Post 8 HTN/ Lipids

Before starting atorvastatin (LIPITOR), it is important to:

A. Document that the patient failed therapy with Niacin and one of the bile acid
sequestrants (Colestipol or Cholestyramine).
B. Be sure the patient is not pregnant.
C. Teach the patient how to do home blood sugar monitoring and be sure patient has
the equipment.
D. Document normal conductivity through heart with EKG.



Some antihypertensive drugs block both alpha and beta receptors. Why would this be a good thing for someone with hypertension?

A. it causes vasodilation
B. it decreases renin release
C. it increases cardiac output
D. 1, 2 only
E. 1,2,3



The mechanism of action of this drug is dilation of arterioles by a direct effect on vascular smooth muscle.

A. clonidine (CATAPRES)
B. captopril (CAPOTEN)
C. hydralazine (APRESOLINE)
D. atropine



Losartan (COZAAR) is an angiotensin II receptor antagonist which would be expected to have which side effect(s):

A. Hypokalemia (low potassium)
B. Pupil constriction
C. Dizziness
D. Dry mouth



Aldosterone alters blood pressure because it

A. causes potassium excretion.
B. dilates blood vessles.
C. causes sodium retention.
D. enhances renin release.



In acute head injury, the osmotic diuretic mannitol may be given to reduce brain swelling. What potential problem would you need to monitor for?

A. The mannitol prevents electrolytes from being excreted by the
kidney.
B. The blood pressure could drop quickly as fluid is pulled from cells into the
blood stream.
C. Urine output typically drops transiently during the first 4 hours.
D. Over time, if the mannitol diffuses into the brain, it would make the swelling
worse.



All of the following are adverse effects of furosemide (LASIX) EXCEPT

A. high blood potassium levels
B. low blood sodium and chloride levels
C. hypotension
D. hearing loss



Hyperlipidemia drug therapy for a person with existing coronary heart disease should begin when:

A. LDL cholesterol is greater than 100.
B. HDL cholesterol is elevated.
C. The patient has lost 10% of his/her body weight.
D. Blood pressure is under control.



R.J. is a 55 yo male with long standing hypertension who has been treated with Dyazide one capsule each day. On this clinic visit, a urine sample is positive for spilled protein. His BP is 136/82. You should:

A. Discontinue the Dyazide. After 1 week, start captopril 25 mg twice each
day.
B. No drug changes are required. He should have a low protein diet.
C. Increase the Dyazide dose to 2 capsule each day.
D. Add captopril 50 mg three times each day.



P.P. is a 52 yo diabetic AA female who just had a stroke. She has had long term HTN. Current meds are: lisinopril 20 mg each day, labetalol 400 mg twice a day, lasix 20 mg twice each day. Current labs include sodium 138 (normal 135-145) and potassium 3.5 (normal 3.5-5). Her BP is 210/118 and her pulse is 75. You should:

A. Increase the labetalol.
B. Add losartan.
C. Increase the lasix.
D. Increase the lisinopril.



A patient crushed his sustained-release verapamil tablet before ingesting it. Which action would you most likely take?

A. Administer short acting verapamil to keep the heart rate down.
B. Check heart rate and administer a beta-blocker such as atenolol (TENORMIN) to
keep the heart rate down.
C. Check the serum creatinine and start dialysis.
D. Check the BP and give fluids and other medication as necessary to keep the BP
up.



P.J. is a 56 year old male who is taking an angiotensin receptor blocker for hypertension. You should teach him to

A. discontinue his medications if he develops a headache.
B. take his medication first thing in the morning to counteract the
sedation.
C. purchase his new prescription 3-4 days before his old prescription runs
out.
D. increase his salt intake to counteract the salt wasting associated with this
drug.



A drug that antagonizes aldosterone would be useful in treating hypertension because it would

A. cause potassium excretion.
B. enhance renin release.
C. block vasoconstriction
D. increase renal excretion of sodium.



Which assessment finding best reflects effective management of hypertension?

A. blood pressure 155/95
B. blood pressure reduced 10%
C. blood pressure less than 130/90
D. increased urinary output with edema reduction


A patient without other cardiac risks has triglycerides 300 mg/dl, HDLs 40 mg/dl and LDLs 150 mg/dl. Which drug (if any) should be given?

A. fenofibrate
B. losartan
C. cholestyramine
D. atorvastatin



John Doe is taking spironolactone (ALDACTONE). You should teach him to

A. take this medication in the evening to avoid sedation.
B. take potassium supplements as this drug lowers potassium levels in the blood.
C. take over the counter medications to reduce hair loss.
D. restrict water intake as this medication causes water retention.



.B. is a 29 yo male with HTN. He takes Hydrochlorothiazide 50 mg and lisinopril 40 mg each day. Current BP is 164/98. You should:

1. Discontinue the ACE inhibitor and add an Angiotensin Receptor Blocker.
2. Increase the ACEi dose.
3. Add a calcium channel blocker.
4. Discontinue the diuretic and add a beta blocker.


Thanks Lily Sok for the additional questions!


Hypertension results from an increase in vascular resistance, and several factors contribute to this. Which of the following would be the MOST POWERFUL way to decrease blood pressure?

A. Decrease the viscosity of the blood
B. Increase the viscosity of the blood
C. Decrease the radius of the vessel
D. Increase the radius of the vessel



Which of the following drugs is most likely to raise serum LDL cholesterol?

A. atorvastatin
B. hydrochlorothiazide
C. Niacin (Vitamin B3)
D. Cholestyramine



S.Q. is a 45 yo diabetic with mild renal disease (creatinine 1.7, normal is 0.6-1.2). She is taking valsartan 320 mg each day, hydrochlorothiazide 50 mg each day, and metoprolol 50 mg twice each day. She has tolerated these drugs without significant side effects. Today her BP is 138/94. You should:

A. Add lisinopril.
B. Increase the metoprolol.
C. Continue the medications as listed.
D. Reduce the valsartan dose.



Which of the following drugs blocks both alpha and beta receptors?

A. carvedilol (COREG)
B. clonidine (CATAPRES) Student Response
C. hydralazine (APRESOLINE) Student Response
D. propranolol (INDEROL) Student Response



All of the following are adverse effects of hydrochlorothiazide (ESIDRIX) EXCEPT

A. dizziness and faintness.
B. hypoglycemia. Student Response
C. high calcium levels.
D. paresthesia.



Diuretics are useful in treating hypertension becasue they

A. decrease preload.
B. increase vessel diameter.
C. block renin release.
D. block angiotensin converting enzyme.



The mechanism of action of furosemide (LASIX) is

A. antagonizing aldoseterone.
B. inhibiting sodium and chloride reabsorption in the loop of Henle.
C. increasing the osmolality of urine, thus increasing urinary output.
D. supressing renin release.