HTN

A 52-year-old woman with NYHA Class III Heart Failure was started on lisinopril 40
mg/day and carvedilol 25 mg BID. She is recently complaining of dizziness. Blood pressure
100/70 mmHg Heart rate 70/min What is the best approach for Heart failure and her
symptoms? 1. lisinopril dose is the max dose in HF
2. BB are gold line and never be the first agent to be decrease ( reserved for long term eff)
A. Decrease carvedilol dose
B. Decrease lisinopril dose C. Stop lisinopril D. Stop carvedilol
A 44-year-old man presents to his doctor for blood pressure check. His blood pressure
reading is 169/95 mmHg. He has been seeing his doctor several times in the last three
months for blood pressure checks and lab tests. Although his lab tests are fine, the doctor
recommended him to start blood pressure reducing medicines. Which of the following
pharmacotherapy regimens would be most appropriate?
A. Amlodipine 5 mg with Lisinopril 10 mg in one pill, daily
B. Lisinopril 10 mg with Atenolol in one pill, twice daily
C. Chlorthalidone 25 mg with Spironolactone 25 mg daily
D. Furosemide 40 mg twice daily and Doxazosin 2 mg daily
A 55-year-old man with an African descent is diagnosed with hypertension with a BP of 140/80.
Which of the following is the most appropriate first line treatment?
B. Amlodipine A. Ramipril C. Carvedilol D. Candesartan
Black adults start with either a thiazide diuretic — such as chlorthalidone or hydrochlorothiazide — or a
calcium channel blocker like amlodipine

A clinical case like this A black race patient is on Amlodipine 5mg his BP was found
164/110mmhg the next adding drug?
Candesartan Ramipril Spironolactone

A clinical case like this patient is on Amlodipine 5mg his BP was found 164/110mmhg the next
adding drug?
Candesartan Ramipril Spironolactone
If there’s thiazide in choices it’ll be the best answer, then ACEIs or ARBs, then lastly spironolactone

For African American Pts First line: *CCB*

If not controlled add *Thiazide* If not controlled add *ACEI*

If can’t tolerate ACEI, change it to *ARBs* If all the above alternatives not enough you can add spironolactone
Mr WD, 42-year-old Afro-Caribbean man, presents to his GP with six-week history of headaches and
lethargy. On examination the following is noted:
■ dipstick – proteinuria +++
■ Blood pressure 180/105 mmHg (120/80 mmHg)
■ Serum creatinine 365 micromol/L (60–110 micromol/L)
■ Serum urea 15.8 mmol/L (3.2–6.6 mmol/L)
■ Weight 98 kg
■ Height 180 cm.
Mr WD was prescribed nifedipine LA 30 mg once daily and enalapril 10 mg twice daily to treat his
hypertension. After one week’s treatment, his blood pressure was still only 150/85 mmHg, but the
patient was complaining of very swollen ankles. He also mentions that he has developed a persistent
cough.
same case of Afro-Caribbean patient taking nifedipine, and Lisinopril. He had severe ankle
swallowing. Which of the following would be temporary fix for his condition?
a. Switch to losartan 50 mg and furosemide 20 mg
b. Switch to Amlodipene (dose) and Bendroflumethiazide (dose)
c. Decrease the nifedipine dose and add furosemide 25 mg
d. Continue on Lisinopril 40 mg and add carvedilol 25 mg
same case of Afro-Caribbean patient taking nifedipine, and Lisinopril. He had severe ankle
swallowing and developed dry cough. Which of the following would be temporary fix for his
condition?
a. Switch to losartan 50 mg and furosemide 20 mg
b. Switch to Amlodipene (dose) and Bendroflumethiazide (dose)
c. Decrease the nifedipine dose and add furosemide 25 mg
d. Continue on Lisinopril 40 mg and add carvedilol 25 mg
Long case of Afro-Caribbean patient. He had severe ankleswelling. Which of the following
drug cause this condition
a. Nifedipine
b. Losartan
c. Metoprolol
d. spironolactone
 Long case of Afro-Caribbean patient. He had severe ankle swelling. Which of the following
would be temporary fix for his
condition:
a. Nifedipine b. Losartan c. Metoprolol d. spironolactone
Long case of patient. He had severe ankle swelling. Which of the following would be temporary
fix for his
condition:
a. Nifedipine b. lisinopril c. losartan d. spironolactone
What is the drug to treat edema caused by amlodipine? ACEIS or ARBS
Drug taken with Amlodipine as prophylaxis (Not asking for combination)? Furosemide (wrong old ans )
Reducing the dosage of amlodipine and adding in an (ACEI), such as cilazapril, or (ARB), such as losartan

Switching to a non-dihydropyridine CCB, such as verapamil or diltiazem Adding a nitrate, such as isosorbide
dinitrate

My correction : add on for edema caused by CCB is ACEI or ARABS not furosemide
Which of the following side effects is very common with dihydropyridine calcium channel
blockers?dihydropyridines (e.g. amlodipine, nifedipine) SE lightheadedness, flushing, headaches, and
peripheral edema.

A. Pulmonary edema B. Swelling of ankles C. Bradycardia D. Pericarditis

Which one of the following CCB is a non-dihydropyridine drug?
A. Nicardipine B. Amlodipine C. Nifedipine D. Diltiazem
A 54-year-old man is diagnosed with stage 1 hypertension. His left ventricular ejection fraction
is less than 40%. What would be the most appropriate drug for him?
Lisinopril A. Amlodipine C. Spironolactone D, hydrochlorothiazide
He is starting to experience a range of side effects, blurred vision, confusions, vomiting and an
irregular heartbeat. His previous medication are review to identify if there could be an
interaction with phenytoin. Which of the following is the most likely cause of the side effects.
A. Digoxin B, Simvastatin C . furosemide. D. Prochlorperazine
Which of the following drugs should be avoided in patients with reduced ejection fraction
heart failure?
A. Hydralazine B. Paracetamol C. Pioglitazone D. Spironolactone
 A 60-year-old woman has been recently diagnosed with stage II hypertension. Which of the
following medications would be suitable for her?
A. Losartan/hydrochlorothiazide B. Atenolol/nifedipine
C. Valsartan/furosemide D. Amlodipine/triamterene
New cardiovascular drug is making hard block of b1 agonist what likely can happen
a) Palpitation b) Sweating c) Extrapyramidal side effect d) Cough and wheezing
65-Which diuretic listed below would have the greatest blood pressure lowering effect when
given in patients with an eGFR below 60 ml/min?
A. Chlorthalidone25mgdaily B. Spironolactone25mgdaily
C. Triamterene 25 mg daily D. Furosemide40mgdaily
66-Which diuretic listed below would have the greatest blood pressure lowering effect when
given in patients with an eGFR below 30 ml/min?
A. Chlorthalidone25mgdaily B. Spironolactone25mgdaily
C. Triamterene 25 mg daily D. Furosemide40mgdaily
Which drug causes faint ? a. Diazepam b. Ramipril
Which drug causes recurrent fall ? diazepam
Which drug causes recent fall ? ramipril
A diabetic pt with HTN and dyslipidemia was ordered to take aspirin 81 and bisoprolol 5 mg and
lisinopril 20 and atorvastatin 40 and metformin 1g what is the medication error the doctor
made? BB MASK THE HYPOGLYCEMIC EFFECT
Hyperkalemia causing drug. – Lisinopril
Metoprolol and lisinopril cause lightheadedness when takentogether. What to do:
Take at bedtime
Stop one drug and add new alternative
Change the dose Its usual side effect
You are reviewing patient medication. Patient doesn’t want to take Lisinopril because she thinks
it’s with no benefit.
Ask her why she doesn’t want to take Lisinopril, tell her about the risk of stopping it and the goals of
taking it, then discuss about further steps.
Call the physician and tell him about the non-compliance and tell him to review her medication.
Inform the patient that you told the physician.
 Dr
hadeel summary