Antihypertensive Medications

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Questions and Answers

What is a potential adverse effect of Triamterene?

Tachycardia

Bradycardia

Hyperkalemia (correct)

Hypoglycemia

Which of the following medications is the drug of choice for treating pregnant women with mild preeclampsia?

ARBs

Beta blockers

ACEI

Labetalol and methyldopa (correct)

Why should beta blockers be used with caution in diabetic patients?

They can increase heart rate

They can cause hypoglycemia

They can increase blood pressure

They can suppress glycogenolysis and mask early signs of hypoglycemia (correct)

What is the preferred antihypertensive medication for African Americans?

Diuretics Signup and view all the answers

Which of the following medication combinations are recommended when blood pressure cannot be adequately controlled by a single drug?

All of the above Signup and view all the answers

Which of the following medications are contraindicated in pregnancy?

ACEIs, ARBs, and DRI's Signup and view all the answers

Which two medications are recommended for pregnant women with hypertension?

Methyldopa and labetalol Signup and view all the answers

Why are ACEIs less effective in African Americans when used as monotherapy?

Because they are less effective in african americans due to genetic differences Signup and view all the answers

What is a contraindication for using Nifedipine?

Unstable Angina Signup and view all the answers

Why is Nifedipine preferred over Verapamil in certain patients?

Because it causes less calcium channel blockade in the heart Signup and view all the answers

What is a common adverse effect of Nifedipine?

Flushing Signup and view all the answers

What is the therapeutic goal of Hydralazine?

To reduce afterload in CHF Signup and view all the answers

What is prescribed to counteract reflex tachycardia caused by Hydralazine?

Beta Blocker Signup and view all the answers

What is a potential interaction of Hydralazine with another medication?

With beta blockers to counteract adverse effects Signup and view all the answers

What is a potential adverse effect of Hydralazine?

Postural hypotension Signup and view all the answers

How long do symptoms of lupus-like syndrome caused by Hydralazine typically last?

6 months Signup and view all the answers

What is the primary mechanism of action of digoxin?

Increasing myocardial contractility and altering electrical activity of the heart Signup and view all the answers

What is a potential interaction of digoxin?

Hypokalemia and increased risk of dysrhythmia Signup and view all the answers

Which of the following medications is preferred for people with lung issues?

Metoprolol Signup and view all the answers

What is the first-line medication for someone with diabetes and/or kidney disease?

Lisinopril Signup and view all the answers

What is the preferred medication for African Americans?

Metoprolol Signup and view all the answers

Which of the following medications is contraindicated in pregnancy?

Lisinopril Signup and view all the answers

What is the antidote for digoxin?

Digibind Signup and view all the answers

What is the preferred medication for patients with type 2 diabetes who also have cardiovascular disease or cardiovascular risk, kidney disease, or heart failure?

Sodium-glucose cotransporter 2 inhibitor and/or glucagon-like peptide 1 receptor agonist Signup and view all the answers

Study Notes

Adverse Effects of Triamterene (Dyrenium)

Hyperkalemia, nausea, vomiting, leg cramps, dizziness

Hypertension in Pregnancy

Labetalol and methyldopa are the drugs of choice for treating pregnant women with mild preeclampsia

Hypertension in Diabetics

ACEI, ARBs, and diuretics in low doses are the preferred antihypertensive drugs
Beta blockers should be used with caution as they can suppress glycogenolysis and mask early signs of hypoglycemia

Hypertension in African Americans

Diuretics are the first choice of drugs for treating hypertension in the African American population
Monotherapy with beta blockers and ACEIs is less effective in African Americans compared to Caucasians
ACEIs should be used in African American patients with type 1 diabetes and proteinuria, or with hypertensive nephrosclerosis

Combination Therapy for Hypertension

ACEI plus a thiazide diuretic, an ACEI plus a CCB, or a beta blocker plus a thiazide are recommended combinations when blood pressure cannot be adequately controlled by a single drug

Contraindications in Pregnancy

ACEIs, ARBs, and DRI's are counteracted in pregnancy
Methyldopa and labetalol are recommended for pregnant women

Digoxin (Lanoxin)

MOA: increases myocardial contractility, alters electrical activity of the heart
Use: treats dysrhythmia (A-fib or flutter) or CHF
Interactions: hypokalemia and increased risk of dysrhythmia
Monitoring: digoxin levels, apical pulse, and assess for decreased S/S of CHF
Teaching: how to monitor HR, hold if below 50, signs of toxicity (altered heart rate or rhythm, visual or gastrointestinal disturbances)
Antidote: Digibind

Metoprolol (Lopressor)

Selective B-Adrenergic Blocker (B1)
Preferred for people with lung issues because it only affects the heart, not the lungs
Treats: angina, HF, HTN, and MI

Medication Preferences

ACEI (Lisinopril) or ARB (losartan) are preferred for diabetic patients with high blood pressure
Metoprolol is preferred for African Americans
Metformin is the first medication to choose when treating patients with diabetes

Nifedipine (CCB)

Contraindications: IR dose is associated with increased mortality in MI and unstable angina
Preferred over verapamil for patients with AV block, heart failure, bradycardia, or sick sinus syndrome
Adverse effects: flushing, dizziness, peripheral edema, gingival hyperplasia, chronic eczematous rash
Patient education and monitoring: monitor BP and angina record, teach patients to keep an angina record and monitor their blood pressure and AE

Hydralazine

MOA: vasodilator, dilates arterioles and peripheral resistance, and arterial blood pressure falls
Therapeutic goal: to reduce BP and reduce afterload in a short time in CHF
Interactions and adverse effects: caution with use in other hypotensive drugs, postural hypotension, reflex tachy, myocardial contractility, NA and water retention, and lupus-like syndrome
If tachycardia reflex is severe, prescribe beta blocker to counteract it

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Description

This quiz covers the use of antihypertensive medications in specific populations, including individuals with triamterene side effects, pregnant women, and diabetics.