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10.3 Flashcards

1
Q

What are thin layer vessels formed by arteries branching down in size as they move away from the heart?

A

Arterioles

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2
Q

What is regulated by relaxing or contracting of the smooth muscle around the arterioles?

A

BP

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3
Q

Compared to veins, _______ have a larger layer of smooth muscle as well as a larger more dense outer layer.

A

arteries

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4
Q

What is considered normal BP?

A

Normal:
SBP: < 120
DBP: < 80

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5
Q

What is considered elevated BP?

A

Elevated:
SBP: 120-129
DBP: < 80

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6
Q

What is considered Stage I Hypertension?

A

Stage I
Hypertension:
SBP: 130-139
DBP: 80-89

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7
Q

What is considered Stage II Hypertension?

A

Stage II
Hypertension:
SBP: ≥140
DBP: ≥ 90

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8
Q

What is Essential hypertension?

A

Hypertension of an unknown cause

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9
Q

What is secondary hypertension?

A

Hypertension of a known cause

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10
Q

Patients must have elevated blood pressure recordings on how many separate visits to be considered for HTN?

A

3-5

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11
Q

What are some differentials for high BP?

A
  • Essential HTN
  • Secondary Hypertension
  • Hyperthyroidism
  • Stimulant use
  • NSAIDS
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12
Q

What labs should you order for someone with expected HTN?

A
  • Fasting glucose
  • UA for proteinuria, hematuria, casts
  • CBC
  • Chemistry
  • TSH
  • Lipid panel
  • EKG
  • CVDR calculator
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13
Q

What kind of lifestyle modifications should you counsel someone on for HTN?

A
  • Diet
  • Weight loss
  • Reduce alcohol
  • Exercise
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14
Q

What should you always do before starting someone on BP meds?

A

MEDADVICE

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15
Q

What’s an example of a diuretic you can give for HTN?

A

Hydrochlorothiazide (HCTZ)

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16
Q

How do diuretics work to lower BP?

A

They work initially by decreasing plasma volume,
but their long term effect is reduction of peripheral vascular resistance.

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17
Q

What is the initial dose patients should be started on for HCTZ?

A

12.5-25 mg daily

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18
Q

What are some adverse reactions to HCTZ?

A

Syncope, hypokalemia, hypomagnesium, hyponatremia, and hypercalcemia, increase in uric acid, glucose, LDL cholesterol, triglycerides, rash, and erectile dysfunction

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19
Q

What are some contraindications for HCTZ?

A

Allergy to sulfonamides, hepatic or renal impairment, electrolyte abnormalities, SLE, seizure disorder, gout.

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20
Q

What is another first line medication for HTN?

A

ACE Inhibitor

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21
Q

What’s an example of ACE Inhibitor you can give patients with HTN?

A

Lisinopril

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22
Q

How much do you initially prescribe Lisinopril for?

A

Initial dose 5-10 mg daily

23
Q

What are some adverse reactions to Lisinopril?

A

Dry cough, hypotension, dizziness, kidney dysfunction, hyperkalemia, angioedema, rash

24
Q

What are some contraindications to prescribing someone Lisinopril?

A

Angioedema, pregnancy, volume depletion, hyponatremia, hyperkalemia, severe CHF.

25
Q

What’s an ARB you can prescribe someone with HTN?

26
Q

What’s the initial dose you prescribe Losartan for HTN?

A

50mg daily

27
Q

What Calcium channel blockers can you prescribe someone for HTN?

A
  • Diltiazem
  • Almodipine
28
Q

What is an alpha beta blocker you can prescribe for HTN?

29
Q

How soon should you re-evaluate a pt after any BP medication change?

30
Q

How long should you wait before adjusting doses of medication?

31
Q

How often should you order a chemistry to evaluate for kidney dysfunction?

A

every year

32
Q

What complications are we trying to prevent with HTN?

A
  • Coronary Artery Disease (CAD)
  • Congestive Heart Failure (CHF)
  • Left Ventricular Hypertrophy (LVH)
  • Peripheral Vasculature Disease (PVD)
  • Cerebral Vascular Disease
  • Renal failure
33
Q

What is considered a Hypertensive URGENCY?

A

NO SIGNS OF END ORGAN DAMAGE
Systolic <220 Diastolic <125

34
Q

What is considered a Hypertensive EMERGENCY?

A

SIGNS OF END ORGAN DAMAGE

35
Q

What are signs of END ORGAN DAMAGE?

A

1) Mental status changes, confusion, headache
2) Intracranial hemorrhage
3) Ischemic stroke
4) proteinuria, hematuria, kidney dysfunction
5) Unstable angina, AMI, CHF, or Aortic dissection.
6) Pulmonary edema

36
Q

In a Hypertensive Emergency you need to reduce blood pressure by what %?
within how long?
to less then < 160/110 within how many hours?

A

25%
1-2 hours
24 hours

37
Q

What exams should you preform on someone with a Hypertensive Emergency?

A
  1. NEURO: deficits, mental status changes, changes in vision, headache, nausea/vomiting.
  2. CARDIO: signs of heart failure (S3, new murmurs), auscultate for carotid bruits, pulmonary edema (rales, crackles), complaints of sudden onset SOB, chest pain.
  3. EYE EXAM: looking for papilledema or hemorrhage.
38
Q

What Labs/Imaging should you order for signs of end organ damage?

A

(1) UA (proteinuria or hematuria)
(2) CMP (renal or liver dysfunction)
(3) Troponins (myocardial injury)
(4) EKG (AMI)
(5) CXR (aortic dissection)
(6) CT

39
Q

What is usually prescribed for Hypertensive Urgency?

A

ORAL MEDS

  • Clonidine
  • Labetalol
  • Metoprolol
40
Q

If someone is having a Hypertensive Emergency then what should you prescribe them?

A

Labetalol 20mg IV

41
Q

After you stabilize a pt with a Hypertensive Emergency you should do what?

42
Q

What is Atherosclerotic Disease?

A

A build up of cholesterol plaque in the walls of arteries causing obstruction of blood flow.

43
Q

Risk factors for atherosclerotic disease:

A

1) Hypercholesterolemia
2) Hypertension
3) Diabetes Mellitus
4) Male gender
5) Smoking
6) Family history

44
Q

What is Atherosclerotic Coronary Artery Disease (CAD)?

A

Coronary atherosclerosis leading to coronary arterial narrowing.

45
Q

Risk Factors for Atherosclerotic Coronary Artery Disease (CAD):

A
  1. Family history
  2. Male gender
  3. Hypercholesterolemia
  4. Diabetes mellitus
  5. Hypertension
  6. Physical inactivity
  7. Abdominal obesity
  8. Cigarette smoking
  9. Excessive alcohol
  10. Poor diet
  11. Metabolic Syndrome
46
Q

What is prescribed for Atherosclerotic Coronary Artery Disease (CAD)?

A

HMG-CoA reductase inhibitors -Statins

Aspirin

47
Q

What is an example of an HMG-CoA reductase inhibitors?

A

Atorvastatin

48
Q

Atherosclerotic Peripheral Vascular Disease (PVD)

A

PVD is occlusive atherosclerotic lesions that develop in the legs, and less commonly, the arms causing decreased perfusion of the extremities.

49
Q

Symptoms/Physical Exam Findings of PVD

A
  • Claudication
  • Pain unrelieved by rest
  • Diminished pulses
  • Ulceration
  • Erectile dysfunction
  • Loss of hair
  • Cool skin
  • Atrophy of muscles
50
Q

Differential Diagnosis for PVD:

A
  • DVT
  • Muscle strain or cramp
  • Neuropathy
51
Q

Labs/Studies PVD:

A
  • Doppler examination with ABI
  • CT Angiography and Magnetic Resonance Angiography
  • Lipid panel
  • Chemistry
52
Q

Non Pharmacological PVD:

A

1) Lifestyle changes: Increase activity and exercise.
2) Low fat diet high in fruits and vegetables.
3) MOST important SMOKING CESSATION.
4) Moderate use of alcohol.
5) Control of HTN, Diabetes, and hypercholesterolemia.

53
Q

What is the pharmacological treatment for PVD?

A

HMG-CoA reductase inhibitors (Lipid lowering medications
collectively known as STATINs).

54
Q

What drugs do we have to treat PVD?

A

Atorvastatin

Aspirin

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