CMN 572 - EXAM 2 (BOOK)
QUESTIONS AND ANSWERS
Chemoprevention (p.10) - Correct Answers -Low dose (81mg) ASA reduces CV events
but increases GI bleeding. Also reduces colorectal, esophageal, gastric, breast,
prostate, and possible lung cancer. Benefits> Risks in middle age adult who are at inc
risk for CV disease (>10%) - and do not have risk of bleeding. Older adults:
risks>benefits = should not be initiated in adults >70yo
Chemoprevention with nonsteroidal antiinflammatory (NSAIDs) - Correct Answers -MAY
reduce risk of colorectal adenomas and polyps but inc risk of heart dx and GIB = not
recommended for colon cancer prevention in average risk patients
Chemoprevention with antioxidant vitamin (E, C and beta carotene) - Correct Answers -
No significant refuction in 5 year incident of mortality from vascular, cancer, or other
major outcomes in high risk patients with CAD or other arterial disease or DM.
Osteoporosis chemoprevention (p. 11) - Correct Answers -Screening for women >65yo
or younger at inc risk for fx
Low adherence to biphosphonate tx (femoral fx, jaw osteonecrosis)
HTN stats - Correct Answers ->45% os US adults have BP >140/90 or are being tx for
htn - only controlled in 52% of ppl. SBP and PP better predictors >50yo. More blacks
than whites.
Measuring BP - Correct Answers -Cuff encircle 80% of the arm circumference, pt
resting for at least 5 min or at least 30 min after smoking or coffee. Ambulatory
pressures are better (white coat)
One single elevated BP not sufficient for tx.
Normal in office <120/80, elevate 120-129/80, st 1 130-139/80-89, stage 2 >140/90
HTN exacerbating factors (primary HTN) - Correct Answers -Obesity, OSA(CPAP
improves BP), inc salt intake, alcohol, smoking, polycythemia, NSAIDs(avoid if high
BP), low potassium intake
Metabolic syndrome - waist, insulin resistance, triglycerimia) - high c reactive protein
and low hdl
Genetics and HTN - Correct Answers -Glucocorticoid aldoteronism - autosomal
dominant - early onset
Mineralocorticoid excess - autosomal recessive
Licorice causes high BP
,Pregnancy HTN - autosomal dominant
Gordon syndrome - autosomal dominant - thiazide diuretic
Fibromuscular dysplasia - Correct Answers -Most commonly affects renal artery and
carotid artery in women <50yo - HTN!
Renal causes - onset before 20 or after 50, resistant to drugs, no atherosclerosis, no
aorta problems, no pad, presence of pulm htn
Primary hyperaldosteronism - Correct Answers -Adenoma of adrenal cortex
(aldesterone elevated>16ng); take plasma aldosterone/renin ratio, hold BP meds for 2-4
weeks, replace with verapimil)
Resistant HTN
Cushing syndrome and htn
Pheochromocytoma and htn - Correct Answers -cushing: Excess glucocorticoid - salt
and water retention
pheo: cathecolamine excess - crisis precipitated by TCA, antidopaminergics, naloxone,
metoclopramine
Drugs that can cause inc in BP - Correct Answers -Cyclosporine, tacrolumys,
angiogenesis inhibitors, and erythropoetin
NSAIDs, cocaine, alcohol
Yohimbine - libido - severe rebound with clonidine
Most adverse events associated with HTN are seen with ___________ rather than
___________. - Correct Answers -Thrombosis; rather than bleeding!
Remember that home and ambulatory BPs are superior to office readings (major
predisposing factor in all types of stroke - SBP)
Labs for HTN - Correct Answers -Hemoglobin; serum electrolytes and serum creatinine;
fasting blood sugar level (hypertension is a risk factor for the development of diabetes,
and hyperglycemia can be a presenting feature of pheochromocytoma); plasma lipids
(necessary to calculate cardiovascular risk and as a modifiable risk factor); serum uric
acid (hyperuricemia is a relative contraindication to diuretic therapy); and urinalysis.
Lifestyle modifications for HTN - Correct Answers -diet rich in fruits, vegetables, and
low-fat dairy foods and low in saturated and total fats (DASH diet) has been shown to
lower blood pressure. Increased dietary fiber lowers blood pressure. For every 7 g of
dietary fiber ingested, cardiovascular risk could be lowered by 9%.
HTN risk factors - Correct Answers -Hypertension1
Cigarette smoking
Obesity (BMI ≥ 30)1
Physical inactivity
Dyslipidemia1
Diabetes mellitus1
,Microalbuminuria or estimated GFR < 60 mL/min
Age (> 55 years for men, > 65 years for women)
Family history of premature cardiovascular disease (< 55 years for men, < 65 years for
women)
USE ASCVD ESTIMATOR!
ACC uses meds if BP >140/90 to target BP <130/80, elderly >65yo >130/80
ACEi (prils) - Correct Answers -Usual initial med for mild to mod htn - more effective in
younger white pts - less effective in blacks and older ppl (ACEi with ccb or diuretic is
potent)
ACEi is choice for pts with T1D (and some t2d) and frank proteinuria
Need baseline BMP, and repeat 1-2 weeks after starting ACEi to eval creatinine and K
SE: sever hypotension with kidney sclerosis, hyperkalemia, chronic dry cough, skin
rash, angioedema dangerous (stop), teratogenic
ARBs (angiotensin II receptor blockers) - Correct Answers -For pts with HF and T2D
ARBs not preferred for blacks
Do not add ARB with ACEi, not advised
SE: rarely cause cough or skin rash or angioedema. Hyperkalemia,, sprue syndrome,
nausea, weight loss, less depression than BB and CCBs
Renin Inhibitors - Correct Answers -Aliskiren - lowers bp, dec albuminuria, limits LVHF,
do not mix with ACEi and ARBs
CCBs (mils, nicardipine, amlodipine, nifedipine) - Correct Answers -Preferred in blacks
over ACEi and BBs
Equivalent to ACEi and diuretics in prevention of CAD
SE: HA, peripheral edema, bradycardia, constipation
Edema minimized by adding ACEi or ARB
Amlodipine is good for severe HF, and SAFE
Thiazide diuretics (HCTZ) and loop diuretics (lasix) - Correct Answers -Reduces
peripheral vascular resistance
Loops lead to electrolyte and volume depletion (shorter duration - for pts with kidney
dysfunction)
MORE POTENT in blacks, older pts, and obese pts
More effective in smokers
Causes osteoporosis in women
OK to use with other BP meds
SE: ED, skin rash, photosensitivity, hypokalemia (inc dietary)
Precipitates gout, causes diabetes, inc LDL, TG
Aldosterone receptor antagonists - - Correct Answers -Spironolactone and Eplerenone -
weak for htn
Effective in blacks
, Prevents organ damage
SE: breast pain and gynecomastia, hyperkalemia
Beta blockers - lols - Correct Answers -Dec. HR. and CO.
Metoprolol good for HFeEF
Not used as first line agents for HTN (ACEi or ARBs are.)
SE: bronchospasms, arrhythmias, nasal congestion, raynauds, CNS s/s, nightmares,
depression, confusion, fatigue, lethargy, ED
Mask hypoglycemia s/s
use with caution for PAD
Do not give BB with phentolamine
Do not give BB for cocaine use
alpha adrenoreceptor antagonists - Correct Answers -Prazosin, terazosin, etc
Unlike BBs and diuretics, no effect on TGs, it can actually increase HDL
SE: hypotension, palpitation, hd, not for pts that had cataract surgery
Clonidine, methyldopa (pregnant), guanabenz, granfacine - Correct Answers -Lowers
bp, secondary or third agents!
SE: sedation, fatigue, dry mouth, postural hypotension, ED, rebound HTN
methyldopa causes hepatitis and hemolytic anemia
Reserpine, guanethidine and guanadrel to lower BP - Correct Answers -Causes
depression, sedation, nasal stuffiness, sleep disturbances, peptic ulcers
Granathidine and guanadrel - diarrhea, hypotension, fluid retention
Hydralazine and Minoxidil - Correct Answers -Arterial vasodilators - reflex tachy - HA,
palpitation and fluid retention
Combine it with diuretic or BBs
Hydralazine can cause lupus like syndrome
Hypertensive meds and cancer - Correct Answers -ACEi and lung cancer
CCBs and breast cancer ????
Initial tx for HTN: - Correct Answers -ACEi, ARBs or CCBs
Thiazides: older pts
Blacks: THIAZIDES
Calcium channel blockers and diuretics are more effective in older or black persons, in
whom renin levels are generally lower.
In diabetic patients, three or four drugs are usually required to reduce systolic blood
pressure to less than 140 mm Hg
QUESTIONS AND ANSWERS
Chemoprevention (p.10) - Correct Answers -Low dose (81mg) ASA reduces CV events
but increases GI bleeding. Also reduces colorectal, esophageal, gastric, breast,
prostate, and possible lung cancer. Benefits> Risks in middle age adult who are at inc
risk for CV disease (>10%) - and do not have risk of bleeding. Older adults:
risks>benefits = should not be initiated in adults >70yo
Chemoprevention with nonsteroidal antiinflammatory (NSAIDs) - Correct Answers -MAY
reduce risk of colorectal adenomas and polyps but inc risk of heart dx and GIB = not
recommended for colon cancer prevention in average risk patients
Chemoprevention with antioxidant vitamin (E, C and beta carotene) - Correct Answers -
No significant refuction in 5 year incident of mortality from vascular, cancer, or other
major outcomes in high risk patients with CAD or other arterial disease or DM.
Osteoporosis chemoprevention (p. 11) - Correct Answers -Screening for women >65yo
or younger at inc risk for fx
Low adherence to biphosphonate tx (femoral fx, jaw osteonecrosis)
HTN stats - Correct Answers ->45% os US adults have BP >140/90 or are being tx for
htn - only controlled in 52% of ppl. SBP and PP better predictors >50yo. More blacks
than whites.
Measuring BP - Correct Answers -Cuff encircle 80% of the arm circumference, pt
resting for at least 5 min or at least 30 min after smoking or coffee. Ambulatory
pressures are better (white coat)
One single elevated BP not sufficient for tx.
Normal in office <120/80, elevate 120-129/80, st 1 130-139/80-89, stage 2 >140/90
HTN exacerbating factors (primary HTN) - Correct Answers -Obesity, OSA(CPAP
improves BP), inc salt intake, alcohol, smoking, polycythemia, NSAIDs(avoid if high
BP), low potassium intake
Metabolic syndrome - waist, insulin resistance, triglycerimia) - high c reactive protein
and low hdl
Genetics and HTN - Correct Answers -Glucocorticoid aldoteronism - autosomal
dominant - early onset
Mineralocorticoid excess - autosomal recessive
Licorice causes high BP
,Pregnancy HTN - autosomal dominant
Gordon syndrome - autosomal dominant - thiazide diuretic
Fibromuscular dysplasia - Correct Answers -Most commonly affects renal artery and
carotid artery in women <50yo - HTN!
Renal causes - onset before 20 or after 50, resistant to drugs, no atherosclerosis, no
aorta problems, no pad, presence of pulm htn
Primary hyperaldosteronism - Correct Answers -Adenoma of adrenal cortex
(aldesterone elevated>16ng); take plasma aldosterone/renin ratio, hold BP meds for 2-4
weeks, replace with verapimil)
Resistant HTN
Cushing syndrome and htn
Pheochromocytoma and htn - Correct Answers -cushing: Excess glucocorticoid - salt
and water retention
pheo: cathecolamine excess - crisis precipitated by TCA, antidopaminergics, naloxone,
metoclopramine
Drugs that can cause inc in BP - Correct Answers -Cyclosporine, tacrolumys,
angiogenesis inhibitors, and erythropoetin
NSAIDs, cocaine, alcohol
Yohimbine - libido - severe rebound with clonidine
Most adverse events associated with HTN are seen with ___________ rather than
___________. - Correct Answers -Thrombosis; rather than bleeding!
Remember that home and ambulatory BPs are superior to office readings (major
predisposing factor in all types of stroke - SBP)
Labs for HTN - Correct Answers -Hemoglobin; serum electrolytes and serum creatinine;
fasting blood sugar level (hypertension is a risk factor for the development of diabetes,
and hyperglycemia can be a presenting feature of pheochromocytoma); plasma lipids
(necessary to calculate cardiovascular risk and as a modifiable risk factor); serum uric
acid (hyperuricemia is a relative contraindication to diuretic therapy); and urinalysis.
Lifestyle modifications for HTN - Correct Answers -diet rich in fruits, vegetables, and
low-fat dairy foods and low in saturated and total fats (DASH diet) has been shown to
lower blood pressure. Increased dietary fiber lowers blood pressure. For every 7 g of
dietary fiber ingested, cardiovascular risk could be lowered by 9%.
HTN risk factors - Correct Answers -Hypertension1
Cigarette smoking
Obesity (BMI ≥ 30)1
Physical inactivity
Dyslipidemia1
Diabetes mellitus1
,Microalbuminuria or estimated GFR < 60 mL/min
Age (> 55 years for men, > 65 years for women)
Family history of premature cardiovascular disease (< 55 years for men, < 65 years for
women)
USE ASCVD ESTIMATOR!
ACC uses meds if BP >140/90 to target BP <130/80, elderly >65yo >130/80
ACEi (prils) - Correct Answers -Usual initial med for mild to mod htn - more effective in
younger white pts - less effective in blacks and older ppl (ACEi with ccb or diuretic is
potent)
ACEi is choice for pts with T1D (and some t2d) and frank proteinuria
Need baseline BMP, and repeat 1-2 weeks after starting ACEi to eval creatinine and K
SE: sever hypotension with kidney sclerosis, hyperkalemia, chronic dry cough, skin
rash, angioedema dangerous (stop), teratogenic
ARBs (angiotensin II receptor blockers) - Correct Answers -For pts with HF and T2D
ARBs not preferred for blacks
Do not add ARB with ACEi, not advised
SE: rarely cause cough or skin rash or angioedema. Hyperkalemia,, sprue syndrome,
nausea, weight loss, less depression than BB and CCBs
Renin Inhibitors - Correct Answers -Aliskiren - lowers bp, dec albuminuria, limits LVHF,
do not mix with ACEi and ARBs
CCBs (mils, nicardipine, amlodipine, nifedipine) - Correct Answers -Preferred in blacks
over ACEi and BBs
Equivalent to ACEi and diuretics in prevention of CAD
SE: HA, peripheral edema, bradycardia, constipation
Edema minimized by adding ACEi or ARB
Amlodipine is good for severe HF, and SAFE
Thiazide diuretics (HCTZ) and loop diuretics (lasix) - Correct Answers -Reduces
peripheral vascular resistance
Loops lead to electrolyte and volume depletion (shorter duration - for pts with kidney
dysfunction)
MORE POTENT in blacks, older pts, and obese pts
More effective in smokers
Causes osteoporosis in women
OK to use with other BP meds
SE: ED, skin rash, photosensitivity, hypokalemia (inc dietary)
Precipitates gout, causes diabetes, inc LDL, TG
Aldosterone receptor antagonists - - Correct Answers -Spironolactone and Eplerenone -
weak for htn
Effective in blacks
, Prevents organ damage
SE: breast pain and gynecomastia, hyperkalemia
Beta blockers - lols - Correct Answers -Dec. HR. and CO.
Metoprolol good for HFeEF
Not used as first line agents for HTN (ACEi or ARBs are.)
SE: bronchospasms, arrhythmias, nasal congestion, raynauds, CNS s/s, nightmares,
depression, confusion, fatigue, lethargy, ED
Mask hypoglycemia s/s
use with caution for PAD
Do not give BB with phentolamine
Do not give BB for cocaine use
alpha adrenoreceptor antagonists - Correct Answers -Prazosin, terazosin, etc
Unlike BBs and diuretics, no effect on TGs, it can actually increase HDL
SE: hypotension, palpitation, hd, not for pts that had cataract surgery
Clonidine, methyldopa (pregnant), guanabenz, granfacine - Correct Answers -Lowers
bp, secondary or third agents!
SE: sedation, fatigue, dry mouth, postural hypotension, ED, rebound HTN
methyldopa causes hepatitis and hemolytic anemia
Reserpine, guanethidine and guanadrel to lower BP - Correct Answers -Causes
depression, sedation, nasal stuffiness, sleep disturbances, peptic ulcers
Granathidine and guanadrel - diarrhea, hypotension, fluid retention
Hydralazine and Minoxidil - Correct Answers -Arterial vasodilators - reflex tachy - HA,
palpitation and fluid retention
Combine it with diuretic or BBs
Hydralazine can cause lupus like syndrome
Hypertensive meds and cancer - Correct Answers -ACEi and lung cancer
CCBs and breast cancer ????
Initial tx for HTN: - Correct Answers -ACEi, ARBs or CCBs
Thiazides: older pts
Blacks: THIAZIDES
Calcium channel blockers and diuretics are more effective in older or black persons, in
whom renin levels are generally lower.
In diabetic patients, three or four drugs are usually required to reduce systolic blood
pressure to less than 140 mm Hg
