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Renal Exam III > Clinical Key Htn > Flashcards

Clinical Key Htn Flashcards

1
Q

Definition of Htn

A 
Office blood pressure ≥140 and/or ≥90
Home blood pressure ≥135 and/or ≥85
Ambulatory blood pressure
• Daytime (or awake) ≥135 and/or ≥85
• Nighttime (or sleep) ≥120 and/or ≥70
• 24 hour ≥130 and/or ≥80
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2
Q

Risk factors for Htn

A
  • Male
  • Age (men ≥55”yr, women ≥65”yr)
  • Smoking
  • Dyslipidemia
  • Impaired fasting glucose (100-125”mg/dL)
  • Obesity (BMI ≥ 30”kg/m 2 or waist circumference: men, ≥102”cm, women, ≥88”cm)
  • Family history or premature cardiovascular disease (men aged
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3
Q

Asymptomatic Target organ damage of Htn

A
  • Left ventricular hypertrophy by ECG or transthoracic echocardiography
  • Chronic kidney disease (eGFR ≤ 60”mL/min/1.73”m 2 )
  • Microalbuminuria (albumin-to-creatinine ratio, 30-300”mg/g)
  • Ankle-brachial index 10”m/sec
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4
Q

Diabetes Mellitus diagnosis

A

(fasting plasma glucose ≥126”mg/dL × 2; or hemoglobin A 1C ≥ 7%; or postload plasma glucose >
198”mg/dL

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5
Q

Established cardiovascular or renal disease

A
  • Stroke or TIA
  • CAD: myocardial infarction, angina, myocardial revascularization
  • Heart failure (with decreased or preserved ejection fraction)
  • Intermittent claudication (symptomatic peripheral artery disease)
  • Chronic kidney disease with eGFR
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6
Q

Chronic kidney disease

clinical clues

diagnostic testing

A

Estimated GFR

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7
Q

Renovascular disease

clinical clues

diagnostic testing

A 
New elevation in serum creatinine, marked
elevation in serum creatinine with ACE
inhibitor or ARB, drug-resistant
hypertension, flash pulmonary edema,
abdominal or flank bruit

Renal sonography (atrophic
kidney), CT or MR
angiography, invasive
angiography

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8
Q

Coarctation of the aorta

clinical clues

diagnostic testing

A

Arm pulses > leg pulses, arm BP > leg BP,
chest bruits, rib notching on chest
radiography

MR angiography, TEE,
invasive angiography

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9
Q

Primary aldosteronism

clinical clues

diagnostic testing

A

Hypokalemia, drug-resistant hypertension

Plasma renin and
aldosterone, 24-hour urine
aldosterone and potassium
after oral salt loading,
adrenal vein sampling
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10
Q

cushing Syndrome

clinical clues

diagnostic testing

A

Truncal obesity, wide and blanching purple
striae, muscle weakness

1”mg dexamethasonesuppression
test, urinary
cortisol after
dexamethasone, adrenal CT

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11
Q

Pheocromocytoma

clinical clues

diagnostic testing

A

Paroxysms of hypertension, palpitations,
perspiration, and pallor; diabetes

Plasma metanephrines, 24-
hour urinary metanephrines
and catecholamines,
abdominal CT or MR imaging

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12
Q

Obstructive sleep apnea

clinical clues

diagnostic testing

A

Loud snoring, large neck, obesity,
somnolence

Polysonography

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13
Q

Diet for Htn

A
  1. Adopt a diet that is:
    • High in vegetables, nuts, fruits, grains, low-fat dairy products, fish, poultry, etc.
    • Low in sweets, sugar-sweetened beverages, and red meats
    Adapt this dietary pattern to calorie requirements, personal/cultural food preferences, and
    medical conditions such as diabetes.
  2. Lower sodium intake
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14
Q

Physical activity for Htn

A
  1. Engage in three to four 40-minute sessions of moderate-to-intense aerobic physical
    activity per week.
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15
Q

thiazide contraindication

A

gout

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16
Q

loop diuretics contraindications

A

hepatic coma

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17
Q

potassium sparing diuretics contraindications

A

Serum potassium
concentration > 5.5”mEq/L
GFR

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18
Q

ACE inhibitor contraindication

A

pregnancy
bilatereral renal artery stenosis
hyperkalemia

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19
Q

Dihydropyridine CCB contraindication

A

as monotherapy in chronic kidney disease with proteinuria

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20
Q

nonidhydropyridine CCB contraindication

A

heart block

Systolic heart failure

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21
Q

ARBs, DRI contraindications

A

Pregnancy

bilateral renal artery stenosis

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22
Q

B adrenergic blockers contraindications

A

heart block
asthma
depression
cocaine and meth abuse

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23
Q

A adrenergic blockers Contraindication

A

orthostatic hypotension
systolic heart failure
left ventricular dysfunction

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24
Q

Central sympatholytics contraindications

A

orthostatic hypotension

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25
Q

directi vasodilators contraindication

A

orthostatic hypotension

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26
Q

thiazide side effects

A

Insulin resistance, new-onset type 2 diabetes
Hypokalemia, hyponatremia
Hypertriglyceridemia
Hyperuricemia, precipitation of gout
Erectile dysfunction (more than other drug classes)
Potentiate nondepolarizing muscle relaxants
Photosensitivity dermatitis

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27
Q

Loop diuretics side effects

A

Interstitial nephritis
Hypokalemia
Potentiate succinylcholine
Potentiate aminoglycoside ototoxicity

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28
Q

K sparing diuretics side effects

A

Hyperkalemia

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29
Q

ACE inhibitor side effects

A 
Cough
Hyperkalemia
Angioedema
Leukopenia
Fetal toxicity
Cholestatic jaundice (rare fulminant hepatic necrosis if the drug is not discontinued)
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30
Q

Dihydropyridine CCB side effects

A 
Headaches
Flushing
Ankle edema
Heart failure
Gingival hyperplasia
Esophageal reflux
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31
Q

Nondihydropytidine CCB Side effects

A

Bradycardia, AV block (especially with verapamil)
Constipation (often severe with verapamil)
Worsening of systolic function, heart failure
Gingival edema or hypertrophy
Increase cyclosporine blood levels

32
Q

ARBs, DRI side effects

A

hyperkalemia

angioedema (rare)

33
Q

B adrenergic blockers side effects

A

New-onset type 2 diabetes (especially in combination with a thiazide)
Heart block, acute decompensated heart failure
Bronchospasm
Depression, nightmares, fatigue
Cold extremities, claudication (β 2 effect)
Stevens-Johnson syndrome
Agranulocytosis

34
Q

A adrenergic blockers side effects

A

Orthostatic hypotension
Drug tolerance (in the absence of diuretic
therapy)
Ankle edema
Heart failure
First-dose effect (acute hypotension)
Potentiate hypotension with PDE-5 inhibitors (e.g., sildenafil)

35
Q

central sympatholytics side effects

A

Depression, dry mouth, lethargy
Erectile dysfunction (dose dependent)
Rebound hypertension with clonidine withdrawal
Coombs test–positive hemolytic anemia
and elevated liver enzymes with α-methyldopa

36
Q

Direct Vasodilators side effects

A

Reflex tachycardia
Fluid retention
Hirsutism, pericardial effusion with minoxidil
Lupus with hydralazine

37
Q

Blood pressure treatment goals

A
38
Q

Preferred first-line htn treatment

A

Three choices: calcium channel blocker, ACE inhibitor or ARB, or thiazide diuretic (chlorthalidone preferred)

39
Q

Combination treatment htn

A

Good option for stage 1 hypertension

ACE inhibitor + calcium channel blocker preferred over an ACE inhibitor + thiazide-type diuretic

40
Q

prehypertenstion

A

ARB

41
Q

htn in general

A

CCB, ACE-I or ARB, D

42
Q

htn in elderly pts

A

CCB, ACE-I or ARB, D

43
Q

HTN WITH LEFT VENTRICULAR HYPERTROPHY

A

ARB, D, CCB

44
Q

htn in pts with dibatees mellitus

A

CCB, ACE-I or ARB, D

45
Q

htn in pts with diabetic nephropathy

A

ARB, D

46
Q

htn in nondiabetic chornic keney disease

A

ACE-I or ARB, BB, D

47
Q

bp reduction for secondary prevention of coronary events

A

ACE-I, CCB, BB, D

48
Q

BP recution for secondary prevention of stroke

A

ACE-I + D, CCB

49
Q

bp management for patient with heart failure

A

D, BB, ACE-I or ARB, aldosterone antagonist

50
Q 
Gestational hypertension (stage 2, without
preeclampsia)
A

Labetalol, nifedipine, methyldopa

51
Q

thoracic aortic aneurysm

A

BB, ACE-I or ARB, D

52
Q

Atrial fibrillation (ventricular rate control)

A

BB, nondihydropyridine CCB

53
Q

psuedoresistant htn

A 
Inadequate medical regimen
Pressor substances (e.g., nonsteroidal
anti-inflammatory drugs [NSAIDs],
calcineurin inhibitors such as
cyclosporine or tacrolimus, or
sympathomimetics such as cocaine or methamphetamine)
White coat reaction, improper blood pressure measurement
Medication nonadherence
54
Q

Truly resistant htn

A 
Chronic kidney disease
Primary aldosteronism
Other secondary hypertension (e.g.,
pheochromocytoma, Cushing syndrome, 
atherosclerotic renal artery stenosis, fibromuscular
renal artery stenosis, Takayasu arteritis,   coarctation of the aorta, hyperthyroidism,
hypothyroidism, hyperparathyroidism)
Difficult primary hypertension
55
Q

Hypertensive crisis with
retinopathy,
microangiopathy, or acute
renal insufficiency

A

Labetalol

56
Q

Hypertensive

encephalopathy

A

Labetalol

57
Q

Acute aortic dissection

A

Nitroprusside plus

metoprolol

58
Q

Acute pulmonary edema

A

Nitroprusside with loop

diuretic

59
Q

Acute coronary syndrome

A

Nitroglycerine

60
Q

Acute ischemic stroke and

BP > 220/120”mm”Hg

A

Labetalol

61
Q

Cerebral hemorrhage and
Systolic BP > 180”mm”Hg
or MAP > 130”mm”Hg

A

Labetalol

62
Q

Acute ischemic stroke with
indication for thrombolytic
therapy and BP >
185/110”mm”Hg

A

Labetalol

63
Q

Cocaine/XTC intoxication

A

Phentolamine (after

benzodiazepines)

64
Q

Pheochromocytoma crisis

A

Phentolamine

65
Q

Perioperative
hypertension during or
after CABG

A

Nicardipine

66
Q

During or after craniotomy

A

Nicardipine

67
Q

Severe

preeclampsia/eclampsia

A 
Labetalol (plus MgSO 4 and
oral antihypertensive
medication such as
nifedipine with or without
methyldopa)
68
Q

Contraindications and side effects

Labetalol

A

Second- or third-degree
AV block; systolic heart
failure, COPD (relative);
bradycardia

69
Q

Contraindications and side effects

nicardipine

A

Liver failure

70
Q

Contraindications and side effects

nitroprusside

A

Liver/kidney failure
(relative), cyanide
toxicity

71
Q

Contraindications and side effects

nitroglycerine

A

none

72
Q

Contraindications and side effects

Urapadil

A

none

73
Q

Contraindications and side effects

Esmolol

A

Second- or third-degree
AV block, systolic heart
failure, COPD (relative);
bradycardia

74
Q

Contraindications and side effects

Phentolamine

A

Tachyarrhythmia,

angina pectoris

75
Q

Health system

A
  • Standardized medication intensification protocol
  • Team-based approach involving clinical pharmacists
  • Pay providers for performance
76
Q

Drug Treatment

A
  • Low-dose combination therapy
  • Best-tolerated drug classes
  • Fixed-dose single pill combinations
  • Long-acting once daily drugs
  • Low-cost generics
77
Q

Patient Engagement

A
  • Low-dose combination therapy
  • Best-tolerated drug classes
  • Fixed-dose single pill combinations
  • Long-acting once daily drugs
  • Low-cost generics

Renal Exam III (17 decks)

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