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competency 10/11 > cardio: HTN > Flashcards

cardio: HTN Flashcards

1
Q

pathophysiology of HTN

A
  • defects in renal sodium hemostasis
  • functional vasoconstriction
  • defects in vascular smooth muscle and structure
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2
Q

secondary causes of HTN

A

CKD, cushing’s syndrome, thyroid disease, NSAIDs, aspirin, decongestants, excessive consumption of licorice, st. john’s wort, bb or centrally acting a-agonists when abruptly discontinued

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3
Q

recommending BP monitor cuff sizes: adult

A

width 37-50% of limb’s length (length: width ratio, 2:1), inflatable bladder must cover 75-100% of the arm’s circumference

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4
Q

recommending BP monitor cuff sizes: obese

A

consider using wrist meters place at level of heart
- below heart - overreads
- above heart - underreads

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5
Q

recommending BP monitor cuff sizes: paediatrics

A

right arm BP, unless coarctation of aorta (aka imbalance of BP on L and R side)

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6
Q

grade 1 HTN

A

140-159/90-99

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7
Q

grade 2 HTN

A

160-179/100-109

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8
Q

grade 3 HTN

A

> = 180/ >= 110

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9
Q

unless c/i, advise patients to reduce weight to a BMI below

A

23kg/m2, and to a waist circumference below 90cm in men and below 80cm in women (for Asians)

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10
Q

advise pt to restrict salt intake to ___g per day

A

5-6

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11
Q

moderate alcohol consumption to no more than

A

2 standard drinks per day for men, and to no more than 1 standard drink per day for women

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12
Q

drug treatment should not be delayed without reason beyond ____________ if indicated

A

3-6months

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13
Q

advise pt to do at least ____ minutes of moderate dynamic exercise ____ days/week

A

30 mins, 5-7 days

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14
Q

any physical exercise above the basal level up to ____mins/week, confers incremental cv and metabolic benefits including BP reduction

A

150

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15
Q

bp lowering effects are likely similar btw classes, but

A

disease outcomes mismatch degree of bp reduction

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15
Q

which antihypertensive drug class have evidence of reducing risk of ESRD?

A

ACEi/ARB - most effective agents to reduce albuminuria, delay progression of diabetic and non-diabetic CKD

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15
Q

should we combine ACEi and ARB?

A

nope, no added benefit and excess of renal adr

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16
Q

when are ACEi/ARBs compellingly indicated?

A

post MI, HFrEF, albuminuria and CKD, HTN in DM

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17
Q

Antihypertensive class choice in pregnancy?

A

Labetalol, methyldopa, nifedipine, or vasodilators
- do not use ACEi (teratogenic in 2nd and 3rd trimester), ARB or direct renin inhibitors

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18
Q

BP target for most pt

A

120-130/70-80

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19
Q

initiation of antihypertensive drug therapy with 2 first-line agent of different classes, either as separate agents or in a fixed-dose combi, is recommended in adults with

A

stage 2 hypertension (BP>160/100mmHg) and an average BP >20/10mmHg above their BP target

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20
Q

what might help w DHP CCB a/w LL edema?

A

tolerance w time and combine w RASi (decr vasoconstriction) with CCBs (decr vascular SM tone)

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21
Q

avoid non-DHP in

A

HFrEF

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22
Q

caution use of non-DHP in

A

high-grade SA and AV block, bradycardia <60bpm, concomitant use of BB

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23
Q

loop diuretics site of action

A

thick ascending limb

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24
Q

thiazides site of action

A

distal convoluted tubule

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25
Q

K-sparing diuretics

A

aldosterone antagonist, mineralocorticoid antagonist

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26
Q

thiazide-like diuretics eg

A

indapamide

27
Q

thiazide-like diuretics vs thiazides

A

thiazide-like diuretics have:
- better BP lowering effect, longer duration of action
- more RCT evidence in reducing CV events and mortality

28
Q

thiazides/thiazides-like diuretics: reduced effectiveness when eGFR<____ml/min

A

45
- thiazides probably ineffective when eGFR<30, may req loop diuretics for intended diuresis

29
Q

ADR of thiazide/thiazide-like diuretics

A

electrolyte dysregulation: hypoK/Na, enhanced Ca reabsorption
dysmetabolic effects: insulin resistance, new-onset DM (do not use with BB, may be attenuated by K-sparing diuretic), hyperTG/LFL, hyperuricemia

30
Q

Which BB can be used with diuretics?

A

Nebivolol

31
Q

ADRs of BBs

A
  • associated with new onset DM (do not use with diuretics, except nebivolol)
  • sexual dysfunction (less with nebivolol)
  • severe claudication: muscle pain triggered by activity
32
Q

Compelling indications for use of BB

A

Angina, heart rate control, a

33
Q

thirdline agents used for

A

resistant hyperTN: full dose of 3 drugs and BP still not controlled

34
Q

compelling indications: HF

A

BB + ACEi/ARB or ARNI
-> aldosterone antagonist
-> diuretics
DO NOT use non-dhp ccb, but can use amlodipine or felodipine

35
Q

compelling indications: angina pectoris

A

BB
-> ACEi/ARB or DHP CCB (reduce LVH)

36
Q

compelling indications: post MI

A

BB
-> ACEi or ARB

37
Q

compelling indications: AF prevention

A

BB, ACEi or ARB (may prevent recurrence)

38
Q

compelling indications: AF ventricular rate control

A

BB

39
Q

compelling indications: DM

A

ACEi or ARB
-> DHP CCB: slows progression of carotid atherosclerosis
-> diuretic or BB

40
Q

compelling indications: DM with albuminuria (moderately or severely increased albuminuria)

A

ACEi or ARB
DO NOT use any combi of ACEi with ARB

41
Q

compelling indications: recurrent stroke prevention

A

thiazide-like diuretic + ACEi

42
Q

compelling indications: gout

A

DO NOT use diuretics

43
Q

compelling indications: bilateral renal stenosis

A

DO NOT use ACEi/ARB

44
Q

compelling indications: ESRD

A

DO NOT use ACE/iARB/aldosterone antagonist (worsens renal function and hyperK)

45
Q

compelling indications: heart block

A

DO NOT use BB, non-DHP CCB

46
Q

compelling indications: peripheral artery disease

A

ACEi or DHP CCB

47
Q

compelling indications: aortic aneursym

A

BB

48
Q

compelling indications: isolated SBP

A

diuretic, or DHP CCB

49
Q

BP goal for 65-80yo

A

stepwise <150mmHg, then <140mmHg if tolerated and achievable, ideally <130mmHg

50
Q

perindopril +/- indapamide

A

reduces intracranial bleeding by 46%, in pt w or without AF on antithrombotic

51
Q

isolated systolic hyperTN

A

wide pulse pressure (SBP-DBP>80mmHg) + SBP>140mmHg and DBP<90mmHg
- function of aging and arteriolar stiffness
- when treating ISH, may lead to orthostatic hypoTN - start low, go slow, watch to avoid OH

52
Q

preferred antihypertensives in older adult

A

CCB, diuretics

53
Q

oral contraceptives can cause

A

incr BP, proportionate with duration fo use

54
Q

orthostatic hypoTN

A

supine-to-standing BP decr by >20mmHg SBP or >10mmHg DBP, within 3 mins of standing
- possible etiologies: age-related, severe volume depletion, baroreflex dysfunction, autonomic insufficency eg diabetes, certain antihypertensives
- postural unsteadiness, dizziness, fainting, may be a/w falls and fractures
- educate pt to rise slowly

55
Q

hypertensive emergency

A

severe HTN (grade 3>180/110mmHg) a/w acute HMOD
- often life threatening and requires immediate but careful intervention to lower BP (usually iv)
- complaints: HA, visual disturbances, chest pain, dyspnea, dizzines sand other neurological deficits
- rarely: somnolence, lethargy, tonic clonic seizures, and corticol blindess may precede a loss of consciousness

56
Q

hypertensive urgency

A

severe HTN but no evidence of acute HMOD, does not require admission to hospital

57
Q

adrenaline moa

A

a1 (vasodilatation of arteries and increased vascular permeability leading to loss of intravascular fluid and subsequent hypotension/vasopressor), b1 (increased myocardial force of contraction (positive inotrope) and heart rate (positive chronotrope)), b2 (bronchial smooth muscle relaxation that helps to relieve bronchospasm) stimulation

58
Q

ACEi is particularly useful in treating

A
  • chronic renal failure: diminish proteinuria and stabilise kidney function (even in the absence of decreased BL), particularly useful in slowing progress of diabetic nephropathy
  • HF and post MI: slowing remodeling effects
59
Q

CCBs bind more effectively to _____ and ____ channels

A

open and inactivated
- binding of the drug reduces freq of opening in response to depolarisation and decreases transmembrane calcium current

vs neuronal cells possess L-type calcium channels but less sensi to these drugs as the channels spend less time in open and unactivated state

60
Q

DHPs vs non-DHPs

A

DHPs are more selective as vasodilators (relax vascular SM, leading to vasodilation) and have less cardiac effects

61
Q

why are skeletal muscles not depressed by CCBs?

A

they use intracellular pools of calcium

62
Q

CCBs: lowering BP

A

DHP = diltiazem = verapamil

63
Q

CCBs: vasodilator

A

DHP>diltiazem>verapamil

64
Q

CCBs: cardiac depressant

A

verapamil>diltiazem>DHP

65
Q

a1 adrenoceptor antagonist MOA

A

block vasoconstriction, esp. visceral blood flow (dilate both resistance and capacitance vessels)

  • retention of salt and water increased when administered without diuretics, hence more effective when used with diuretic or bb
66
Q

toxicities of a1 blockers

A

dizziness, palpitations, headache, lassitude

67
Q
A

competency 10/11 (31 decks)

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