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Clinical Medicine II > Cardiology: Hyper/Hypotension > Flashcards

Cardiology: Hyper/Hypotension Flashcards

1
Q

Primary Hyperaldosteronism Triad:

A
  1. Hypokalemia
  2. Metabolic alkalosis
  3. HTN
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2
Q

Pheochromocytoma Triad:

A
  1. HA
  2. Sweating/Tachycardia
  3. HTN
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3
Q

What is a major factor that correlates with an onset of HTN?

A

incidence increases proportionally with age.

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4
Q

Adults with risk factors for HTN should be screened how often and if their BP was previously measured in what range?

A

Semi annually if BP was 120-129

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5
Q

What is the gold standard for HTN diagnosis?

A

ambulatory blood pressure monitoring

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6
Q

What are the 7 questions to ask on Hx of HTN?

A

Duration

FHx

SHx

Medications (estrogen, adrenal steroids, sympathomimetics)

Risk Factors

Sx of secondary causes

Sx of target organ damage

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7
Q

The following sxs are indicative of what condition?

muscle weakness 
tachy 
sweating
tremor
skin thinning
flank pain
sleep apnea
A

Secondary HTN

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8
Q

What are sx to look for target organ damage?

A 
HA
transient weakness/blindness
loss of visual acuity
CP
dyspnea
claudicaiton
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9
Q

What conditions should be evaluated for during the PE for HTN?

A 
heart failure
renal failure
CVA
Dementia
aortic dissection
retinopathy
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10
Q

In general exam for HTN what should you look for?

A

body fat distribution (cushings)

skin leasions

muscle strength

alertness

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11
Q

HEENT considerations for HTN

A

fundoscopy for:

hemorrhage
papiledema
cotton wool spots

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12
Q

Neck considerations for HTN

A

carotid bruits

thyroid/goiter (Graves)

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13
Q

What should you evaluate for during the cardiac physical exam?

A 
size
rhythm
sounds
displaced PMI
new murmur
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14
Q

Abdominal considerations for HTN

A

renal masses
renal bruits
abdominal aorta mass/bruits
femoral pulses/bruits

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15
Q

For which patients should you get a urinary albumin to creatinine ratio

A

DM

CKD

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16
Q

What should be included in basic testing for primary HTN

A

Fasting glucose

CBC

lipid panel

serum creatinine w/ eGFR, sodium, potassium, calcium

TSH

UA

EKG

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17
Q

What are the “big 4” medications for HTN?

A

diuretics

ACE inhibitors

Angiotensinogen Receptor Blockers (ARB)

Calcium Channel Blockers (CCB)

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18
Q

what four medications can be considered after the 1st line “big 4”?

A

beta blockers

alpha blockers

central alpha agonists

direct renin inhibitors

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19
Q

Blood pressure that is not controlled despite adherence to an appropriate three drug regimen or requires 4 drugs is called what?

A

resistant HTN

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20
Q

How often should monitoring/fu occur after staring medications or changing doses?

A

monthly

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21
Q

What is the target BP with pharmacologic therapy?

A

130/80

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22
Q

A pt. presents with with elevated BP. How should it be managed and when should f/u occur?

A

promote lifestyle habits

reassess in 3-6 months

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23
Q

A patient presents with stage 1 HTN. You calculate the ASCVD risk, which is greater than 10%. How do you manage the patient and when do you want f/u?

A

lifestyle and BP medication monotherapy

f/u in 1 month

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24
Q

A patient presents with stage 1 HTN. You calculate ASCVD risk, which is less than 10%. How do you manage the patient?

A

lifestyle therapy

f/u in 3-6 months

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25
Q

A patient presents with Stage 2. How do you manage the condition and when do you want f/u?

A

lifestyle and BP meds

f/u in 1 month

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26
Q

Your stage 1/2 HTN patient comes in for f/u. BP goal is not met. How do you proceed>

A

assess and optimize adherence

consider intensification of therapy

F/u in 1 month

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27
Q

Your stage 1/2 HTN patient comes in for f/u. BP goal has been met. When do you want to followup?

A

3-6 mo follow up

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28
Q

In a pt. with CKD, albuminuria and concurrent HTN… what do you prescribe?

A

ACE Inhibitor

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29
Q

A pt. presents with CKD and HTN. No albuminuria is present. What do you prescribe?

A

any of the 1st line tx.

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30
Q

A pt. presents with DM, albuminuria, and HTN. What pharmacological agents should be considered?

A

ACE inhibitor or ARB

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31
Q

A pt. presents with DM and HTN without albuminuria. what should you prescribe

A

any 1st line tx

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32
Q

A pt. presents with HFrEF. What drugs should be avoided?

what about HFpEF?

A

HFrEF: non-dihydropyridine CCBs

HFpEF: ACE, ARB, beta blocker

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33
Q

What are the 4 types of diuretics?

A

thiazide
loop
potassium sparing
aldosterone antagonists

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34
Q

What is DOC of the diuretic class?

A

Thiazide diuretics, chlorthalidone

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35
Q

When taking chlorthalidone (thiazide diuretic), what must be monitored?

A

hyponatremia
hypokalemia
uric acid and calcium levels

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36
Q

What are contraindications for chlorthalidone (thiazide diuretic)?

A

hypersensitivity to sulfa

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37
Q

What drug is a loop diuretic?

A

furosemide (lasix)

38
Q

for what condition is furosemide/lasix (loop diuretics) indicated?

A

symptomatic HF

39
Q

what should you monitor for when taking furosemide (loop diuretics)?

A

hyponatremia
hypokalemia
calcium

40
Q

what are the contraindications for furosemide (lasix)

A

sulfa hypersensitivity

41
Q

what drug is a potassium sparing diuretic?

A

triamterene

42
Q

Is triamterene (potassium sparing diuretic) a strong or weak antihypertensive?

43
Q

What are the side effects of triamterene (potassium sparing diuretic)?

A

hyperkalemia
nephrolithiasis
renal dysfunction

44
Q

What are the precautions for tx with triamterene (potassium sparing diuretic)?

A

avoid in mod-sev CKD

caution combining with ACE inhibitors, ARBs, DRI, K supplements

45
Q

What drug is an aldosterone antagonist?

A

spironolactone

46
Q

What is the preferred pharmacological agent in primary patients with primary aldosteronism?

A

spironolactone, aldosterone antagonists

47
Q

What is a common use of spironolactone for HTN management?

A

used as an add on in resistant HTN

48
Q

What are the contraindications for spironolactone (aldosterone antagonists)

A

renal impairment

49
Q

What are the contraindications of ACE inhibitors?

A

pregnancy
angioedema
renal artery stenosis

50
Q

This class of drugs has the following side effects:

cough
hyperkalemia
angioedema
dizziness
acute renal failure
A

ACE Inhibitors

51
Q

An ACE Inhibitor cannot be combined with…

52
Q

What are the compelling indications of an ACE Inhibitor?

A

DM
CKD
post-MI
heart failure

53
Q

What is the common suffix of ARBs?

54
Q

For what patients should you consider an ARB?

A

CKD
DM
Heart Failure

55
Q

an ARB cannot be combined with..

A

ACE inhibitors

56
Q

what are the contraindications of an ARB?

A

pregnancy

renal artery stenosis

57
Q

what are the side effects of ARBs?

A

hyperkalemia
acute renal failure
angioedema

58
Q

Which CCB has a stronger cardiac depressant effect: Non-dihydropyridine or dihydropyridine?

A

non-dihydropyridine

59
Q

Which two drugs are non-dihydropyridine CCBs?

A

verapamil

diltiazem

60
Q

Which CCBs are dihydropyridine CCBs?

A

“ipine” drugs

61
Q

Contraindications of non-dihydropyridines…

A

use with beta blockers

heart failure with reduced EF

62
Q

Contraindications of dihydropyridines…

A

heart failure with reduced EF

63
Q

this drug class can cause the following side effects:

headache
peripheral edema
bradycardia
dizziness

64
Q

Which drug is a direct renin inhibitor?

65
Q

This drug class has the following side effects:

hyperkalemia
renal impairment
hypersensitivity rxn

A

direct renin inhibitors: aliskiren

66
Q

contraindications of direct renin inhibitors?

A

use with an ACE inhibitor or ARB in DM pts

pregnancy

67
Q

What are the side effects of alpha blockers?

A

orthostatic hypotension

reflex tachycardia

68
Q

For what patients should you consider an alpha blocker?

A

BPH patients

69
Q

When should you consider use of a central alpha agonist?

A

last line of defense

70
Q

Are central alpha agonists safe in pregnancy?

71
Q

What drug is a central alpha agonist?

A

methyldopa

72
Q

When is use of a central alpha agonist contraindicated

A

liver failure

73
Q

What is a special consideration when stopping methyldopa (central alpha agonist)?

A

avoid abrupt cessation

74
Q

This condition has the following characteristics:

asymptomatic

no evidence of end-organ damage

diastolic > 120

A

hypertensive urgency

75
Q

what is a common cause of hypertensive urgency?

A

nonadherence to antihypertensive meds or low-sodium diet

76
Q

This condition has the following characteristics:

Diastolic > 120

evidence of acute end organ damage

A

hypertensive emergency

77
Q

A patient presents with a DP of 125. What is your Dx, Tx strategy and goal?

A

Hypertensive urgency

rest, increase meds, add diuretic

counsel on sodium restriction

78
Q

You have a patient presenting with a DP of 125, and complaints of loss of visual acuity. What is your Dx, Tx strategy?

A

hospitalize to ICU

address underlying cause

reduce BP no more than 25% within an hour.

79
Q

What can be ordered to address the underlying cause of a hypertensive emergency?

A 
neuro exam
CXR
EKG
UA
electrolytes/creatinine
CT/MRI
80
Q

what drug is contraindicated for hypertensive emergency?

A

nefidipine

81
Q

if your hypertensive emergency patient is stable, what is the BP goal?

A

160/100-110 over 2-6 hours, normal BP over 24-48 hours

82
Q

what drugs are used to treat hypertensive emergency?

A

IV nitrates, CCBs, adrenergic blockers, hydralazine

83
Q

after 5 minutes of supine rest, upon standing, orthostatic hypotension can be diagnosed as a drop in _____ systolic or ______ diastolic

A

20 mmHg drop systolic

10 mmHg drop diastolic

84
Q

Autonomic dysfunction

volume depletion

medications

These all can cause…

A

orthostatic hypotension

85
Q

A patient presents with:

Weakness
Dizziness
Visual blurring
syncope

what should be included in your DDx?

A

orthostatic hypotension

86
Q

How should you evaluate orthostatic hypotension

A

med list

hx of volume loss

neuro exam

CBC, CMP, EKG

87
Q

Cardiogenic shock occurs when there is circulatory failure, manifesting as ______

A

hypotension

88
Q

What are common causes of cardiogenic shock?

A

MI

Atrial, ventricular arrhythmias

valve/ventricle septal rupture

89
Q

Absolute hypotension is described as…

A

SBP < 90, MAP < 65

90
Q

Relative hypotension is described as…

A

SBP drop > 40 mmHg

91
Q

profound hypotension occurs when?

A

vasopressor-dependent

Clinical Medicine II (31 decks)

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