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Internal Medicine > Ambulatory Medicine - Step UP > Flashcards

Ambulatory Medicine - Step UP Flashcards

1
Q

MCC of secondary HTN

A

renal artery stenosis

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2
Q

what types of medications can cause secondary HTN?

A

OCPs, decongestants, estrogen, appetite suppressants, chronic steroids, TCAs, NSAIDs

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3
Q

mechanism of action of OCPs in causing HTN

A

estrogen-mediated increase in synthesis of angiotensinogen in the liver

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4
Q

who should be screened for secondary HTN

A
  • pts with HTN before age 25 or greater than 55 yo
  • key features in hx/PE
  • pts. refractory to standard tx
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5
Q

features of Conn syndrome

A

HTN and hypokalemia due to increased aldosterone

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6
Q

tx. of Conn syndrome

A

K+ sparing diuretics, surgery

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7
Q

malignant HTN

A

sufficient elevation of BP to cause papilledema and other manifestations of vascular damage (encephalopathy, nephropathy)

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8
Q

which hypertensive drugs are contra-indicated in pregnancy?

A

ACEi/ARBs
thiazides
CCBs

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9
Q

what HTN drugs are safe in pregnancy?

A

B-blockers

hydralazine

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10
Q

best initial HTN drug choice for African-American patients

A

thiazide diuretics

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11
Q

who should BB be avoided in?

A

pts with hx. of asthma, COPD, heart block and depression

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12
Q

what anti-HTN drug is preferred among diabetics?

A

ACEi

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13
Q

when are alpha-blockers considered in tx. of HTN

A

in pt with concurrent BPH

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14
Q

when are vasodilators like hydralazine and minoxidil used to tx. HTN

A

in combo with BB and diuretics in pts with refractory HTN

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15
Q

what drug is used for tx of HTN in pts post-MI

A

beta blocker

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16
Q

which HTN drugs can decrease LV systolic function in CHF

A

ACEi and/or BB

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17
Q

what drugs are least effective in african americans

A

ACEi

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18
Q

ACCOMPLISH trial

A

tx. with ACEi benazepril PLUS CCB amlodipine was more effective than tx. with ACEi + diuretic

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19
Q

endocrine secondary causes of hyperlipidemia

A

hypothyroidism
DM
Cushing’s syndrome

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20
Q

renal causes of hyperlipidemia

A

nephrotic syndrome

uremia

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21
Q

medications that can cause hyperlipidemia

A 
steroids
estrogen
thiazide diuretics
B-blockers
HIV protease inhibitors
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22
Q

what levels of LDL significantly predispose to increased CAD risk

A

> 160 mg/dL

23
Q

how can you calculate LDL cholesterol

A

total cholesterol - HDL - TG/5

24
Q

goal for total cholesterol levels

A

< 200 mg/dL

25
Q

goal for LDL in a diabetic? for diabetic and CAD?

A

1) < 100 mg/dL

2) < 70 mg/dL

26
Q

effect of HDL on cholesterol

A

every 10 mg/dL increase in HDL, reduces CAD risk by 50%

27
Q

which lipid lowering drugs can induce transient elevations in LFTS

A

statins and fibrates

28
Q

what other tests should you order if a patient has hyperlipidemia?

A

TSH - hypothyroidism
LFTs - chronic liver disease
BUN, Cr, urinary proteins
glucose levels

29
Q

effects of Statins

A

lower LDL levels

- reduce mortality from cardiovascular events and significantly reduce total mortality

30
Q

side effects of statins

A

monitor LFTs - monthly for first 3 months, then every 3-6 months
monitor CPK- decrease CoQ in muscle cells= myopathy

31
Q

side effects of niacin

A

lower TG levels, lowers LDL levels, increases HDL

32
Q

note about use of niacin

A
  • do not use in diabetics (may worsen glycemic control)
  • most potent agent for increasing HDL
  • flushing effect
  • check LFTs and CPK levels
33
Q

effects of bile-acid binding resins

A

lower LDL and increase TG levels

- effective when used in combo with statins or niacin in high risk pts

34
Q

effects of fibrates (gemfibrozil)

A

lower VLDL and TG
increase HDL
- primarily for lowering TG

35
Q

side effects of fibrates

A 
gynecomastia
gallstones
mild GI side effects
weight gain
myopathies
36
Q

first line therapy for high TG levels

A

weight loss, aerobic exercise, glycemic control in DM and low fat-diet

37
Q

medications to lower TG levels

A

fibrates
fish oils
nicotinic acid

38
Q

what kind of headache causes pain that is tight and a band-like pattern around the head most intense in the neck or back of head and can be accompanied by tight posterior neck muscles?

A

tension headache

39
Q

what are tension headaches commonly associated with?

A

anxiety, depression and stress

40
Q

tx of tension headaches

A

eliminate causal factor

NSAIDS, acetaminophen and aspirin

41
Q

man experiences excruciating periorbital pain unilaterally along with ipsilateral lacrimation, facial flushing and nasal stuffiness/discharge - dx?

A

cluster headache

42
Q

characteristics of pain in cluster headache

A

usually awakens the patient form sleep and attacks can occur nightly for 2-3 months and then disappear; worse with alcohol and sleep

43
Q

DOC for acute cluster headache attack

A

sumatriptan (Imitrex)

- O2 inhalation can be beneficial

44
Q

prophylaxis of cluster headaches

A

verapamil -daily

45
Q

alternate agents for prophylaxis of cluster headaches

A

ergotamine,methysergide, lithium, prednisone

46
Q

classic presentation of a visual aura in migraine

A

bilateral homonymous scotoma

- bright, flashing crescent-shaped images with jagged edges that often appear on a page obscuring the underlying print

47
Q

characteristic pain in a migraine

A

severe, throbbing, unilateral headache that is aggravated by coughing, physicial activity and bending down; may be accompanied by photophobia, NV or increased sensitivity to smell

48
Q

first line therapy for a migraine

A

NSAIDs - ibuprofen, naproxen

49
Q

2nd line therapy for moderate-severe migraines

A

triptans or dihydroergotamine

50
Q

contraindications of dihydroergotamine

A 
CAD
pregnancy
TIAs
PVD
sepsis
51
Q

contraindications of sumatriptan

A

CAD, pregnancy, uncontrolled HTN, MAOIs, SSRIs, lithium, basilar artery migraine, hemiplegic artery

52
Q

what is the best drug for tx. of migraine severe migraine symptoms

A

sumitriptan

- should not be used > 1-2x/week

53
Q

best drug for prophylaxis of a migraines

A

propranolol

- TCAs are also first line

54
Q

second-line agents for migraine prophylaxis

A

methysergide
verapamil
valproic acid

Internal Medicine (9 decks)

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