Dyslipidemia and HTN

Question 1

Definition of dyslipidemia: total cholestero, LDL, TG, HDL

Answer 1

Total cholesterol > 200
LDL >130
TG > 150
HDL < 40

Question 2

Si/sx of high TG or LDL

Answer 2

Xanthomas: eruptive nodules in skin over tendons
Xanthelasmas: yellow fatty deposits in the skin around the eyes
Lipemia retinalis: creamy appearance of retinal vessels

Question 3

When to get lipid profile

Answer 3

> 35 y/o or > 20 w/ CAD risk factors

Repeat q5 years

Question 4

ATP III risk stratification

Answer 4

0-1 risk factors:
LDL goal < 160, Start lifestyle modification at LDL > 160, start drug therapy at LDL >190

2+ risk factors:
LDL goal < 130, start lifestyle modification at LDL > 130, start drug therapy at LDL > 130

CAD or CAD equivalents:
LDL goal < 100, start lifestyle modification at LDL > 100, start drug therapy at LDL > 100

Question 5

Definition of HTN

Answer 5

SBP > 140 or DBP > 90

Question 6

Beta blocker selectivity

Answer 6

A-M = B1 selective
N-Z = nonselective
Labetalol is a nonselective B blocker that is also an alpha blocker

Question 7

HTN classification

-normal, pre-HTN, Stage I, Stage II

Answer 7

Normal: SBP < 120 and DBP < 80

Pre-HTN: SBP = 121-139 OR DBP = 81-89

Stage I: SBP = 140-159 OR DBP = 90-99
-monotherapy indicated, usually thiazide

Stage II: SBP > 160 OR DBP > 100
-multiple therapy: thiazide, beta-blocker, ACEi, or a CCB

Question 8

HTN derived eye findings

Answer 8

Cotton-wool exudates
AV nicking
hemorrhage

Question 9

BP goal in diabetics or renal dz w/ proteinuria

Answer 9

< 130/80

Question 10

Tx of HTN in pregnancy

Answer 10

Methyldopa
Labetalol
Hydralazine
Nifedipine

Question 11

Contraindications to HTN tx

-COPD, Gout, Depression

Answer 11

COPD: no non-selective B-blockers ie M-Z
Gout: avoid diuretics
Depression: avoid beta-blockers

Question 12

Tx for uncomplicated HTN

Answer 12

Diuretics, ACEi, B-blockers

Question 13

Tx for HTN in CHF

Answer 13

Loop diuretics, ACEi/ARB, spironolactone. B-blockers except during exacerbations- use dobutamine to help pump

Question 14

Tx for HTN in DM

Answer 14

ACEi, diuretics, B-blockers, CCBs

-B-blockers can mask hypoglycemia so be careful

Question 15

Tx for HTN in post-MI

Answer 15

NO DIURETICS

B-blockers, ACEi/ARB, aldosterone antagonists

Question 16

Tx for HTN in BPH

Answer 16

A1 blocker ie terazosin

Diuretics

Question 17

Tx for HTN in isolated systolic HTN

Answer 17

diuretics, ACEi, dihydropyridine CCB

Question 18

Tx for HTN in CKD

Answer 18

ACEi/ARB

Question 19

Common vasodilators

Answer 19

Nitrates: venodilate
Hydralazine: aretriolar dilation
-hydralazine decreases afterload while nitrates decrease preload. the combination has similar effect to ACEi

Nitroprusside: both arterial and ventilation; CN- toxicity

Question 20

Common causes of secondary HTN

Answer 20

Renal disease, renal artery stenosis, OCP use, pheochromacytoma, Conn’s syndrome, Cushing’s syndrome
Coarctation of the aorta

Question 21

Etiologies of renal artery stenosis

Answer 21

Young patients: fibromuscular dysplasia

Older patients: atherosclerosis

Question 22

Conn’s syndrome triad

Answer 22

unexplained HTN, hypokalemia, and metabolic acidosis

Question 23

Hypertensive urgency vs. emergency

Answer 23

Urgency: SBP >200 or DBP > 100

Emergency: urgency + end-organ damage

Question 24

Malignant HTN

Answer 24

HTN emergency + papilledema (required for diagnosis)

-can present w/ hematuria