Clinical Care of the CV System Flashcards
What are the types of hypertension?
Essential and Secondary
What is the form of hypertension that is applied to 95% of all hypertensive patients when no single cause cause can be identified?
Essential
What are examples of identifiable causes that impact secondary hypertension?
Renal disease Renal artery stenosis Pregnancy Pheochromocytoma Cushing Syndrome Hyperthyroidism Estrogen use Drug induced
Which type of hypertension is usually asymptomatic?
Essential
What type of HTN has identifiable cause and should be suspected in patients dx at an early age, after 50 or difficulty controlling with multiple medications?
Secondary Hypertension
What are some non-disease/illnesses examples that could cause secondary HTN?
Stimulant use Adrenal Steroids OTC supplements Anorexia medications NSAIDs Oral contraceptive Alcohol withdrawal Obesity
What laboratory test should be ordered to diagnosis HTN, looking for evidence of end organ damage?
Fasting Glucose UA (protein/hematuria, casts) CBC Chemistry TSH Lipid Panel EKG Calculate 10 year ASCD risk, over 40 y/o
How many visits must a patient be evaluated for blood pressure recordings?
3-5
First line treatment of a HTN patient is what?
Lifestyle modifications
What are some examples of lifestyle modifications?
Diet
Weigh reduction
Reduced alcohol consumption
Increase physical activity
What is the secondary course of treatment after lifestyle modifications?
Pharmacological
What is the BP goal with pharmacological invertentions?
Most patients < 140/90
DM or kidney disease patients < 130/80
What are the pharmacological classes to treat HTN? What are the first line classes?
Diuretics (first line) Angiotensin Converting Enzyme Inhibitor (ACEi) (first line) Angiotensin Receptor Blockers (ARBs) Calcium Channel Blocker (CCB) Alpha Blocker
What is an example of a diuretic given?
Hydrochlorothiazide (HCTZ)
What is the initial dose of HCTZ? What do you titrate to?
12.5mg - 25 mg daily
50mg daily
What are the examples of ACEi given?
-prils
Lisinopril
Enalapril
Captopril
What is the initial dose and titrate does for ACEi?
5-10 mg daily
40 mg daily
What are examples of ARBs given?
-sartans
Losartan
What is the initial dose and titrating dose of Losartan?
50mg daily
100mg daily
What are examples of CCBs given?
Diltiazem
Amlodipine
What is the initial and titrate does for diltiazem?
180 mg daily
360 mg daily
What is the initial and titrate dose of amlodipine?
2.5 mg daily
10 mg daily
Sick sinus syndrome is a adverse reaction of what CCB?
Diltiazem
Which CCB can cause peripheral edema in up to 20% of patients?
Amlodipine
What is the example given of Alpha blockers?
Terazosin
What is the initial and titrate does of terazosin?
1mg daily
20 mg daily
Re-evaluation of patients prescribed antihypertensive medications happens when?
1 month after medication change
3 months before adjusting dose
Patients who are prescribed anti-hypertensives should be doing what?
At home logs
Taking medication at least 3x per week
Care for hypertension should include what actions?
Referral to MO for starting medications
Renew previously prescribed medication that is controlling HTN
Blood work annually for kidney dysfunction
What are some complications of HTN is left uncontrolled?
Cardiovascular disease (CAD, CHF, LVH) Renal failure Aortic dissection Stroke Dementia Alzheimer's Peripheral vascular disease Retinal damage/hemorrhage
What is the main difference between HTN urgency and HTN emergency?
Urgency has no signs of end organ damage, emergency has signs.
What is the BP seen during HTN Urgency?
SBP >220
DBP >125
What is the DBP see during HTN emergency?
DBP > 130
How fast must a BP be reduced with a HTN urgency?
A few hours
How fast does a HTN Emergency BP need to be reduced?
25% within 1-2 hrs
<160/110 in 24 hrs
What are signs that end organ damage is occurring?
Hypertensive encephalopathy
Intracranial hemorrhage
Ischemic Stroke
Hypertensive nephropathy (proteinuria, hematuria, progressive kidney dysfunction)
Unstable angina, AMI, CHF, Aortic dissection
What would a fundoscopic examination possibly reveal in a PT with a HTN emergency?
Papilledema or hemorrhage
Neurological exams for HTN emergency should look for what symptoms?
Deficits mental status changes changes in vision headache nausea and vomiting
Cardiovascular and pulmonary exams for HTN emergency should look for
Signs of heart failure (S3/ new murmurs) Carotid bruits Pulmonary edema Sudden onset SOB chest pain
What labs would you take to determine end organ damage?
UA Comprehensive Metabolic panel Troponins EKG CXR CT head or aorta
What is the treatment plan for HTN urgency?
PO Medications Reinstate previously prescribed PO medications Initiate PO alpha or beta-blocker -A-Clonidine -B- (lol)s
Clonidine’s MOA stimulates alpha-2 adrenergic receptors in the brain resulting in what
reduced sympathetic outflow from CNS producing a decreased in peripheral resistance.
HTN Emergency treatment includes what
IV access O2 if SAT <94% Reduce BP by 25% in 1-2 hrs <160/110 in next 24 hrs Labetalol 20mg IV over 10 mins then 40-80mg q10m, 300mg max Metoprolol 25mg PO x2/day Monitor end organ damage
What disease ifs primarily of the arterial endothelium?
Atherosclerotic Disease
What are the different sites that are most commonly affected?
Coronary arteries Lower extremities arteries cerebral arteries carotid arteries aorta
What is the number one killer in the US, that affects mainly men?
Atherosclerotic Coronary Artery Disease (CAD)
Metabolic syndrome, a risk factor for CAD, is what?
Combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes.
What are the values of triglycerides, HDL, and fasting glucose as it relates to metabolic syndrome?
Tri- >150mg/dL
HDL- <40 men <50 women
fast glu- >110
What are the labs you want for CAD patient?
Lipid
EKG
Fasting glucose
Troponin
What is the non pharm treatment plan for CAD?
Lifestyle changes low fat diet smoking cessation (most important) moderate use of alcohol control HTN, DM
What is the pharm treatment of CAD?
HMG-CoA (statins)
Atorvastatin 10mg, max 80mg
Aspirin 81mg
What is the interval of LFT checks after starting statins to monitor for hepatotoxicity?
Initial
3-6 months
What is the disease that is occlusive atherosclerotic lesions that develop in the legs and arms causing decreased perfusion of the extremities?
Atherosclerotic Peripheral Vascular Disease (PAD)
What is the pharm treatment of PAD?
Trial of phosphodiesterase inhibitor: Cilostazol
What disease is an acute occlusion due to emboli or thrombus in the limb?
Acute Arterial Occlusion of a Limb
What are the percentages of the locations an emboli can go after breaking off in acute arterial occlusion PT?
50% lower extremity
20% cerebrovascular
30% upper limb, renal and mesenteric circulation
What are the 6 P’s?
Pain Pallor Poikilothermia (coolness) Pulselessness Paresthesia Paralysis
What is the dose for enoxaparin (lovenox)?
1mg/kg SC q12h
immediate revascularization of an acute arterial occlusion of a limb is recommended in what amount of time?
< 3 hrs
100% irreversible tissue damage at 6 hrs
What is defined as an elevated total or low density (LDL) cholesterol or low levels of high-density (HDL)
Dyslipidemia
What is refer to as an abnormally high concentration of fats or lipids in the blood and interchangeable with dyslipidemia?
Hyperlipidemia
What is the action for ASCVD risk calculator total over 5% in a patient 40-79 y/o?
Initiation of treatment with a STATIN
