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PANCE 2.0 > Cardiology #3 (Hypertension) > Flashcards

Cardiology #3 (Hypertension) Flashcards

1
Q

What is hypertension defined as?

A
  • Systolic blood pressure of 130 mmHg or more and/or diastolic blood pressure 80 mmHg or more
  • Elevations must be at least 2 different readings on 2 separate visits
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2
Q

What is considered Stage I hypertension?

A

Systolic: 130-139
Diastolic: 80-89

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3
Q

What is considered stage II hypertension?

A

Systolic: 140 or greater
Diastolic: 90 or greater

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4
Q

What is the MCC of primary hypertension?

A

Idiopathic etiology

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5
Q

What is the MCC of secondary hypertension?

A

Renovascular (renal artery stenosis, etc.)

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6
Q

What are other causes of secondary hypertension?

A
  • Cushing syndrome
  • Pheochromocytoma
  • Coarctation of the aorta
  • Sleep apnea
  • Alcohol use
  • OCPs
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7
Q

What is the initial management of a newly diagnosed hypertensive patient?

A
  • Lifestyle modifications
  • -Salt restriction ( < 2.4 g/day)
  • -Smoking cessation
  • -Exercise ( > 30 minutes/day most days/week)
  • -Diet (DASH diet)
  • -Weight reduction (achieve BMI 18.5-24.9)
  • -Limited alcohol consumption (< 2 drinks/d in men, < 1 drink/d in women)
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8
Q

What are the components of an initial workup for a patient with hypertension?

A
  • 12 lead ECG
  • Funduscopy (retinopathy)
  • Creatinine
  • Cholesterol
  • Urine albumin to creatinine ratio
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9
Q

In patients who fail a trial of diet and exercise, what is the next treatment step?

A

Medical management with medication

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10
Q

What are some complications of uncontrolled hypertension?

A
  • Cardiovascular: CAD, heart failure, MI, aortic dissection, PVD
  • Neurologic: TIA, stroke, ruptured aneurysms, encephalopathy
  • Nephropathy: (2nd MCC of end stage renal disease in the US)
  • Optic: retinal hemorrhage, blindness, retinopathy
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11
Q

What is the blood pressure target in a hypertensive patient? How about if they are 60 years or older?

A

140/90 mmHg

< 150/90 mmHg in adults 60 years or older

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12
Q

What two classes of anti-hypertensives should be used in African Americans?

A

Thiazides

CCB

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13
Q

What class of anti-hypertensives should be used if the patient also has gout?

A

CCB

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14
Q

What is the only ARB that doesn’t cause hyperuricemia?

A

Losartan

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15
Q

If the patient has hypertension and DM, what classes of meds should be used?

A

ACEi and ARB

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16
Q

What are some examples of ACE inhibitors?

A
  • Pril
  • -Lisinopril
  • -Enalapril
  • -Ramipril
  • -Benazepril
17
Q

What are the common side effects of ACE inhibitors?

A
  • Cough
  • Hyperuricemia
  • Hyperkalemia
  • Angioedema
  • 1st Dose Hypotension

Think, CHHAD uses ACEs

18
Q

If the patient has Atrial flutter or A-fib, what medications should help with both conditions?

A
  • Beta Blockers

- CCB

19
Q

What is one major contraindication of an ACE and ARB?

A

Pregnancy

20
Q

Name some Beta Blockers. Which are cardioselective (B1)? Which are nonselective (B1, B2). Which cover (B1 and B2)?

A

Cardioselective: Atenolol, Metoprolol, Esmolol
Nonselective: Propanolol
Both: Labetalol, Carvedilol

21
Q

Adverse effects of Beta Blockers

A
  • Fatigue
  • Depression
  • Impotence
  • Hypoglycemia in DM
22
Q

Nonselective BB are contraindicated in patients with ______ or _______ because it may worsen Reynaud’s or peripheral vascular disease

A

asthma

COPD

23
Q

Name 6 thiazide-type diuretic medications

A
  • Hydrochlorothiazide
  • Chlorthalidone
  • Furosemide
  • Spironolactone
  • Amiloride
  • Eplerenone
24
Q

Which diuretics are potassium sparing diuretics and what does that mean?

A

Spironolactone, Amiloride, Eplerenone

-Inhibits aldosterone-mediated Na/H20 absorption (spares potassium)

25
Q

What is a common side effect of Spironolactone?

A
  • Hyperkalemia

- Gynecomastia

26
Q

MOA of diuretics

A

-Prevent kidney Na/water reabsorption at the distal diluting tubule.

27
Q

What are some common side effects of diuretics?

A 
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypokalemia
Hyponatremia
28
Q

Name some calcium channel blockers

A
  • Nifedipine
  • Amlodipine
  • Verapamil
  • Diltiazem
29
Q

Name some ARBs

A

-Artans

  • Losartan
  • Valsartan
  • Irbesartan
  • Candesartan
30
Q

What is a hypertensive urgency?

A

-SBP > 180 mmHg and/or DBP > 120 mmHg without evidence of end organ damage

31
Q

What is the rate of reduction for hypertensive urgency?

A

Gradual reduction of mean arterial pressure by no more than 25% over 24-48 hours with ORAL medications (Clonidine, Captopril, Labetalol, Nicardipine, Furosemide)

32
Q

What is the treatment goal for a patient with hypertensive urgency?

A

Blood pressure 160/100 or less

33
Q

What is the medication of choice for a patient with hypertensive urgency and what is the common side effect of this medication?

A

Clonidine

Rebound hypertension if discontinued abruptly (mimics pheochromocytoma)

34
Q

Symptoms of hypertensive urgency

A

-General: Headache (MC), dyspnea, chest pain, AMS, delirium, seizures, nausea, vomiting

35
Q

What is a hypertensive emergency

A

SBP > 180 and/or DBP > 120 with evidence of end organ damage

36
Q

Management of hypertensive emergency

A

IV blood pressure agents and reduce MAP gradually about 10-20% in first hour and then additional 5-15% over the next 23 hours

37
Q

First-line treatment for a patient with HTN encephalopathy (confusion, headache, nausea, vomiting)

A

Nicardipine, Clevidipine, Labetalol, Sodium Nitroprusside

38
Q

What is the treatment for aortic dissection associated with hypertensive emergency?

A

BB: Labetalol, Esmolol

PANCE 2.0 (62 decks)

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