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Clinical Care of the CV System Flashcards

1
Q

What are the types of hypertension?

A

Essential and Secondary

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2
Q

What is the form of hypertension that is applied to 95% of all hypertensive patients when no single cause cause can be identified?

A

Essential

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3
Q

What are examples of identifiable causes that impact secondary hypertension?

A 
Renal disease
Renal artery stenosis
Pregnancy
Pheochromocytoma
Cushing Syndrome
Hyperthyroidism
Estrogen use
Drug induced
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4
Q

Which type of hypertension is usually asymptomatic?

A

Essential

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5
Q

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?

A

Secondary Hypertension

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6
Q

What are some non-disease/illnesses examples that could cause secondary HTN?

A 
Stimulant use
Adrenal Steroids
OTC supplements
Anorexia medications
NSAIDs
Oral contraceptive
Alcohol withdrawal
Obesity
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7
Q

What laboratory test should be ordered to diagnosis HTN, looking for evidence of end organ damage?

A 
Fasting Glucose
UA (protein/hematuria, casts)
CBC
Chemistry
TSH
Lipid Panel
EKG
Calculate 10 year ASCD risk, over 40 y/o
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8
Q

How many visits must a patient be evaluated for blood pressure recordings?

A

3-5

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9
Q

First line treatment of a HTN patient is what?

A

Lifestyle modifications

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10
Q

What are some examples of lifestyle modifications?

A

Diet
Weigh reduction
Reduced alcohol consumption
Increase physical activity

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11
Q

What is the secondary course of treatment after lifestyle modifications?

A

Pharmacological

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12
Q

What is the BP goal with pharmacological invertentions?

A

Most patients < 140/90

DM or kidney disease patients < 130/80

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13
Q

What are the pharmacological classes to treat HTN? What are the first line classes?

A 
Diuretics (first line)
Angiotensin Converting Enzyme Inhibitor (ACEi) (first line)
Angiotensin Receptor Blockers (ARBs) 
Calcium Channel Blocker (CCB) 
Alpha Blocker
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14
Q

What is an example of a diuretic given?

A

Hydrochlorothiazide (HCTZ)

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15
Q

What is the initial dose of HCTZ? What do you titrate to?

A

12.5mg - 25 mg daily

50mg daily

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16
Q

What are the examples of ACEi given?

A

-prils

Lisinopril
Enalapril
Captopril

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17
Q

What is the initial dose and titrate does for ACEi?

A

5-10 mg daily

40 mg daily

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18
Q

What are examples of ARBs given?

A

-sartans

Losartan

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19
Q

What is the initial dose and titrating dose of Losartan?

A

50mg daily

100mg daily

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20
Q

What are examples of CCBs given?

A

Diltiazem

Amlodipine

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21
Q

What is the initial and titrate does for diltiazem?

A

180 mg daily

360 mg daily

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22
Q

What is the initial and titrate dose of amlodipine?

A

2.5 mg daily

10 mg daily

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23
Q

Sick sinus syndrome is a adverse reaction of what CCB?

A

Diltiazem

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24
Q

Which CCB can cause peripheral edema in up to 20% of patients?

A

Amlodipine

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25
What is the example given of Alpha blockers?
Terazosin
26
What is the initial and titrate does of terazosin?
1mg daily | 20 mg daily
27
Re-evaluation of patients prescribed antihypertensive medications happens when?
1 month after medication change | 3 months before adjusting dose
28
Patients who are prescribed anti-hypertensives should be doing what?
At home logs | Taking medication at least 3x per week
29
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
30
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 ```
31
What is the main difference between HTN urgency and HTN emergency?
Urgency has no signs of end organ damage, emergency has signs.
32
What is the BP seen during HTN Urgency?
SBP >220 | DBP >125
33
What is the DBP see during HTN emergency?
DBP > 130
34
How fast must a BP be reduced with a HTN urgency?
A few hours
35
How fast does a HTN Emergency BP need to be reduced?
25% within 1-2 hrs | <160/110 in 24 hrs
36
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
37
What would a fundoscopic examination possibly reveal in a PT with a HTN emergency?
Papilledema or hemorrhage
38
Neurological exams for HTN emergency should look for what symptoms?
``` Deficits mental status changes changes in vision headache nausea and vomiting ```
39
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 ```
40
What labs would you take to determine end organ damage?
``` UA Comprehensive Metabolic panel Troponins EKG CXR CT head or aorta ```
41
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 ```
42
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.
43
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 ```
44
What disease ifs primarily of the arterial endothelium?
Atherosclerotic Disease
45
What are the different sites that are most commonly affected?
``` Coronary arteries Lower extremities arteries cerebral arteries carotid arteries aorta ```
46
What is the number one killer in the US, that affects mainly men?
Atherosclerotic Coronary Artery Disease (CAD)
47
Metabolic syndrome, a risk factor for CAD, is what?
Combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes.
48
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
49
What are the labs you want for CAD patient?
Lipid EKG Fasting glucose Troponin
50
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 ```
51
What is the pharm treatment of CAD?
HMG-CoA (statins) Atorvastatin 10mg, max 80mg Aspirin 81mg
52
What is the interval of LFT checks after starting statins to monitor for hepatotoxicity?
Initial | 3-6 months
53
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)
54
What is the pharm treatment of PAD?
Trial of phosphodiesterase inhibitor: Cilostazol
55
What disease is an acute occlusion due to emboli or thrombus in the limb?
Acute Arterial Occlusion of a Limb
56
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
57
What are the 6 P's?
``` Pain Pallor Poikilothermia (coolness) Pulselessness Paresthesia Paralysis ```
58
What is the dose for enoxaparin (lovenox)?
1mg/kg SC q12h
59
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
60
What is defined as an elevated total or low density (LDL) cholesterol or low levels of high-density (HDL)
Dyslipidemia
61
What is refer to as an abnormally high concentration of fats or lipids in the blood and interchangeable with dyslipidemia?
Hyperlipidemia
62
What is the action for ASCVD risk calculator total over 5% in a patient 40-79 y/o?
Initiation of treatment with a STATIN

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