an ACE inhibitor? - ANSWER
Dry, hacking cough in some patients. Can switch to an angiotensin
blocker which won't cause cough. Reduce dose with either of these if Cr
>2.5. Most are associated with hypotension, dizzi ness, HA, fatigue,
orthostatic hypotension, tachyphylaxis.
What is the action of an ACE inhibitor? - ANSWER Decreases angiotensin
II and aldosterone. Vasodilatation on the venous and arterial sides of the
heart. Blocks the RAAS system leads to rennin acts on angiotensinogen
to angiotensin I to angiotensin II through ACE. Angiotensin II stimulates
aldosterone causing sodium and water while losing potassium via the
kidney. ACE is also involved in the inactivation of bradykinin a
vasodilator. Bradykin is what causes the cough (irritating the lungs).
What is the action of an Angiotensin Receptor Blocker? - ANSWER Blocks
the angiotensin II receptor to leading to increasing vascular tone and
stimulating vascular smooth muscle contraction. One of the greatest
advantages: doesn't produce the dry, hacking cough that ACE-Is do.
Similar to ACE-I except to bradykinin activity (no cough), lowers BP,
decreases vascular resistance, decreases pulmonary cap wedge pressure,
decreases HR, increases cardiac index.
What ethnic background should not be prescribed long-acting beta-
agonists? - ANSWER African Americans, increased incidence of death in
this population
What is tiotropium used to treat? - ANSWER COPD, after patient stops
smoking, this medication slow the progression of COPD.
,What is the action of a Calcium Channel Blocker? - ANSWER Decrease
the amount of calcium inside the cell to control blood pressure.
Dihydropyridine CCB: inhibits transmembrane influx of extracellular
calcium ions across myocardial and vascular smooth muscl e cell
membranes without changing serum calcium concentrations. This results
in inhibition of cardiac and vascular smooth muscle contraction, thereby
dilating main coronary and systemic arteries. Vasodilatation with
decreased peripheral resistance and increased heart rate.
Nondihydropyridine CCB: inhibits extracellular calcium ion influx across
membranes of myocardial cells and vascular smooth muscle cells.
Resulting in inhibition of cardiac and vascular smooth muscle
contraction and thereby dilating main coronary and systemic arteries. No
effect on serum calcium contractions. Substantial inhibitory effects on
cardiac conduction system, acting principally at AV node, with some
effects at sinus node.
What are the adverse effects of a dihydropyridine-type calcium channel
blocker? - ANSWER Causes edema of the feet and hands, especially feet.
Amlodipine and nifedipine. Type 2 (dihydropyridine=vessel loving) =
peripheral edema. Type 1 (non-dihydropyridine=heart
loving)=bradycardia, dizziness, hypotension.
A 70-year-old patient is admitted with peripheral edema. He is taking a
calcium channel blocker and metformin. What is the cause of his
peripheral edema? - ANSWER The edema is not related to metformin.
Type 1 CCB more commonly exhibit peripheral edema. Pts report
swelling of the hands, feet, ankles, and decreased urine output.
, What special populations should not be prescribed pseudoephedrine? -
ANSWER Children under the age of 4, first line treatment for coughs and
colds is increased fluids and symptomatic management. Schedule III -
addictive personalities, HTN, CAD. Children under 4= Infants cause
sudden death, not recommended for children under 4. Anytime thinking
of cough and cold medications you should always think of the elderly,
very young and HTN.
How is amlodipine metabolized? - ANSWER All CCBs are metabolized by
the liver in the CYP 3A4. Avoid, don't administer CCB with grapefruit
juice, it will increase amlodipine level. Has a half life of 30 -50 hours
(56hr in hepatic impairment), eliminated via urine.
A patient is prescribed amlodipine. She develops reflex tachycardia.
What is the reason for the development of bradycardia? - ANSWER It
increases the myocardial oxygen delivery in patients with angina. Sub -
peripheral vasodilatation causes such a dramatic drop in BP that
baroreceptor reflex is triggered. The baroreceptors are in the aortic
arch. The baroreceptor causes sympathetic stimulation of the heart. It
increases pulse, it increases contractile force. Peripheral or facial edema
can result. Hypotension is a common adverse effect of CCB. A beta
blocker can be administered to prevent the reflex tachycardia. When
prescribing CCB you always start low and progress slow. Older patients
should be started at half the regular dose. Decrease in SA and AV node
conduction velocity occurs.
What drug should be prescribed for a patient with nasal congestion with
hypertension? - ANSWER Nasal oxymetazoline or nasal azelastine.
Cromolyn sodium, ipratropium bromide, or corticosteroids by inhalation
can be used safely for nasal congestion by patients with HTN.
