Pharmacology Chapter 12 Quiz

Hypertension Treatment

• Secondary hypertension is treated by addressing the underlying cause.
• Primary (essential) hypertension management typically involves multiple medications.
• First-line treatments for primary hypertension:
  • Thiazide-type diuretics
  • ACE inhibitors
  • ARBs (Angiotensin II Receptor Blockers)
  • CCBs (Calcium Channel Blockers)
• Factors influencing the choice of first-line treatment:
  • Patient's race
  • Side effect profiles of drugs
  • Patient preferences
• ACE inhibitors and ARBs are less commonly used as first-line treatments in Black patients.
• CCBs are not suitable for patients suffering from constipation.
• If one drug fails to achieve target blood pressure, a second first-line treatment should be added.

Heart Failure Management

• Patients with heart failure often require additional medications, including beta blockers, diuretics, and other antihypertensives.
• In cases of decompensated heart failure, beta blockers should not be administered.
• First pharmacological step for heart failure treatment aims at reducing fluid volume, typically using loop diuretics and an aldosterone receptor blocker like spironolactone.
• Key agents in heart failure treatment include diuretics, ACE inhibitors or ARBs, and beta blockers (carvedilol, metoprolol, bisoprolol).
• Adding an aldosterone receptor blocker helps prevent hypokalemia and decreases digoxin toxicity.

Digoxin and Ionotropic Agents

• Digoxin is no longer first-line due to lacking evidence for mortality reduction; it is reserved for controlling symptoms in patients on optimized therapy.
• Positive ionotropic agents increase heart contractility but may have side effects such as gastrointestinal issues and dysrhythmias.
• Pathognomonic symptoms of digoxin toxicity include yellow/green halos in vision.
• Treat digoxin toxicity with anti-digoxin antibodies like DigiFab and Digibind, which prevent digoxin from binding to Na/K ATPase.

Additional Heart Failure Treatments

• PDE inhibitors like inamrinone and milrinone are utilized for acutely ill patients but have side effects including hepatotoxicity and thromobocytopenia.
• Dobutamine is a beta-1 selective agonist useful in decompensated heart failure with hypotension.
• Theophylline, a less selective PDE inhibitor, is used in asthma or COPD but is not first-line therapy.

Angina Types and Management

• Angina arises when cardiac workload surpasses perfusion capabilities.
• Three forms of angina: stable, unstable, and Prinzmetal's angina.
• Stable angina is a result of coronary artery disease, while unstable angina involves acute episodes of chest pain unrelieved by usual measures.
• Prinzmetal's angina is caused by coronary vasospasm, potentially independent of coronary artery disease.
• Treatment for Prinzmetal's angina includes CCBs for prophylaxis and nitrates for acute relief.

Stable Angina Treatment

• Management of stable angina includes acute relief with nitrates, alongside prophylactic measures like long-acting nitrates, CCBs, beta-blockers, statins, and antiplatelet therapy.
• Lifestyle modifications critical for patients include smoking cessation, diet improvements, regular exercise, and stress management.
• Aggravating factors for angina include hypertension, diabetes, dyslipidemia, and depression.

Ranolazine

• Acts by modifying Na-dependent calcium channel conductance during ischemia and inhibiting fatty-acid oxidation in heart cells.
• Prescribed for angina prophylaxis to manage symptoms.