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Hypertension and Dyslipidemia Therapy Flashcards

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  1. A patient with stage 2 hypertension and CKD (eGFR 35 mL/min) is started on lisinopril 10 mg daily. Two weeks later, serum creatinine rises 25% from baseline. What is the most appropriate next step?

    Answer: Continue lisinopril; a <30% creatinine rise is acceptable

    An increase in serum creatinine up to 30% above baseline after initiating an ACE inhibitor is acceptable and expected due to reduced glomerular efferent vasoconstriction.

  2. Which antihypertensive drug class is most associated with causing hyperkalemia in patients with CKD?

    Answer: ACE inhibitors

    ACE inhibitors block angiotensin II–mediated aldosterone release, reducing potassium excretion and predisposing CKD patients to hyperkalemia.

  3. A patient on rosuvastatin 20 mg develops unexplained muscle pain. CK is 12,000 U/L. What is the most appropriate action?

    Answer: Discontinue rosuvastatin immediately

    Markedly elevated CK (>10× ULN) with muscle symptoms indicates myopathy/rhabdomyolysis and requires immediate statin discontinuation.

  4. According to ACC/AHA guidelines, which patient qualifies for high-intensity statin therapy based on ASCVD risk alone?

    Answer: 60-year-old with established ASCVD

    Established ASCVD is a primary indication for high-intensity statin therapy regardless of baseline LDL.

  5. A pregnant patient in her first trimester is found to have a BP of 158/102 mmHg. Which antihypertensive is CONTRAINDICATED?

    Answer: Lisinopril

    ACE inhibitors are contraindicated in pregnancy due to risk of fetal renal dysgenesis, oligohydramnios, and neonatal renal failure.

  6. Ezetimibe lowers LDL primarily through which mechanism?

    Answer: Inhibiting cholesterol absorption in the small intestine via NPC1L1

    Ezetimibe selectively inhibits the NPC1L1 transporter on intestinal enterocytes, reducing cholesterol absorption and lowering LDL.

  7. A patient is on amlodipine 10 mg and lisinopril 20 mg but BP remains 150/92 mmHg. Which add-on therapy is most guideline-supported for a third-line agent?

    Answer: Chlorthalidone

    JNC and ACC/AHA guidelines recommend a thiazide-type diuretic (preferably chlorthalidone) as the third drug in a three-drug combination regimen for resistant hypertension.