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AGACNP > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

BP equation

A

BP = HR (heart rate) x SV (stroke volume) x PVR (peripheral vascular resistance)
* Increase in any part of formula will increase BP

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2
Q

Brain: outcome of HTN

A

stroke, vascular (multi-farct) dementia

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3
Q

Cardiovascular system: outcome of HTN

A

atherosclerosis, myocardial infarction (MI), left ventricular hypertrophy (*most common), heart failure

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4
Q

Kidney: outcome of HTN

A

hypertensive nephropathy, renal failure

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5
Q

Eye: outcome of HTN

A

hypertensive retinopathy w/ risk of blindness

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6
Q

Wt reduction for HTN and dyslipidemia: recommendation and average SBP reduction rate

A

BMI = 18.5-24.9

SBP reduction = 5-20 mm Hg/10 kg Wt loss

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7
Q

DASH eating plan for HTN and dyslipidemia: recommendation and average SBP reduction

A

Rec: diet rich in fruit, vegies, low-fat dairy product

SBP reduction = 8-14 mm Hg

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8
Q

Sodium reduction in HTN: recommendation and average SBP reduction

A

Rec: 2.4 g Na or 6g NaCl

SBP reduction = 2-8 mm Hg

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9
Q

Aerobic exercise for HTN and sydlipidemia: recommendation and average SBP reduction

A

Rec: moderate to vigorous aerobic exercise min. 40 min/day, 3-4 days per wk
SBP reduction = 4-9 mm Hg

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10
Q

Alcohol consumption for HTN: recommendation and average SBP reduction

A

Rec: Men- limit to < 2 drinks/day, women; limit to < 1 drink/day
SBP reduction = 2-4 mm Hg

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11
Q

Meds for HTN and other cardiac meds: Classes (6)

A 
Diuretic (thiazide)
ACEI
ARB
(Diuretic, ACEIs and ARBs are the main HTN meds)
CCB
Beta-blockers
Aldosterone antagonist
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12
Q

Good HTN meds for Afro-Am Pts

A

Diuretics and CCBs

*Afro-Am Pts tend to not respond to ACEIs

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13
Q

Diuretic (thiazide): examples, mechanism, adverse effects

A

E.g.: HCTZ (HydroDiuril), chlorthalidone (Hygroton)
BP= HR x SV x PVR (decrease PVR)
Ca sparing. Less effective w/ GFR < 30 mL/min/1.73

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14
Q

ACEI (-pril): examples, mechanism, adverse effects

A 
E.g.: Lisinopril (Prinivil, Zestril), enalapril (Vasotec)
BP= HR x SV x PVR (decrease PVR)
K sparing (hyperkalemia risk w/ inadequate fluid intake, renal impairment, when used w/ aldosterone antagonist. Cough (use ARB instead). Do not use during pregnancy
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15
Q

ARB (-sartan): examples, mechanism, adverse effects

A 
E.g.: Losartan (Cozaar), telmisartan (Micardis)
BP= HR x SV x PVR (decrease PVR)
K sparing (hyperkalemia risk w/ inadequate fluid intake, renal impairment, when used w/ aldosterone antagonist.  Do not use during pregnancy. Do not use w/ ACEI
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16
Q

Ca channel blocker (CCB): examples, mechanism, adverse effects

A

Dihydropyridine examples: Amlodipine (Norvasc), all w/ -ipine suffix
Other CCB example: Diltiazem (Cardizem LA)
BP= HR x SV x PVR (decrease PVR)
Ankle edema. Avoid use or use w/ caution in Pts w/ HF, renal or hepatic impairment

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17
Q

Beta-adrenergic antagonist (beta-blockers, -lol suffix): examples, mechanism, adverse effects

A

Cardioselective: Atenolol (Tenoretic), metoprolol (Toprol, Lopressor)
Non-cardioselective: propranolol (Inderal), labetalol
BP = HR (decrease) x SV (decrease) x PVR
Avoid non-cardioselective beta blocker in Pts w/ low airway Dz

18
Q

Aldosterone antagonist: examples, mechanism, adverse effects

A

E.g.: Spironolactone (Aldactone), eplerenone (Inspra)
BP = HR x SV x PVR (decrease)
Gynecomastia risk w/ prolonged use. Hyperkalemia risk w/ ACEI, ARB use or volume depletion including excess diuresis

19
Q

Normal BP range

A

SBP < 120 and DBP < 80 mm Hg

20
Q

Elevated BP range

A

SBP 120-129 mm Hg and < 80 mm Hg

21
Q

Stage 1 HTN range

A

SBP 130-139 mm Hg or 80-90 mm Hg

22
Q

Stage 2 HTN range

A

SBP =/> 140 mm Hg or DBP =/> 90 mm Hg

23
Q

Hypertensive emergency

A

> 180 mm Hg and/or > 120 mm Hg

24
Q

Elevated BP: intervention, drug Thx consideration

A

120-129/80 mm Hg
Non-pharmacological Thx
Reassess BP in 3-6 months

25
Q

Stage 1 HTN: intervention, drug Thx consideration

A

130-139/80-90 mm Hg
Non-pharmacological Thx, reassess BP in 3-6 months. *Reasess in 1 mo. w/ clinical ASCVD or estimated 10 yr CVD risk =/> 10%.
First line: thiazide diuretics, CCBs, ACEIs or ARBs

26
Q

Stage 2 HTN: intervention, drug Thx consideration

A

Non-pharmacological Thx and BP lowering med
Reassess BP in 1 mo.
Consider initiating 2 1st line agents of different classes.

27
Q

Hypertensive urgency vs. hypertensive emergency

A

Urgency: HTN w/ minimal or no acute target organ damage (SBP > 180 mm Hg and/or DBP > 120 mm Hg)
Emergency: HTN w/ acute target organ ischemia and damage
Encephalopathy, hemorrhagic/ischemic stroke, papilledema, ACS, HF, pulmonary edema, aortic dissection, proteinuria, hematuria, acute renal failure

28
Q

Dyslipidemia: Screening guidelines

A
  • Complete lipid profile (fasting) starting at age 20 (then every 5 years)
  • Older than age 40 years, screen every 2 to 3 years
  • Preexisting hyperlipidemia: Screen annually or more frequently
29
Q

Total Cholesterol values: Normal, borderline, high

A
  • Normal: Less than 200 mg/dL
  • Borderline: Between 200 and 239 mg/dL
  • High: Greater than 240 mg/dL
30
Q

HDL Cholesterol values: Normal (men, women)

A

Men: Greater than 40 mg/dL
Women: Greater than 50 mg/dL
- Greater than 60 mg/dL is HIGH!

31
Q

Which medications can increase HDL?

A

Statin, niacin

32
Q

LDL Cholesterol values: Optimal, high, very high

A

Optimal: Less than 100 mg/dL
High: 160 - 189 mg/dL
Very high: Greater than 190 mg/dL

33
Q

Triglycerides: Normal

A

Normal: Less than 150 mg/dL

34
Q

Dyslipidemia/hyperlipidemia Tx

A

Life style changes: Wt reduction, regular exercise, DASH diet, lowering saturated fat, smoking cessation)

35
Q

Lipid-lowering medications

A

Statins

36
Q

Statin drug interactions

A
  • Avoid grapefruit juice
  • Fibrates
  • Antifungals (itraconazole, ketoconazole)
  • Macrolides (erythromycin, clarithromycin, telithromycin)
  • Amiodarone (Cordarone)
  • some CCBs (diltiazem, amlodipine, verapamil)
37
Q

Causes of secondary HTN (HTN w/ identifiable cause)

A
  1. Sleep apnea
  2. Drugs
  3. CKD
  4. Primary aldosteronism
  5. Renovascular Dz
  6. ushing’s or long term corticosteroid use
  7. Pheochromocytoma
  8. Coarctation of the aorta
  9. Thyroid or parathyroid Dz
38
Q

Hypertensive urgency: definition

A

BP > 180/ >120; HTN w/ minimal or no acute target organ damage; must be reduced within a few hours

39
Q

Hypertensive crises: PO Thx

A

CCB: Nicardipine PO 30 mg (repeat q8hrs until the target BP is achieved)
Captopril PO 12.5-100 mg (q8hrs)
Labetalol PO 200 mg (repeat q 3-4hrs)
Clonidine 0.2 mg loading then 0.1 mg q1hr (clonidine is unpredictable so use carefully)

40
Q

Hypertensive crises: IV Thx

A 
Nitroprusside: 0.25 - 10 mcg/kg/min
Labetalol 20 - 80 mg IV push q10 min
Nicardipine 5-15 mg/hr
Nitroglycerin 5 - 1000 mcg/min
Esmolol 0.5 mg/kg loading dose then 0.05-0.2 mg/kg/min
Hydralazine: 10-20 mg q 20-30 min
41
Q

Hypertensive emergency: definition

A

HTN w/ acute target organ ischemia and damage; decrease MAP by 25 per cent within min to 2 hrs w/ IV agents. Goal = DBP , 110 mm Hg within 2-6 hrs.

42
Q

Hypertensive emergency: clinical manifestation

A

Neurologic: encephalopathy, hemorrhagic or ischemic stroke, papilledema
Cardiovascular: ACS, HF, pulmonary edema, aortic dissection
Renal: proteinuria, hematuria, acute renal failure

AGACNP (21 decks)

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