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CP > A: HYPERTENSION > Flashcards

A: HYPERTENSION Flashcards

1
Q

Blood pressure is elevated enough to perfuse tissues and organs

A

Hypertension

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2
Q

High blood pressure

A

Hypertension

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3
Q

It is not a disease but an important risk factor for cardiovascular complications

A

Hypertension

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4
Q

It can be defined as a condition where blood pressure is elevated to an extent where clinical benefit is obtained from blood pressure

A

Hypertension

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5
Q

What are the Classification of Hypertension

A

Normal: < 120mmHg Systolic and < 80mmHg Diastolic

Pre hypertension or Elevated: 120-139 mmHg Systolic and 80-89mmHg Diastolic

HBP/HTN Stage 1: 140-159mmHg Systolic or 90-99mmHg Diastolic

HBP/HTN Stage 2: Greater than 160mmHg Systolic or Greater than 100mmgHg Diastolic

HTN Crisis: >180 mmHg or >120 mmHg

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6
Q

Blood Pressure Categories:
Normal

A

< 120mmHg Systolic and < 80mmHg Diastolic

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7
Q

Blood Pressure Categories:
Pre hypertension or Elevated

A

P120-139 mmHg Systolic and 80-89mmHg Diastolic

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8
Q

Blood Pressure Categories:
HBP/HTN Stage 1

A

140-159mmHg Systolic or 90-99mmHg Diastolic

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9
Q

Blood Pressure Categories:
HBP/HTN Stage 2

A

Greater than 160mmHg Systolic or Greater than 100mmgHg Diastolic

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10
Q

Blood Pressure Categories:
HTN Crisis

A

> 180 mmHg or >120 mmHg

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11
Q

Types, Causes, or Incidence of Hypertension

A

Primary Hypertension / Essential
Secondary Hypertension

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12
Q

No specific cause of Hypertension

A

Primary Hypertension / Essential

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13
Q

Identifiable cause

A

Secondary Hypertension

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14
Q

Physiology, or Formula of BP or HTN

A

BP = CO ✕ TPR

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15
Q

CO stands for

A

Cardiac Output

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16
Q

TPR stands for

A

Total Peripheral Resistance

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17
Q

Formula of CO

A

SV x HR

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18
Q

SV stands for

A

Stroke Volume

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19
Q

HR stands for

A

Heart Rate

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20
Q

Complications of HTN

A

1.) Cardiac Effects
a.) Left ventricular Hypertrophy
b.) Accelerated Atherosclerosis
2.) Renal Effects
3.) Cerebral Effects
4.) Retinal Effects

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21
Q

Blood pressure is measured using a

A

Sphygmomanometer

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22
Q

A device composed of an inflatable cuff to restrict the blood flow, and a mercury or mechanical manometer to measure the pressure

A

Sphygmomanometer

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23
Q

Blood Pressure is measured by

A

Sphygmomanometer
Manual (Mercury & Aneroid)
Digital

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24
Q

What is a present symptom in HTN

A

Headache

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25
Q

It is usually unclear if this is caused by hypertension or is an incidental finding

A

Headache

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26
Q

Predisposing Factors

A
  • Family history
  • Patient history
  • Racial predisposition
  • Obesity
  • Smoking
  • Stress
  • Sedentary lifestyle
  • Intake of fats and salts
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27
Q

Patient’s history and other physical findings suggest an underlying cause of hypertension

A

Secondary Hypertension

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28
Q

Diseases or Disorders that can cause High Blood Pressure

A

Primary aldosteronism
Pheochromocytoma
Renal artery stenosis

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29
Q

It is a clinical situation in which blood pressure is very high with minimal or no symptoms, and NO signs or symptoms indicating acute organ damage

A

Hypertensive urgency

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30
Q

Hypertensive emergency is also known as

A

Malignant hypertension or accelerated

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31
Q

A high blood pressure with potentially life-threatening symptoms and signs indicative of acute impairment of one or more organ systems

A

Hypertensive emergency

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32
Q

Diagnosis: Home or ambulatory blood pressure measurements is recommended to prevent

A

“white coat hypertension”

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33
Q

It is recommended to prevent “white coat hypertension”

A

Home or ambulatory blood pressure measurements

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34
Q

The number of times the heart beats in one minute

A

Cardiac Output

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35
Q

Diagnostics

A

CBC
Lipid Profile (HDL, LDL, Triglycerides)
SGOT
SGPT
Na
K
Ca
BUN
BUA
FBS & RBS
CREA
HBA1C
Urinalysis

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36
Q

What are the Lipid Profile

A

HDL, LDL, and Triglycerides

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37
Q

What are the electrolytes needed in Diagnostic

A

Na, K, and Ca

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38
Q

General Principle for the treatment of HTN

A

To lower blood pressure toward NORMAL with minimal side effects and to prevent or reverse organ damage

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39
Q

Candidates for the treatment of HTN

A

Patients with diastolic >90mmhg and systolic of >140mmhg

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40
Q

Non- specific measures / Non- Pharmacologic measures

A
  • Weight loss results in reduction in BP of about 2.5/1.5 mmHg per kg (for overweight patients)
  • Reduce salt intake (aim is <100 mmol daily sodium intake)
  • Diet high in fruit and vegetables, legumes and whole grain cereal improves cardiovascular risk
  • Regular dynamic exercise for at least 30 minutes on most days
  • Alcohol intake should be restricted
  • Quit smoking
41
Q

Non-Pharmacologic Approaches: Weight loss results in reduction in BP of about __ (for overweight patients)

A

2.5/1.5 mmHg per kg

42
Q

Non-Pharmacologic Approaches: Diet high in fruit and vegetables, legumes and whole grain cereal improves __

A

Cardiovascular risk

43
Q

Non-Pharmacologic Approaches: Reduce salt intake (aim is __ daily sodium intake)

A

<100 mmol

44
Q

Non-Pharmacologic Approaches: Regular dynamic exercise for at least __ on most days

A

30 minutes

45
Q

AB/CD Algorithm by

A

Williams et al 2004

46
Q

Initial choice of ACE inhibitor or angiotensin
receptor blocker and β blocker as first line
therapy in younger nonblack patients (<55
years)

A

Treatment A/B

47
Q

Said patients often have hypertension associated with high concentration of renin. It is therefore logical to treat them with drugs that antagonize the renin-angiotensin system

A

Treatment A/B

48
Q

In treatment A/B the initial choice as first line therapy are

A

ACE inhibitor or angiotensin
receptor blocker and β blocker

49
Q

Treatment A/B is suitable for

A

younger nonblack patients (<55
years)

50
Q

For elderly and black patients, who tend to have hypertension associated with low renin concentration, calcium channel blockers and thiazide diuretics are recommended

A

Treatment C/D

51
Q

What is the recommended medicine in the treatment C/D

A

calcium channel blockers and thiazide diuretics

52
Q

Treatment C/D is suitable for

A

elderly and black patients

53
Q

What happens if initial drug therapy fails

A

A or B is combined with C or D

54
Q

MOA: inhibition of the conversion of angiotensin 1 to angiotensin 2

A

Ace Inhibitors

55
Q

Ace Inhibitors example

A

Captopril
Enalapril (enalaprilat)
Fosinopril
Lisinopril
Dolapril
Perindopril

56
Q

MOA: works by blocking the binding of
Angiotensin 2 to the receptor

A

Angiotensin Receptor Blockers

57
Q

ARBS stands for

A

Angiotensin Receptor Blockers

58
Q

ACE inhibitors stands for

A

Angiotensin-converting enzyme

59
Q

Angiotensin Receptor Blockers example

A

Telmisartan
Losartan
Olmesartan
Valsartan

60
Q

MOA: Blocks Beta adrenergic system

A

Beta Blockers

61
Q

Whites with high cardiac output, high heart rate and normal vascular resistance
respond the best with

A

Beta Blockers

62
Q

In Beta Blockers the stimulation of renin secretion is

A

blocked

63
Q

In Beta Blockers the cardiac contractility is

A

decreased

64
Q

In Beta Blockers the reduction in heart rate

A

decreases cardiac output

64
Q

In Beta Blockers the sympathetic output is

A

decreased

65
Q

Beta blockers must be used cautiously in patients with

A

DM, Reynaud’s syndrome, & Neurological Disorder

66
Q

NO beta blocker is safe with patients with

A

bronchospastic problem

67
Q

What are the Beta-1 Selective Beta blockers

A

Metoprolol
Atenolol
Acebutolol
Esmolol
Betaxolol
Nebivolol

68
Q

First B1 selective

A

Metoprolol

69
Q

Have high intrinsic activity

A

Acebutolol

70
Q

Shortest T1/2 (Half-life)

A

Esmolol

71
Q

What are Non-Selective Beta blockers

A

Propranolol
Nadolol
Timolol
Pindolol
Penbutolol
Carvedilol ( with alpha blocking property)

72
Q

Effective after Acute MI to prevent sudden death

A

Timolol

73
Q

1st adrenergic to have high intrinsic activity

A

Pindolol

74
Q

Significant Interaction in CCB

A

Beta blocker + Calcium Channel Blocker

75
Q

MOA: Inhibits influx of calcium through slow channels in vascular smooth muscle and cause relaxation

A

Calcium Channel Blocker

76
Q

These agents must be used with extreme caution or not at all in patient with conductive disturbances involving SA and AV node

A

Non-Dihydropyridine

77
Q

Non-Dihydropyridine example

A

Verapamil
Diltiazem

78
Q

Dihydropyridine example

A

Nifedipine
Amlodipine
Clevidipine
Isradipine
Felodipine
Nicardipine (2ND GENERATION )

79
Q

To produce more selective effects on specific target tissues than the first generation agents

A

Dihydropyridine

80
Q

Blocks the peripheral postsynaptic Alpha-1
adrenergic receptor

A

Peripheral Alpha-1 Adrenergic Antagonist

81
Q

Given to HTN patients who have not responded to initial HTN therapy

A

Peripheral Alpha-1 Adrenergic Antagonist

82
Q

Peripheral Alpha-1 Adrenergic Antagonist

A

terazosin
prazosin
doxazosin

83
Q

Side effect of Zosin

A

may cause 1st dose phenomenon

84
Q

MOA: act primarily within the CNS on alpha 2 receptors to decrease sympathetic outflow to the cardiovascular system

A

Centrally Active Alpha Agonist

85
Q

Centrally Active Alpha Agonist Example

A

Methyldopa
Clonidine
Guanabenz
Guanfacine

86
Q

Decrease TPR and CO

A

Methyldopa

87
Q

Acts centrally , as well as peripherally, by depleting catecholamine stores in the brain and in the peripheral adrenergic system

A

Reserpine

88
Q

Given in low doses to treat refractory hypertension

A

Reserpine

89
Q

Contraindicated to patients with history of
depression

A

Reserpine

90
Q

usual dose of Reserpine

A

0.1 to 0.25 mg per day

91
Q

Second line agents in patients with refractory to initial therapy

A

Vasodilators

92
Q

First line agents in patients with refractory to initial therapy

A

Reserpine

93
Q

MOA: directly inhibits renin = reduction of production of Angiotensin 2

A

Aliskiren (Renin Inhibitor)

94
Q

Vasodilators example

A

Hydralazine
Minoxidil
Nitroprusside

95
Q

Arteriole relaxation & decrease of systemic vascular resistance

A

Hydralazine

96
Q

decreases peripheral resistance

A

Minoxidil

97
Q

releases nitric oxide

A

Nitroprusside

98
Q

What forms in the blood vessel that causes HBP

A

Plaque

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