101414 HTN cases Flashcards
risk factors for HTN?
race-African American family history high salt diet sedentary lifestyle abnormal BMI smoking dyslipidemia alcohol drug use (cocaine is alpha agonist)
what is an initial step in treating HTN?
lifestyle modification
before starting medications for HTN, what should you do?
lab for electrolytes and kidney fxn (hyperaldosteronism)
CBC to rule out anemia as cause
urinalysis to look for blood or protein as indicator of kidney disease
why are thiazides usually chosen first line for HTN?
lower side effect profile as compared to ACE
however ACE and thiazides are first line meds
what are meds best used in pregnancy for HTN?
methyldopa
labetalol
hydralazine
what are signs of increased intracranial pressure?
vision changes slurred speech vomiting numbness tingling headaches
if pt presents with headaches from HTN, what organ systems would you also be concerned about? what should you check?
eye exam
cardiopulmonary exam (delayed S2, S3 or S4, rales, ECG to look for L ventricular hypertrophy)
urine–blood and protein? electrolkytes and kidney fxn.
screen for diabetes and hyperlipidemia
if pt is hypertension stage 2 (160/100), what should you start pt on in terms of meds?
two agents simultaneously
what anticipatory guidance should there be for HTN pt started on medication?
watch for light headedness, palpitations, weakness, or decreased urine output
HCTZ can cause hyponatremia and hypokalemia
ACE inhibitors can cause hyperkalemia and chronic cough. both can cause kidney injury. –so need to monitor electrolytes and kidney fxn in 1 month along with BP
if meds are bringing HTN down to goal, what should you do?
titrate current meds to maximal levels before starting new agents
Cushing’s triad
combo of elevated BP, low HR, low resp rate
what can dark urine suggest in the context of HTN?
renal failure secondary to HTN
why are ibuprofen and NSAIDs in general bad for BP?
they raise BP b/c of prostaglandin inhibition (prostaglandins dilate afferent arteriole to increase renal blood flow)
what should you be careful of in lowering BP in someone w/ chronically high BP?
not dropping BP too fast because can get hypoperfusion. should not lower systolic BP more than 25% in 24 hrs
nitroprusside side effect
cyanide poisoning (peripheral vasodilation and flushing)
