CC January 2015 Multidrug therapy for hypertension

echoecho's version from 2015-05-20 15:50


Question Answer
***The combination of beta blocker and thiazide diuretic may increase incidence of?hyperglycemia
*** The combination of beta-blocker/thiazide combinations can also increase?fatigue and sexual dysfunction
*** Diltiazem (Cardizem), a nondihydropyridine calcium channel blocker, has what 2 activities?1) antihydertensive 2) negative chronotropic activity
*** When Diltiazem (Cardizem) is used in conjunction with a beta blocker, what can occur?symptomatic bradycardia (especially in pts w/ underlying cardiac conduction disease)
*** When a beta-blocker combined with centrally-acting alpha-agonists (Clonidine {Catapres}) are associated with increased incidence of?bradycardia, severe rebound HTN after sudden cessation of therapy
Spironolactone (Aldactone), an aldosterone antagonist, when used with an ACEI can reduce ____ clearance and potentiate the development of ______?potassium; hyperkalemia
Potassium-sparing diuretics like triamterene may also increase the risk of hyperkalemia when used in conjunction with either what two drugs?) spironolactone 2) ACEI
*** Risk for developing hyperkalemia has been associated with a base line potassium of > ____ and GFR < ____?5; 45
Combination diuretic therapy in the absnece of severe edema or heart failure can greatly increase the risk of ____ abnormalities?electrolyte
Use of 2 or more ACEI / ARBs provides no benefit over single agent therapy, true or false?true
There is an increase in the risk of renal dysfunction and hyperkalemia with what combination?ACEI / ARB combination
*** Concerns over the potential increase in vascular events with aggressive hypertensive menagement have led clinicians to revisit goals of therapy. What is the J-point phenomenon?where cardiovascular events may increase with further reduction in diastolic BP, have led to scaling back attempts to reduce diastolic HTN in fear that coronary blood flowmay be compromiased during distole
*** Recent studies, indicated cardiac events in conjunection with diastolic lowering are seen predominately in pts w/ systolic BP > _____ mm Hg?140
List benefits of multidrug therapy for HTN?1) improvement in HTNsive control - more prompt BP response and greater probability of sachieving goals, especially in those w/ higher elevations of BP 2) reduction in individual drug dose, thus potentially decreasing the adverse effects of each individual agt 3) complementary effects where one agt may reduce or eliminate the side effect of another med (ACEi use may decrease the peripheral edema noted with dihydropyridine calcium channel blockers)
List the disadvantages of multidrug therapy for HTN?1) increase the risk of drug-drug interactions because more medications are being used 2) amplify the side effects of medications with similar properties 3) reduce patient compliance with prescribed therapy requiring multiple pills
Combination formualtions may improve _____? compliance
Question Answer
The JNC-8 recommends?1) initiate single-drug therapy and titrate as needed to a maximum doses until a second agt is required 2) initiate single therapy and add a second agt if the pt does not reach target w/ the initial drug and dose 3) initiate combination therapy at the onset of HTN management