HTN

Which of the following drugs can cause sprue-like enteropathy? Answer A Avapro B Minoxidil C Benicar D Betaxolol E Cardura

C

Which of the following antihypertensives is associated with thiocyanate and cyanide toxicity with prolonged use? Answer A Nitroprusside B Nitroglycerin C Esmolol D Hydralazine E Clevidipine

A

A patient gave the pharmacist a prescription for Lotrel. Which of the following is the generic of Lotrel? Answer A Amlodipine and benazepril B Amlodipine and valsartan C Amlodipine, valsartan and hydrochlorothiazide D Amlodipine and olmesartan E Aliskiren and amlodipine

A Exforge contains amlodipine and valsartan.

A 32 year-old female patient has gone to see her primary care physician. The doctor is looking at her blood work, which includes the following parameters: total cholesterol 202 mg/dL, HDL 52 mg/dL, LDL 130 mg/dL, TG 96 mg/dL, BUN 18 mg/dL, SCr 0.8 mg/dL, hCG+, with a blood pressure of 168/102 mmHg. Which of the following medications can be safely administered? Answer A Labetalol B Lipitor C Accupril D Losartan E Aliskiren

A The patient is pregnant (hCG+). She cannot use ACE inhibitors, angiotensin-receptor blockers, or direct renin inhibitors. These medications, if used, should be discontinued as soon as pregnancy is detected. Statins should also be avoided. Labetolol is a safe choice in pregnancy.

After a few days, AC's blood pressure is at a safe level and she is to be discontinued on her home regimen. Which of the following pharmacist recommendations would help with AC's medication compliance? Answer A Discontinue Zestril and hydrochlorothiazide and start Zestoretic. B Discontinue all medications except hydrochlorothiazide. C Discontinue Zestril and hydrochlorothiazide and start Tenoretic. D Discontinue Catapres and start Catapres-TTS patch daily. E Discontinue Zestril and start Prinivil.

A Zestoretic is the combination product containing lisinopril and hydrochlorothiazide. A combination drug may help with AC's compliance. A clonidine patch is another thing to consider but the patch is dosed weekly, not daily.

The package labeling for aliskiren has a contraindication that warns not to use aliskiren in combination with which drugs in patients with diabetes? Answer A ARBs B Beta-blockers C Thiazide-type diuretics D Methyldopa E Non-dihydropyridine calcium channel blockers

A) ARBS

AC receives counseling on all of her home medications at discharge. The pharmacist tells her "this medication can cause dry mouth, constipation and fatigue". Which medication is the pharmacist referring to? Answer A Clonidine B Hydrochlorothiazide C Zestril D Atrovent E Hydralazine

A) Clonidine Clonidine is not used first-line and has many side effects that make it a difficult drug for patients to tolerate, including constipation, dry mouth, fatigue, lethargy, aggravation of depression and sexual dysfunction/impotence.

Choose the correct statements concerning Cleviprex: (Select ALL that apply.) Answer A It comes in a milky white emulsion. B It is contraindicated in patients with a soy or egg allergy. C It is an intravenous non-dihydropyridine calcium channel blocker. D The medication must be discarded after 4 hours of use. E An infusion of 12 mL/hr would provide 576 kcal per day.

A, B, E Cleviprex (clevidipine) is a dihydroyridine CCB. It must be administered using strict aseptic technique and should be discarded 12 hours of use. The lipid emulsion provides 2 kcal/mL (this is different than other lipid emulsions, specifically propofol which provides 1.1 kcal/mL). An infusion of 12 mL/hr would provide 576 kcal per day (12 mL/hr x 2 kcal/mL x 24 hrs).

A patient is prescribed Aldactone. What are the labeled indications for Aldactone? (Select ALL that apply.) Answer A Hypertension B Heart failure C Diabetes D COPD E Pulmonary hypertension

A,B

Which of the following medications should be taken with food? (Select ALL that apply.) Answer A Carvedilol immediate-release B Metoprolol succinate C Metoprolol tartrate D Carvedilol controlled-release E Bisoprolol

A,B,C,D

Which of the following antihypertensive agents is available as an injection? (Select ALL that apply.) Answer A Chlorothiazide B Nicardipine C Esmolol D Labetalol E Lisinopril

A,B,C,D Other injectable antihypertensive medications include hydralazine, enalaprilat, methyldopa, propranolol, metoprolol, celvidipine, diltiazem and verapamil.

SH, a 55 year-old white male, has just been diagnosed with hypertension. He has no other known medical conditions. His blood pressure runs between 162-170/97-99 mmHg. Choose an appropriate initial treatment regimen for this patient? (Select ALL that apply.) Answer A Losartan and hydrochlorothiazide B Amlodipine and benazepril C Ziac D Exforge E Hydrochlorothiazide and labetalol

A,B,D Exforge: AMlodipine /Valsartan Two agents can be considered since SH has stage 2 hypertension (≥ 140/90 mmHg) and he is > 20/10 mmHg above his goal BP of < 130/80 mmHg. Beta blockers are not considered first line for essential hypertension. Refer to the 2017 ACC/AHA hypertension guideline posted with the online course, or the summary provided in the Errata and Updates document (available under Student Resources) on the RxPrep Website.

Which of the following statements are true regarding enalapril? (Select ALL that apply.) Answer A It can retain potassium; potassium levels must be monitored. B It should not be used in patients with bilateral renal artery stenosis. C It comes in an oral and patch formulation. D It can cause a dry, hacking cough. E It has been shown to be beneficial in slowing progression of diabetic kidney disease.

A,B,D,E

A patient with hypertension has been prescribed nicardipine ER. Which of the following are possible side effects from the use of nicardipine? (Select ALL that apply.) Answer A Peripheral edema B Flushing C Hypokalemia D Gingival hyperplasia E Hyperuricemia

A,BD Refer to p. 739 of the 2018 RxPrep Course Book. DHP CCB decrease BP by inhibiting Ca ions from entering vascular smooth muscle which results in peripheral arterial vasodilation. Drugs that cause peripheral vasodilation have similar side effect profiles (peripheral edema, flushing, headache, palpitations). All calcium channel blockers can cause gingival hyperplasia, or overgrowth of the gums. Careful tooth cleaning and dental care are required to help preserve the patient's teeth.

JR, a 52 year old Mexican male, has hypertension and he is currently taking Lotrel. His BP today is 151/91 mmHg. Which of the following medication recommendations would be in accordance with hypertension treatment guidelines? (Select ALL that apply.) Answer A Change Lotrel to Exforge HCT B Change Lotrel to Tekturna C Add hydrochlorothiazide D Add valsartan E Change Lotrel to Azor

A,C

Which of the following options are appropriate to gain further control of KB's blood pressure? (Select ALL that apply.) Answer A Increase the Altace dose B Add irbesartan C Add chlorthalidone D Add aliskiren E Increase the Norvasc dose

A,C Doses of current medications can be titrated to maximum tolerated doses or additional agents can be added. The max dose of Norvasc is 10 mg. When adding drugs, it is recommended to choose from one of the four preferred drug classes as long as an ACE inhibitor or ARB is not used together. Aliskiren (a direct renin inhibitor) is contraindicated in combination with ACE inhibitors or ARBS.

VK, a 63 year-old black male, is newly diagnosed with type 2 diabetes. He is also found to have hypertension, hypercholesterolemia, and peripheral arterial disease. Which of the following medications would be appropriate to start first-line for BP control? (Select ALL that apply.) Answer A Thiazide-type diuretics B ACE inhibitors C ARBs D Calcium channel blockers E Beta blockers

A,D African American patients should be started on a thiazide-type diuretic or calcium channel blocker as long they do not have chronic kidney disease or albuminuria.

History of Present Illness: AC is a 67-year old female who is brought to the urgent care clinic by her daughter with headache and confusion. After reviewing her information, the urgent care clinic sends AC to the emergency room. Allergies: NKDA Past Medical History: Hypertension Mild COPD Physical Exam/Vitals (at urgent care clinic): BP 222/128 mmHg HR 87 BPM RR 18 BPM Height: 5' 5" Weight: 144 pounds Home Medications (ran out of her blood pressure medications 4 days ago): Zestril 20 mg PO daily Hydrochlorothiazide 25 mg PO daily Catapres 0.2 mg PO BID Flonase 2 sprays per nostril daily Atrovent MDI 2 puffs Q6H PRN shortness of breath Labs (in emergency room): Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.9 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 50 (7 - 20) SCr (mg/dL) = 2.5 (0.6 - 1.3) GLU (mg/dL) = 140 (100 - 125) Ca (mg/dL) = 9.5 (8.5 - 10.5) AST (units/L) = 30 (10 - 40) ALT (units/L) = 28 (10 - 40) Hgb A1C = 6.4 % Urinalysis = albumin (+) and ketones (-) Additional Notes (per daughter): AC has no history of renal or hepatic impairment. She struggles keeping up with her medications sometimes. Question In addition to hydrochlorothiazide, AC is taking which of the following medications for high blood pressure? (Select ALL that apply.) Answer A Lisinopril B Fosinopril C Amlodipine D Clonidine E Losartan

A,D The generic name of Catapres is clonidine. The generic name of Zestril is lisinopril

YP has hypertension. He states he feels fine and cannot believe he has to take medication but because his physician told him to, he began to take lisinopril 10 mg daily. He developed an irritating, dry cough and was switched to irbesartan. He took the irbesartan for awhile then stopped using it. Which of the following factors can contribute to poor medication adherence in patients with hypertension? (Select ALL that apply.) Answer A Lack of understanding of the need to take medication B Inability to afford the medications C Side effects from the medications D Hypertension is asymptomatic; therefore, the patient does not experience any symptom relief E The patient does not believe in taking medications

All of the above

A cardiologist has ordered nebivolol 5 mg PO daily for a patient. Which of the following is a mechanism of action of nebivolol? Answer A Inhibitor of beta-1 and beta-2 adrenergic receptors B Inhibitor of beta-1 adrenergic receptors C Prevents nitric oxide-dependent vasoconstriction D Inhibitor of alpha-1 and alpha-2 adrenergic receptors E Inhibitor of alpha-1 adrenergic receptors

B

A patient gave the pharmacist a prescription for Atacand 8 mg 1 tablet by mouth daily #30. Which of the following is an appropriate generic substitution for Atacand? Answer A Valsartan B Candasartan C Irbesartan D Perindopril E Labetalol

B

A patient gave the pharmacist a prescription for Avapro 150 mg by mouth daily #30. Which of the following is an appropriate generic substitution for Avapro? Answer A Amlodipine B Irbesartan C Verapamil D Valsartan E Candesartan Correct The generic name of Avapro is irbesartan.

B

Referring to the figure, which choice best represents the site where chlorthalidone exerts its mechanism of action? Answer A Choice A B Choice B C Choice C D Choice D E Choice E

B

What is the brand name of metoprolol succinate? Answer A Lopressor B Toprol XL C Sectral D Zebeta E Dutoprol

B

Question AK, a 68 year-old white male, is being treated at the clinic for hypertension. Today his BP is 147/93 mmHg. His PMH is significant for GERD, diabetes and gout. AK is currently taking Janumet XR, Motrin, Hyzaar and Zantac. Which of the following medications would be appropriate to add for better BP control? Answer A Hydrochlorothiazide B Adalat CC C Lotensin D Toprol XL E AK does not need additional BP lowering because he is > 65 years of age.

B AK is currently taking Hyzaar (losartan + HCTZ), therefore calcium channel blockers are the first line agents to consider next. Per the 2017 ACC/AHA hypertension guidelines, ambulatory patients ≥ 65 years of age should be treated to a SBP < 130 mmHg. Refer to the 2017 ACC/AHA hypertension guideline posted with the online course, or the summary provided in the Errata and Updates document (available under Student Resources) on the RxPrep Website.

How rapidly should AC's blood pressure be reduced? Answer A 5-10% in the next 4-6 hours B 15-20% in the next hour C 25-30% in the next 10 minutes D 40% by the next day E As fast as possible to reach her goal of < 130/80 mmHg

B Blood pressure should be reduced by no more than 25% within the first hour. Too rapid of a reduction in BP can lead to ischemic complications. Too slow of a reduction in BP can lead to further end organ damage. The BP should be lowered in a controlled manner.

Choose the correct statement regarding carvedilol to carvedilol CR dosing: Answer A Carvedilol 25 mg BID is equivalent to Coreg CR 40 mg daily. B Carvedilol 6.25 mg BID is equivalent to Coreg CR 20 mg daily. C Carvedilol 12.5 mg BID is equivalent to Coreg CR 30 mg daily. D Carvedilol 3.125 mg BID is equivalent to Coreg CR 5 mg daily. E Carvedilol 25 mg BID is equivalent to Coreg CR 20 mg daily.

B The starting dose of carvedilol immediate release is 3.125 mg BID for heart failure (equivalent to Coreg CR 10 mg), or 6.25 BID for hypertension (equivalent to Coreg CR 20 mg). The Coreg CR doses are 10 mg, 20 mg, 40 mg or 80 mg daily.

Diltiazem and verapamil affect the hepatic metabolism of other drugs. This is due to the following reason: Answer A They are CYP 450 3A4 inducers. B They are CYP 450 3A4 inhibitors. C They are CYP 450 2D6 inducers. D They are CYP 450 2C9 inducers. E They are CYP 450 2C19 inhibitors.

B These drugs are 3A4 enzyme inhibitors and can raise the concentration of 3A4 substrates.

Based on the information provided, AC is likely experiencing: Answer A Hypertensive urgency B Hypertensive emergency C Acute liver failure D Hyperglycemic crisis E COPD exacerbation

B AC has extremely elevated blood pressure with acute organ damage (newly elevated SCr and protein in the urine indicates renal dysfunction).

A patient with diabetes, hypertension, and peptic ulcer disease is on aspirin, glyburide, enalapril, metoprolol, chlorthalidone, and famotidine. Which of the patient's medications may block signs and symptoms of hypoglycemia? Answer A Enalapril B Metoprolol C Aspirin D Chlorthalidone E Famotidine

B The physiologic response to hypoglycemia is mediated by sympathetic/adrenergic stimulation. Therefore, beta blockers can mask many signs and symptoms of hypoglycemia.

Which of the following drugs is a nonselective beta blocker (blocks both beta-1 and beta-2 receptors)? Answer A Metoprolol B Propranolol C Atenolol D Nebivolol E Clonidine

B Propranolol is a non-selective beta blocker. It easily penetrates the CNS, making it a good choice for migraine prophyalxis.

Question Which of the following medications are direct vasodilators? (Select ALL that apply.) Answer A Labetalol B Hydralazine C Minoxidil D Methyldopa E Doxazosin

B,C Hydralazine and minoxidil are direct vasodilators.

BF is a 71 year old African-American female with hypertension. Her last BP reading was 165/101 mmHg and she is willing to be started on medication. According to the 2017 ACC/AHA hypertension guideline, which of the following statements are correct for treating hypertension in BF? (Select ALL that apply.) Answer A BF should be started on either an ACE inhibitor, ARB, CCB and/or thiazide-type diuretic. B BF should be started on either a CCB or thiazide-type diuretic. C BF should be treated to a goal systolic BP of < 130 mmHg. D BF should be treated to a goal BP of < 150/90 mmHg. E It is not recommended to start BF on two medications initially.

B,C Ambulatory, non-institutionalized patients ≥ 65 years of age should be treated to a goal systolic BP of < 130 mmHg. A thiazide-type diuretic and/or a CCB is preferred since BF is black. Patients with stage 2 hypertension (≥ 140/90 mmHg) who are > 20/10 mmHg above goal BP can be initiated on two medications. Refer to the 2017 ACC/AHA hypertension guideline posted with the online course, or the summary provided in the Errata and Updates document (available under Student Resources) on the RxPrep Website.

JG is a white male patient who presents with high blood pressure on several visits. Which classes of medications are appropriate as initial therapy for JG? (Select ALL that apply.) Answer A Potassium-sparing diuretics B ACE inhibitors C Angiotensin receptor blockers D Calcium channel blockers E Thiazide-type diuretics

B,C,D,E

A patient gave the pharmacist a prescription for Cozaar she needed filled. Her other medication is Yaz contraceptive pills. The pharmacy is in a supermarket and the pharmacist notices the patient has Morton Salt Balance in her shopping cart, which contains potassium chloride. Which of the following are correct counseling statements for this patient? (Select ALL that apply.) Answer A Her new medication is safe in pregnancy. B Yaz can increase potassium. C Her new medication can cause a dry, hacking cough. D Her new medication, and the salt substitute, can increase her potassium. E Her new medication can decrease the effectiveness of Yaz.

B,D

Which of the following antihypertensives should not be taken with grapefruit or grapefruit juice? (Select ALL that apply.) Answer A Lopressor B Cardizem LA C Coreg D Calan SR E Procardia XL

B,D,E All calcium channel blockers are substrates of CYP 3A4. Counsel patients to avoid grapefruit (the juice and the fruit), or try an alternative drug that does not interact. Separating the time a person drinks or eats grapefruit from the drug will not work. Diltiazem and verapamil are also 3A4 enzyme inhibitors and can raise the concentration of 3A4 substrates.

patient has high blood pressure, but a slow heart rate. The patient occasionally suffers from orthostatic hypotension and syncope. The physician is concerned and does not wish to use a blood pressure medication which can lower heart rate. Choose an agent that does not lower heart rate: Answer A Clonidine B Amlodipine C Diltiazem D Verapamil E Atenolol

B- AMlodipine Beta blockers (without ISA activity), clonidine and the non-dihydropyridine calcium channel blockers are anti-hypertensive agents that lower heart rate. This can be useful in a patient with a fast heart rate, or tachycardia. A normal heart rate ranges from 60-100 BPM.

JF has systolic heart failure with an ejection fraction of 33%. Which of the following medications could potentially worsen his heart failure condition? Answer A Amlodipine B Verapamil C Eplerenone D Labetalol E Candesartan

B- Verapamil Verapamil and diltiazem are not used in systolic heart failure. Amlodipine and some of the other dihydropyridines are considered cardiac-neutral (they are not used to treat heart failure but are safe to use if needed for additional blood pressure lowering).

History of Present Illness: TW, a 65 year old African American male, presents to the clinic to begin drug treatment for his high blood pressure. He has recently retired from construction work and is now able to focus more on his health. Allergies: Bactrim (rash) Past Medical History: Diabetes mellitus type 2 Newly diagnosed hypertension Dyslipidemia Current Medications: Zocor 40 mg PO QHS Metformin 1000 mg PO BID Tums 1-2 tablets Q4-6H PRN MVI daily Vitals: Height: 5'10" Weight: 175 lbs BP: 158/94 mmHg HR: 83 BPM RR: 20 BPM Temp: 98.6ºF Pain: 1/10 1/10 Labs (2 months prior): AST (units/L) = 24 (10 - 40) ALT (units/L) = 21 (10 - 40) TC (mg/dL) = 190 (125 - 200) TG (mg/dL) = 160 (< 150) HDL (mg/dL) = 45 (> 40) LDL (mg/dL) = 101 (<100) GLU (mg/dL) = 140 (100 - 125) Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 3.6 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 22 (7 - 20) SCr (mg/dL) = 1.1 (0.6 - 1.3) Ca (mg/dL) = 9.5 (8.5 - 10.5) Hgb A1C = 7.2 % Urinalysis = albumin (-) and ketones (-) Question TW is started on amlodipine. Which of the following statements is correct? Answer A His metformin dose will need to be reduced. B TW should stop taking Tums since amlodipine is a calcium channel blocker. C If kept on Zocor, the dose will need to be reduced. D Zocor should be discontinued since TW does not have high cholesterol. E TW should be started on lisinopril instead of amlodipine.

C

KB is started on hydrochlorothiazide 25 mg daily. Which of the following statements are correct? Answer A Blood glucose can decrease. B Magnesium can increase. C Uric acid can increase. D Sodium can increase. E LDL can decrease.

C

Which medication is paired correctly with it's mechanism of action? Answer A Nebivolol: blocks beta-1 and beta-2 receptors B Clonidine: an alpha-2 adrenergic antagonist C Labetalol: blocks beta-1, beta-2 and alpha-1 receptors D Amiloride: inhibits sodium reabsorption in the proximal convoluted tubule. E Diovan: prevents conversion of angiotensin I to angiotension II

C

How should KB's healthcare provider respond when KB says he feels fine and therefore should not have to take medication? Answer A Hypertension causes headaches and shortness of breath; if KB feels fine, he can discontinue his medications. B Hypertension is symptomatic; KB probably feels fine because he takes his Altace and Norvasc. C Hypertension is asymptomatic; if left untreated, it can lead to stroke, kidney disease and heart disease. D Hypertension is symptomatic; KB can take his medications only when he has symptoms. E Hypertension is asymptomatic; if taking medication is disrupting KB's quality of life, he can discontinue treatment.

C Hypertension is usually asymptomatic unless the patient is experiencing a hypertensive crisis. The absence of symptoms can lead to non-compliance but it is important that patients understand the risks of high blood pressure and the benefits of obtaining blood pressure control with medications and lifestyle measures.

A patient has hypertension and suffers from migraines. Which of the following agents can be used to lower blood pressure and prevent migraines? Answer A Metoprolol B Tenormin C Inderal LA D Lisinopril E Amlodipine

C Propranolol (Inderal LA, Inderal XL) is a non-selective beta blocker and is highly lipophilic. It crosses the blood-brain barrier easily and is used for migraine headache prophylaxis, essential tremor, stage fright, hypertension and a few other conditions.

A 35-year old female patient is started on hydrochlorothiazide 25 mg daily. Which of the following statements is correct? Answer A She should use birth control while taking this medication because it is teratogenic. B She has an increased risk for low bone density; calcium and vitamin D intake should be optimized. C Hypokalemia can be avoided with intake of potassium rich foods or potassium supplements. D If she has headaches while using this medication, it is best to use over the counter ibuprofen. E If she misses a dose, she should can double the next dose to make sure her blood pressure doesn't get too high.

C Thiazides increase calcium so they can modestly increase bone density when taken long-term. Thiazides are not teratogenic. Hypokalemia is the primary side effect of hydrochlorothiazide; it is more common at higher doses (e.g., 50 mg) and can be avoided with intake of potassium rich foods or supplements. Patients with high blood pressure should avoid NSAIDs and should never double doses of medication.

JE presents to her doctor's office with hypertension. She is prescribed Ziac. This medication contains: Answer A Benazepril and amlodipine B Olmesartan and amlodipine C Bisoprolol and hydrochlorothiazide D Valsartan and amlodipine E Irbesartan and hydrochlorothiazide

C Ziac contains bisoprolol and hydrochlorothiazide.

VC comes to the clinic for a follow up visit for his hypertension and diabetes management. He has been taking four medications to control his blood pressure for a long time. Today, the pharmacist notices a butterfly rash across VC's nose and upper cheeks. Which of the following medications is most likely to cause this side effect? Answer A Hydrochlorothiazide B Enalapril C Hydralazine D Eplerenone E Verapamil

C Hydralazine can cause drug-induced lupus erythematosus (DILE) which is dose and duration related. The classic finding is a butterfly rash on the face. Methyldopa is another antihypertensive drug that can cause DILE.

Which of the following organizations sets the guidelines for the management of hypertension? Answer A The American Society of Hypertension Physicians B The American Society for Vascular Medicine C The American College of Cardiology/American Heart Association D The International Federation for Hypertension E The National Council on Hypertension

C- ACC/AHA In 2017, the ACC/AHA task force on clinical practice guidelines published new hypertension guidelines. The report was approved by multiple professional organizations.

VC comes to the clinic for a follow up visit for his hypertension and diabetes management. He has been taking four medications to control his blood pressure for a long time. Today, the pharmacist notices a butterfly rash across VC's nose and upper cheeks. Which of the following medications is most likely to cause this side effect? Answer A Hydrochlorothiazide B Enalapril C Hydralazine D Eplerenone E Verapamil

C- Hydralazine Hydralazine can cause drug-induced lupus erythematosus (DILE) which is dose and duration related. The classic finding is a butterfly rash on the face. Methyldopa is another antihypertensive drug that can cause DILE.

JF is a 62 year-old African American male. His potassium level is 4.2 mEq/L, sodium is 141 mEq/L, BUN is 24 mg/dL and his serum creatinine is 1.2 mg/dL. JF's current medications include atenolol and citalopram. The physician is considering starting fosinopril. JF has a risk factor for developing angioedema. Which risk factor for angioedema is present in this patient? Answer A Age B Gender C Race D Concurrent medications E Electrolyte profile

C- Race There is a higher incidence of angioedema in black patients. Counsel the patient to report any swelling of the lips, mouth, tongue, face, or neck immediately.

In addition to medications, what lifestyle modifications are important for KB? Answer A Lose weight in order to reach a normal body mass index B Maintain a waist circumference < 35 inches C Limit sodium intake to < 1,500 mg daily D Limit alcohol consumption to 3 drinks daily E Exercise for 20 minutes three days a week Correct

C- limit sodium intake

A 62 year-old female patient comes to the clinic for follow-up evaluation of her osteoporosis. Her BP last visit was 158/92 mmHg and this visit it is 154/95 mmHg. According to the 2017 ACC/AHA hypertension guidelines, what is this patient's goal BP? Answer A < 140/90 mmHg B < 120/80 mmHg C < 130/80 mmHg D < 140/80 mmHg E < 150/90 mmHg

C: 130/80 The goal BP for this patient is < 130/80 mmHg. Refer to the 2017 ACC/AHA hypertension guideline posted with the online course, or the summary provided in the Errata and Updates document (available under Student Resources) on the RxPrep Website.

A patient gave the pharmacist a prescription for Catapres TTS-1 #4. Choose the correct counseling statement for this medication. Answer A Take this medication by mouth four times daily. B This patch does not need to be removed before an MRI procedure. C Replace the patch every 72 hours. D Rotate the site where you place the patch. E This is the highest dose available of this medication.

D

A patient gave the pharmacist a prescription for Diovan 80 mg by mouth daily #30. Which of the following is an appropriate generic substitution for Diovan? Answer A Candesartan B Irbesartan C Olmesartan D Valsartan E Losartan

D

A patient is using chlorthalidone 25 mg daily and has a reported potassium level of 4.6 mEq/L and a CrCl of 25 mL/min. Which of the following statements is correct? Answer A The patient needs an agent to lower her potassium level. B Chlorthalidone works by blocking Na+ reabsorption in the proximal tubules of the nephron. C Chlorthalidone is also useful in treating dyslipidemia. D Chlorthalidone is less effective when CrCl is less than 30 mL/min. E Chlorthalidone has been shown to be less effective than other thiazide-type diuretics.

D

Which of the following statements regarding hypertensive urgency are correct? Answer A The definition is a blood pressure greater than 160/110 mmHg. B It requires hospitalization for treatment with intravenous medication. C Two antihypertensive medications should be started simultaneously. D It is extremely high blood pressure in the absence of acute end organ dysfunction. E Acute, progressive end organ dysfunction is present due to severely elevated blood pressure.

D

History of Present Illness: TW, a 65 year old African American male, presents to the clinic to begin drug treatment for his high blood pressure. He has recently retired from construction work and is now able to focus more on his health. Allergies: Bactrim (rash) Past Medical History: Diabetes mellitus type 2 Newly diagnosed hypertension Dyslipidemia Current Medications: Zocor 40 mg PO QHS Metformin 1000 mg PO BID Tums 1-2 tablets Q4-6H PRN MVI daily Vitals: Height: 5'10" Weight: 175 lbs BP: 158/94 mmHg HR: 83 BPM RR: 20 BPM Temp: 98.6ºF Pain: 1/10 1/10 Labs (2 months prior): AST (units/L) = 24 (10 - 40) ALT (units/L) = 21 (10 - 40) TC (mg/dL) = 190 (125 - 200) TG (mg/dL) = 160 (< 150) HDL (mg/dL) = 45 (> 40) LDL (mg/dL) = 101 (<100) GLU (mg/dL) = 140 (100 - 125) Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 3.6 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 22 (7 - 20) SCr (mg/dL) = 1.1 (0.6 - 1.3) Ca (mg/dL) = 9.5 (8.5 - 10.5) Hgb A1C = 7.2 % Urinalysis = albumin (-) and ketones (-) Question Which class of medications is most appropriate as initial therapy for TW? Answer A Beta blockers B ACE inhibitors C Angiotensin receptor blockers D Calcium channel blockers E Thiazide-type diuretics

D In black hypertensive patients, including those with diabetes but no evidence of albuminuria, initial therapy should include a CCB or a thiazide-type diuretic. Even though cross-reactivity is unlikely, thiazide-type diuretics are contraindicated in patients with a sulfonamide allergy. TW is allergic to Bactrim. ACE inhibitors or ARBS are first line only when the patient has chronic kidney disease or albuminuria.

Case History of Present Illness: AC is a 67-year old female who is brought to the urgent care clinic by her daughter with headache and confusion. After reviewing her information, the urgent care clinic sends AC to the emergency room. Allergies: NKDA Past Medical History: Hypertension Mild COPD Physical Exam/Vitals (at urgent care clinic): BP 222/128 mmHg HR 87 BPM RR 18 BPM Height: 5' 5" Weight: 144 pounds Home Medications (ran out of her blood pressure medications 4 days ago): Zestril 20 mg PO daily Hydrochlorothiazide 25 mg PO daily Catapres 0.2 mg PO BID Flonase 2 sprays per nostril daily Atrovent MDI 2 puffs Q6H PRN shortness of breath Labs (in emergency room): Na (mEq/L) = 141 (135 - 145) K (mEq/L) = 4.9 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 50 (7 - 20) SCr (mg/dL) = 2.5 (0.6 - 1.3) GLU (mg/dL) = 140 (100 - 125) Ca (mg/dL) = 9.5 (8.5 - 10.5) AST (units/L) = 30 (10 - 40) ALT (units/L) = 28 (10 - 40) Hgb A1C = 6.4 % Urinalysis = albumin (+) and ketones (-) Additional Notes (per daughter): AC has no history of renal or hepatic impairment. She struggles keeping up with her medications sometimes. Question Of the medications AC stopped taking, which one has most likely caused her acute rise in blood pressure? Answer A Hydrochlorothiazide B Lisinopril C Atrovent D Clonidine E Flonase

D - Clonidine Clonidine causes rebound hypertension due to a sudden increase in sympathetic outflow. If discontinued, clonidine requires a slow taper to prevent this acute rise in blood pressure.

JG, a 63 year-old black male, has a past medical history significant for hypertension, hypercholesterolemia, chronic kidney disease and peripheral arterial disease. What is JG's goal BP according to the 2017 ACC/AHA hypertension guidelines? Answer A Less than 120/80 mmHg B Less than 140/90 mmHg C Less than 140/80 mmHg D Less than 130/80 mmHg E Less than 150/90 mmHg

D 130/80

A 54 year-old female has hypertension and COPD. She is already using a thiazide-type diuretic, a calcium channel blocker and an angiotensin receptor blocker but her blood pressure remains elevated at a range of 142-154/84-92 mmHg. She will be started on beta blocker therapy. Which of the following agents is most appropriate? Answer A Nadolol B Carvedilol C Propranolol D Metoprolol E Timolol

D- Metoprolol With a chronic breathing condition (asthma, COPD, emphysema), the non-selective beta blockers should be avoided.

JS suffers from constipation. She spends a good deal of money buying over-the-counter MiraLax and occasionally needs to use a glycerin suppository. She asks the pharmacist for help. The pharmacist looks at her medications and finds that she takes ramipril, lovastatin, cholestyramine, hydralazine, verapamil and sertraline. Which medication/s could be contributing to JS's chronic constipation? Answer A Hydralazine B Sertraline C Ramipril D Lovastatin E Verapamil

E

Which medication is considered first-line for the treatment of hypertension in pregnancy? Answer A Atenolol B Spironolactone C Irbesartan D Diltiazem E Methyldopa

E

A patient gave the pharmacist a prescription for Cardizem CD 120 mg 1 PO daily #30. Which of the following is an appropriate generic substitution for Cardizem CD? Answer A Amlodipine extended-release capsule B Metoprolol extended-release capsule C Verapamil extended-release capsule D Carvedilol extended-release capsule E Diltiazem extended-release capsule

E Be careful when using the orange book to find a suitable generic alternative with diltiazem formulations. Cardizem CD is rated AB3, and needs an AB3 generic. Diltiazem has four different long-acting designations (AB1, AB2, AB3 and AB4).

A hospitalized patient was given Kayexalate this morning. The pharmacist is reviewing her medications. Which of the following medications on the profile most likely needs to be discontinued? Answer A Metoprolol B Chlorthalidone C Hydralazine D Clonidine E Spironolactone

E The patient was given sodium polystyrene sulfonate (Kayexalate), which is used to treat hyperkalemia. Spironolactone is a potassium-sparing diuretic.

TR, a 59 year-old white male, has been diagnosed with hypertension. He also has diabetes. His blood pressure runs between 170-174/97-99 mmHg. Choose an appropriate initial treatment regimen for this patient? (Select ALL that apply.) Answer A Losartan and hydrochlorothiazide B Amlodipine and benazepril C Lisinopril and irbesartan D Amlodipine and aliskiren E Amlodipine and hydrochlorothiazide

a, b, e Do not combine and ACE inhibitors and ARBs; beta blockers and aliskiren are not recommended first-line.

What is the mechanism of action of clonidine? Answer A Acts as an alpha-1 agonist, resulting in a decrease in norepinephrine release B Acts as an alpha-1 antagonist, resulting in an increase in norepinephrine release C Acts as an alpha-2 agonist, resulting in a decrease in norepinephrine release D Acts as an alpha-2 antagonist, resulting in a decrease in norepinephrine release E Acts as an alpha-1 and alpha-2 antagonist, resulting in an increase in norepinephrine release

c