Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 2 (Sam) > 1 - Hypertension > Flashcards

1 - Hypertension Flashcards

1
Q

Why are more women likely to get hypertension than males?

A

B/c they live longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some complications of HTN

A
  • congestive heart failure
  • renal failure
  • peripheral vascular disease
  • erectile dysfunction
  • cerebrovascular disease
  • stroke
  • heart attack
  • *more in slides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 2 biggest risk factors for a CV event?

A
  • smoking

- diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why don’t we want to start diagnosing HTN on the first clinic visit?

A
  • could be something they did differently that day (coffee, exercise)
  • could be white coat HTN
  • don’t want to start someone on a life time med if they don’t actually need it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the BP goal for treating HTN in order to reduce complications?

A

140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Should people with mild hypertension (say 143/95) take antihypertensives?

A

Not really beneficial:

-antihypertensive drugs used in mild hypertension (140-159/90-99) have not been shown to reduce mortality or morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What kind of Q’s do you want to ask a patient that is hypertensive?

A
  • diet
  • lifestyle (exercise)
  • smoker?
  • stress
  • family history
  • ask about other meds (both Rx and OTC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some types of drugs that can increase BP?

A
  • NSAIDs
  • decongestants
  • alcohol
  • estrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long should you wait after implementing lifestyle changes to start medication?

A

3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List some non-pharms for lowering BP

A
  • decrease salt intake
  • exercise 30-60 mins of moderate-vig intensity 4-7 days/week
  • weight reduction
  • decrease alcohol
  • decrease caffeine
  • manage stress
  • DASH diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some examples of anti-hypertensives?

A
  • diuretic
  • ACEi
  • ARB
  • Ca channel blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you choose which antihypertensive to start a patient on? (What things are we going to be comparing)

A
  • efficacy
  • adverse drug reactions
  • convenience
  • cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is any antihypertensive more efficacious than the rest?

A

No - similar efficacy between the agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If they are all the same efficacy, then we will look at adverse drug reactions:
List some side effects of thiazides

A
  • dizziness
  • increased urination (generally short lived)
  • increased sun-sensitivity (minor, would only be a concern if starting thiazide and then going to a tropical location)
  • hypokalemia, hyponatremia, increased lipids, increased uric acid, increased glucose
  • muscle cramps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of patients would warrant caution when thinking about giving them a thiazide?

A
  • Hx gout
  • hypokalemic
  • hyponatremic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If they are all the same efficacy, then we will look at adverse drug reactions:
List some side effects of ACEi

A
  • DRY COUGH

- increase K+, increase serum creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of patients would warrant caution when thinking about giving them an ACEi?

A
  • Hx bilateral renal artery stenosis

- NSAID use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If they are all the same efficacy, then we will look at adverse drug reactions:
List some side effects of ARBs

A
  • increase K+

- increase serum creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of patients would warrant caution when thinking about giving them an ARB?

A
  • Hx bilateral renal artery stenosis

- NSAID use

20
Q

If they are all the same efficacy, then we will look at adverse drug reactions:
List some side effects of Beta Blockers

A
  • cold extremities
  • fatigue
  • nausea
  • decrease HR
  • decrease exercise tolerance
  • vivid dreams
  • impotence
21
Q

What type of patients would warrant caution when thinking about giving them beta blockers?

A
  • Hx asthma
  • severe PAD (pulmonary artery disease)
  • heart block
22
Q

If they are all the same efficacy, then we will look at adverse drug reactions:
List some side effects of Ca2+ channel blockers

A

DHP: flushing, ankle deem, headache, increased HR

non-DHP: same for DHP, plus decreased HR, heart block, worsened HF, constipation

23
Q

What type of patients would warrant caution when thinking about giving them a Ca2+ channel blocker?

A

Hx heart failure (for non-DHP)

24
Q

What are the DHP’s?

A
  • amlodipine

- nifedipine

25
Q

What are the non-DHP’s?

A
  • verapamil

- diltiazem

26
Q

What is a general rule for antiHTN meds?

A

Using 1/2 standard doses –> only 20% less BP reduction

*increasing dose barely increases efficacy and all it does is increase side effects

27
Q

Is there any anti-HTN’s that are more convenient? (regarding dosing schedules)

A

Not really - either once daily or twice daily dosing

28
Q

Is there any anti-HTN’s that are more cost-effective?

A
  • thiazides are very cheap

- calcium channel blockers are the highest (about $10-30/30days)

29
Q

If you started someone on a thiazide, what would you want to monitor and when?

A
  • dizziness (esp if old and frail)
  • check sodium and potassium levels
  • prob do this in about 2 weeks
30
Q

If you started someone on an ACEi, what do you need to monitor?

A
  • warn them about dry cough
  • check kidney fcn
  • check potassium and creatinine levels
  • check these in a couple of weeks

*IF OLD AND FRAIL DO THIS IN 2 WEEKS

31
Q

If a patient is experiencing dizziness from a thiazide that they started 2 weeks ago, what do you tell them?

A
  • that the dizziness should go away in 2-4 weeks

- taking them in the morning may help

32
Q

What does it mean when albumin:creatinine ratio is high?

A

it means that the kidney is leaky bc albumin is a big ass molecule and shouldn’t be escaping into the urine

33
Q

What is the BP target for anti-HTN meds?

A

140/90

34
Q

What is the BP target for anti-HTN meds when the pt is diabetic?

A

140/90

*this does not change bc no RCT has ever shown a target of 130/80 to reduce complications of DM2

35
Q

For a person with CV or kidney disease in addition to diabetes and hypertension, what is the first line anti-hypertensive?

A

ACEi/ARB

36
Q

Does it matter what agent you start a pt on if they have diabetes and hypertension?

A

No - ALLHAT study (slide 53) showed no difference in outcomes, incidence of ESRD, or CHD between a diuretic, ACEi, and Ca channel blocker.

37
Q

If a patient has kidney disease and HTN, what med should they be on?

A

ACEi or ARB

38
Q

Diabetic patients:
Long-term CV protection is similar for traditional first line agents

True or false?

A

True

39
Q

Diabetic patients:

For those WITHOUT kidney disease, ACEi and ARB reduce likelihood of developing _______, but not doubling of SCr or ESRD

A

microalbuminuria

40
Q

Diabetic patients:

For those WITH kidney disease, what agent should they be on and why?

A

ACEi or ARB bc they both delay progression of nephropathy to ESRD

41
Q

Discuss the pros and cons of either increasing the dose or adding another drug if a patient is far off from their target BP (140/90) ??

A

Increasing the dose:

  • limits the amounts of meds they’re on
  • they’re already used to the drug and it’s potential side effects
  • REMEMBER THE GENERAL RULE ABOUT ANTI-HTN: won’t provide much increase in efficacy but will increase side effects

Adding another drug:

  • in this case, more efficacious (additive effect, but won’t double side effects like increasing the dose would)
  • con: has to add another pill to their life
42
Q

Taking greater than or equal to 1 anti-HTN med at _____ may be beneficial

A

bedtime

43
Q

If a patient is not far off target BP (140/90) would increasing a dose be appropriate or would you add another drug?

A

Bc he is not far off target, increasing an agent would be an ok option here bc we don’t need to reduce it that much

*if he’s farther off target, could think about adding another agent

44
Q

If you start a patient on a CCB, what labs would you order?

A

no labs

45
Q

What side effects would you expect from a CCB?

A

This is a vasodilator so:

  • flushing
  • headache
  • edema
46
Q

Elderly are more sensitive to sympathetic inhibition and volume depletion which can cause ???

A
  • increased orthostatic HTN

- increased morbidity, increase risk of falls

47
Q

What is the target BP for the very elderly? Why?

A

150/80

*don’t want it too low as this can lead to syncope and falls

Clinical 2 (Sam) (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions