AGNP AANP HTN REVIEW ACTUAL QUESTIONS

AGNP (AANP) HTN REVIEW (ACTUAL / ) QUESTIONS

AND VERIFIED CORRECT ANSWERS GRADED A+

Proteinuric chronic kidney disease Heart failure, MI complicated by systolic dysfunction as well as high risk pts without systolic dysfunction.(reduced CV mortality) Recurrent stroke prevention with diuretic

LVH: Helps reverse left ventricular remodeling and

hypertrophy due to HTN.

ACE Inhibitors Agents with more than 50% of their peak effect at 24 hours, may be taken once daily. Tranolapril, Fosinopril, and Ramipril

But remember to check BP in AM and different times of day to determine adequate control.

AM is when the BP is highest and most likely to have CV events occur.

LABS: Serum K+ and creatinine before Rx and approx 1 week

after starting Rx.(also refer to previous slide on lab and test recommendations)

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Start low in elderly and in patients with renal insufficiency. If creatinine increases over 30-35%% after starting ACEI, discontinue until further evaluation.

ACEI adverse effects Most troublesome side effect is cough (present in 10-20% of pts)

Renal insufficiency up to 35% rise in creatinine is acceptable following institution of ACEI therapy-if higher, stop ACEI and check for bilateral RAS

Hyperkalemia -when used in conjunction with NSAIDS, potassium sparing drugs or supplements Remember to warn about salt substitute containing potassium!

Uncommon side effects: rash, taste disturbances, angioedema

(rare) agranulocytosis (rare and prevalent only at very high doses)

DO NOT GIVE IN PREGNANCY!!!! Be Careful with women of childbearing age!

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No ACE inhibitors or ARBs in Pregnancy SUMMARY AND RECOMMENDATIONS — There are significant fetal risks associated with the use of ACE inhibitors and ARBs in all stages of pregnancy. Early exposure to ACE inhibitors (and probably ARBs) may lead to cardiovascular and central nervous system malformations.

Angiotensin II receptor blockers (ARBs)

Mechanism of action: blocks angiotensin II receptor, thus

inhibiting the vasoconstrictive effects and associated stimulation of aldosterone production.

No effects on bradykinin metabolism-so no cough side effect.(some sources state much less chance)

Research and emerging data: preserves renal function,

reverses LV remodeling, and lowers CV mortality and morbidity. Also slows dementia!

Same labs and monitoring as ACEIs (nephrologists may Rx ACEI and ARB for some patients with chronic renal failure)

May be more expensive (losartan is generic as of 2010)

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Calcium Channel Blockers

Mechanism of Action:

Impedes the entry of calcium in heart and vascular smooth muscle cells, resulting in decreased calcium concentration, which reduces vascular smooth muscle contraction and lowers peripheral resistance.

Slows conduction and reduces inotropy(force of contraction) in heart.

Mild natriuretic effect

CCBs are well-tolerated and effective in lowering BP, particularly in elderly and African Americans.

May be preferred in patients with COPD and asthma.

This makes them useful in pts with sodium retention.(elderly and African Americans)

Isolated Systolic HTN with increased risk of stroke:

initial use of CCB continues to be supported by trial-based evidence.

CCB: Nondihydropyridines

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