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IDC Stuff > Clinical Care of the CV System > Flashcards

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
Q

What is the example given of Alpha blockers?

A

Terazosin

26
Q

What is the initial and titrate does of terazosin?

A

1mg daily

20 mg daily

27
Q

Re-evaluation of patients prescribed antihypertensive medications happens when?

A

1 month after medication change

3 months before adjusting dose

28
Q

Patients who are prescribed anti-hypertensives should be doing what?

A

At home logs

Taking medication at least 3x per week

29
Q

Care for hypertension should include what actions?

A

Referral to MO for starting medications
Renew previously prescribed medication that is controlling HTN
Blood work annually for kidney dysfunction

30
Q

What are some complications of HTN is left uncontrolled?

A 
Cardiovascular disease (CAD, CHF, LVH)
Renal failure
Aortic dissection
Stroke
Dementia
Alzheimer's
Peripheral vascular disease
Retinal damage/hemorrhage
31
Q

What is the main difference between HTN urgency and HTN emergency?

A

Urgency has no signs of end organ damage, emergency has signs.

32
Q

What is the BP seen during HTN Urgency?

A

SBP >220

DBP >125

33
Q

What is the DBP see during HTN emergency?

A

DBP > 130

34
Q

How fast must a BP be reduced with a HTN urgency?

A

A few hours

35
Q

How fast does a HTN Emergency BP need to be reduced?

A

25% within 1-2 hrs

<160/110 in 24 hrs

36
Q

What are signs that end organ damage is occurring?

A

Hypertensive encephalopathy
Intracranial hemorrhage
Ischemic Stroke
Hypertensive nephropathy (proteinuria, hematuria, progressive kidney dysfunction)
Unstable angina, AMI, CHF, Aortic dissection

37
Q

What would a fundoscopic examination possibly reveal in a PT with a HTN emergency?

A

Papilledema or hemorrhage

38
Q

Neurological exams for HTN emergency should look for what symptoms?

A 
Deficits
mental status changes
changes in vision
headache
nausea and vomiting
39
Q

Cardiovascular and pulmonary exams for HTN emergency should look for

A 
Signs of heart failure (S3/ new murmurs)
Carotid bruits 
Pulmonary edema
Sudden onset SOB
chest pain
40
Q

What labs would you take to determine end organ damage?

A 
UA
Comprehensive Metabolic panel 
Troponins
EKG
CXR
CT head or aorta
41
Q

What is the treatment plan for HTN urgency?

A 
PO Medications
Reinstate previously prescribed PO medications
Initiate PO alpha or beta-blocker
-A-Clonidine
-B- (lol)s
42
Q

Clonidine’s MOA stimulates alpha-2 adrenergic receptors in the brain resulting in what

A

reduced sympathetic outflow from CNS producing a decreased in peripheral resistance.

43
Q

HTN Emergency treatment includes what

A 
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
Q

What disease ifs primarily of the arterial endothelium?

A

Atherosclerotic Disease

45
Q

What are the different sites that are most commonly affected?

A 
Coronary arteries
Lower extremities arteries
cerebral arteries
carotid arteries
aorta
46
Q

What is the number one killer in the US, that affects mainly men?

A

Atherosclerotic Coronary Artery Disease (CAD)

47
Q

Metabolic syndrome, a risk factor for CAD, is what?

A

Combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes.

48
Q

What are the values of triglycerides, HDL, and fasting glucose as it relates to metabolic syndrome?

A

Tri- >150mg/dL
HDL- <40 men <50 women
fast glu- >110

49
Q

What are the labs you want for CAD patient?

A

Lipid
EKG
Fasting glucose
Troponin

50
Q

What is the non pharm treatment plan for CAD?

A 
Lifestyle changes
low fat diet
smoking cessation (most important) 
moderate use of alcohol
control HTN, DM
51
Q

What is the pharm treatment of CAD?

A

HMG-CoA (statins)
Atorvastatin 10mg, max 80mg

Aspirin 81mg

52
Q

What is the interval of LFT checks after starting statins to monitor for hepatotoxicity?

A

Initial

3-6 months

53
Q

What is the disease that is occlusive atherosclerotic lesions that develop in the legs and arms causing decreased perfusion of the extremities?

A

Atherosclerotic Peripheral Vascular Disease (PAD)

54
Q

What is the pharm treatment of PAD?

A

Trial of phosphodiesterase inhibitor: Cilostazol

55
Q

What disease is an acute occlusion due to emboli or thrombus in the limb?

A

Acute Arterial Occlusion of a Limb

56
Q

What are the percentages of the locations an emboli can go after breaking off in acute arterial occlusion PT?

A

50% lower extremity
20% cerebrovascular
30% upper limb, renal and mesenteric circulation

57
Q

What are the 6 P’s?

A 
Pain
Pallor
Poikilothermia (coolness)
Pulselessness
Paresthesia
Paralysis
58
Q

What is the dose for enoxaparin (lovenox)?

A

1mg/kg SC q12h

59
Q

immediate revascularization of an acute arterial occlusion of a limb is recommended in what amount of time?

A

< 3 hrs

100% irreversible tissue damage at 6 hrs

60
Q

What is defined as an elevated total or low density (LDL) cholesterol or low levels of high-density (HDL)

A

Dyslipidemia

61
Q

What is refer to as an abnormally high concentration of fats or lipids in the blood and interchangeable with dyslipidemia?

A

Hyperlipidemia

62
Q

What is the action for ASCVD risk calculator total over 5% in a patient 40-79 y/o?

A

Initiation of treatment with a STATIN

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