Foundations-HTN Flashcards
1
Q
List the systemic diseases HTN is a precursor to (4)
A
- Hypertensive Retinopathy
- Cerebrovascular Dz
- Renal failure
- Cardiovascular dz
2
Q
What is the number one attributable risk factor for death worldwide?
A
Suboptimal BP
3
Q
How many Americans have HTN?
A
75 million= 1 in 3 adults
4
Q
Approximately how many American adults have pre-hypertension?
A
1/3
5
Q
How many death in 2013 included BP as a primary or contributing cause of death?
A
36,000= 1,000 deaths/day
6
Q
What increases the cardiovascular risk for women @ age 55-64?
A
Endogenous Estrogen
7
Q
What race/ethnicity has the highest rate of HTN?
A
African Americans
8
Q
At what pressure does the CVD risk DOUBLE? And @ what increment?
A
BP= 115/75
@ increments of 20/10
9
Q
List the signs of secondary HTN causes (4)
A
- Hypokalemia
- Abdominal bruit–>renal artery stenosis
- Labile pressures w/ tacky, sweating, tremor
- Family Hx of kidney dz
10
Q
When would you suspect secondary HTN?
A
- Young age of onset
- Onset of diastolic HTN @ age older than 50 years (usu. systolic increases in the elderly)
- Target oran damage @ presentation
- Poor response to generally effective therapy
11
Q
What isa S4 (presystolic) gallop due to?
A
Decreased compliance of the left ventricle
12
Q
What is the USPSTF screening recommendation for adults age 18-39
A
Every 3-5 yrs IF:
- normal BP
- No risk factors
13
Q
What is the USPSTF screening recommendation for adults age 40+ OR @ high risk?
A
Annually
14
Q
What is the diagnostic criteria for HTN?
A
-Based on the avg. of 2 or more, properly measured, seated, BP readings on each of 2 or more office visits
15
Q
What is the JNC 7 classification for normal BP?
A
<120 AND <80
16
Q
What is the JNC 7 classification for pre-HTN?
A
120-139 OR
80-89
17
Q
What is the JNC 7 classification for Stage 1 HTN?
A
140-159 OR
90-99
18
Q
What is the JNC 7 classification for Stage 2 HTN?
A
> or equal to 160 OR
> or equal to 100
19
Q
Based on JNC 7, what is the goal BP for the general population?
A
140/90
20
Q
Based on JNC 7, what is the goal BP for pt’s with DM or Renal dz?
A
130/80
21
Q
What is the JNC 8 BP criteria for adults up to age 59
A
<140/90, including pt’s with CKD and DM
22
Q
What is the JNC 8 BP criteria for adults age 60+
A
<150/99
23
Q
What is the ADA target BP?
A
<140/90
Risk-Based individualization to lower targets
–>130/80
24
Q
What is the 2017 ACC/AHA normal BP?
A
<120 AND
<80
25
What is the 2017 ACC/AHA elevated BP?
120-129 AND
| <80
26
What is the 2017 ACC/AHA Stage 1 HTN category?
130-130 OR
| 80-89
27
What is the 2017 ACC/AHA Stage 2 HTN category?
> or equal to 140 OR
| > or equal to 90
28
What percentage of stage I office HTN can be attributed to white coat HTN?
20-25%
29
What is the percentage of patients with masked HTN?
- 10%
| - @ increased CV risk!
30
What diagnostic test would your order to check for chronic kidney dz?
Estimated GFR
31
What diagnostic test would your order to check for coarctation of the aorta?
CT angiography
32
What diagnostic test would your order to check for Cushing's syndrome?
- History
| - Dexamethasone suppression test
33
What diagnostic test would your order to check for Pheochromocytoma
24-hr urinary metanephrine and normetanephrine
34
What diagnostic test would your order to check for Primary aldosteronism and other mineralocorticoid excess state
24-hr urinary aldosterone level or specific measurements of other mineralocorticoid
35
What diagnostic test would your order to check for renovascular HTN?
- Doppler flow study
| - Magnetics resonance angiography
36
What diagnostic test would your order to check for Thyroid/parathyroid dz?
- TSH
| - Serum PTH
37
According to ACC/AHA 2017 Tx goals, What stage of HTN do you initiate anti-hypertensive meds?
stage 2 HTN
38
According to ACC/AHA 2017 Tx goals, When do you initiate anti-hypertensive meds with patients who have stage 1 HTN?
With 1 or more of the following:
1. established ASCVD
2. Type 2 DM
3. CKD
4. 10-year calculated ASCVD risk of @ least 10%
39
Why do you need to caution lowering a patient's DBP <55 to 60 in a patient over 60 w/ isolated systolic HTN
Low DBP is associated with increased risk of MI and stroke
40
How many people with HTN have their blood pressure under control?
54%
41
How much does salt restriction (<1500 mg/day) decrease your BP?
5/3 mmHg
42
How much does the DASH diet decrease your BP?
6/4 mmHg
43
How much does alcohol reduction decrease your BP?
2-4 mmHg in SBP
44
How much does exercise decrease your BP?
4-6/3 mmHg
45
How much does 1 lb of weight loss decrease your BP?
1 mmHg per 1 lb lost
46
What percentage of pt's will diuretic medications control their BP?
50% with pt's with mild-to-moderate HTN
47
What are the main side effects of Thiazide Type Diuretics?
- Hypokalemia
- Hyponatremia
- Dyslipidemia
48
What are the contraindications to Thiazide Type Diuretics?
-Hypersensitivity to sulfonamide derived drugs
49
What patients would you prescribe Furosemide (Lasix) for?
Pt's with kidney dz or fluid retention
50
What are the main side effects of Furosemide(Lasix)
- Hypokalemia
- Hypocalcemia
- Hypercholesterolemia
51
What drug do you supplement with potassium?
Furosemide (lasix)
52
What are the side effects of Triamterene (Dyrenium)
- Hyperkalemia-->esp. w/ CKD, DM
- Nephrolithiasis
- Renal Dysfunctoin
53
What are the side effects of Spirnolactone (Aldactone, Aldactazide)
- Hyperkalemia
| - Gynecomastia
54
What are the contraindications of Spirnolactone (Aldactone, Aldactazide)
- Renal impairment
- DM w/ proteinuria
- Hyperkalemia
55
What are the two types of calcium channel blockers
| (-dipine)?
1. Non-Dihydropyridines= cardiac depressant affect
| 2. Dihydropyridines= selective vasodilators
56
What are the contraindications for non-DHP?
Acute MI
- AV block
- Cardiogenic shock
- Heart failure
- Hypotension
- Sick sinus syndrome
- Ventricular dysfunction or V tachycardia
- WPW syndrome
57
What are the contraindications for DHP?
- Acute MI
| - In urgent/emergent HTN, immediate release nifedipine is contraindicated
58
Side effects of non-DHP
Bradycardia
Constipation
Gingival hyperplasia
Worsening heart failure
59
Side effects of DHP
Peripheral edema
Headache
Flushing
60
What anti-hypertensive is less effective in blacks, elderly or in predominant systolic HTN?
ACE inhibitors
61
What are the contraindications of ACE inhibitors?
Pregnancy
Angioedema (also a side effect)
Renal artery stenosis (acute renal failure is a side effect)
62
What is the MOA in ACE inhibitors?
Inhibit the RAAS system
| Stimulate Bradykinin=vasodilator effect
63
What is the MOA in ARBS?
Inhibit the RAAS system
64
What is the suffix in ARBS?
-sartan
65
What is the suffix in ACE inhibitors?
-pril
66
What is the suffix in calcium channel blockers?
-dipine
67
What is MOA of calcium channel blockers?
Inhibition of calcium influx into myocardial and vascular smooth muscle cell-->
Decrease in calcium inhibits the contractile process-->leading to vasodilation
=Reduced peripheral vascular resistance
68
What anti-hypertensive has an increased efficacy in blacks and elderly?
Calcium channel blockers
69
What are the contraindications for ARBS?
- Pregnancy
| - Renal artery stenosis
70
What are the side effects of ARBs?
- Hyperkalemia
- Angioedma
- Acute renal failure
71
Give an example of a direct renin inhibitor?
Aliskiren (Tekturna)
72
What is the MOA of direct renin inhibitors?
Inhibit enzyme activity of renin-->reducing the activity of Angiotensin I and II, and Aldosterone
73
What are the side effects of Direct Renin Inhibitors?
Hyperkalemia
Renal Impairment
Hypersensitivity Reactions= anaphylaxis, Angioedema
74
What are the contraindications of Direct Renin Inhibitors?
- Use with Ace-1 or ARB
| - Pregnancy
75
What is the suffix of Beta Blockers?
-lol
76
What ist he MOA of Beta Blockers
Blocks the activity of catecholamines at β adrenoreceptors-->leads to decreased:
- Cardiac output
- PVR
- Renin activity
77
What are the contraindications of Beta Blockers?
```
AB block
cardiogenic shock
heart failure
hypotension
asthma
COPD
```
78
What are the side effects of Beta Blockers?
```
Exercise intolerance
Fatigue
Bradycardia
Sexual dysfunction
Depression
Exacerbate reactive airway disease
Exacerbate peripheral vascular disease
```
79
List the two types of Central Alpha Agonists
1. Clonidine
| 2. Methyldopa
80
What anti-hypertensive are safe for pregnant woman?
1. Methyldopa
2. Nifedipine
3. Labetalol
81
What is the MOA of central alpha agonists?
Stimulate α2 adrenergic receptors in the brain= reduces CNS sympathetic outflow
82
What are the side effects of central alpha agonists?
```
Anticholinergic side effects
Bradycardia
Orthostatic hypotension
Dizziness
Rebound HTN
```
83
What are the side effects of methyldopa
Hepatitis
Hemolytic anemia
Fever
84
What are the contraindications of central alpha agonists?
Methyldopa in liver disease
85
List the Alpha Blockers
Doxazosin (Cardura)
Terazosin (Hytrin)
Prazosin (Minipress)
86
What is the suffix of Alpha Blockers
-zosin
87
What is the MOA of Alpha Blockers
Targets α1 receptors on vascular smooth muscle, causing peripheral vascular resistance to decrease, thus decreasing blood pressure
88
What are the side effects of Alpha Blockers?
Orthostatic Hypotension
Reflex tachycardia
Dizziness
89
If albuminuria is present in CKD or Diabetic pt's, what anti-hypertensive would you use?
1. ACE-1
| 2. ARB
90
What anti-hypertensive med helps prevent A-fib recurrence?
ARBs
91
What is the preferred anti-hypertensive in thoracic aortic dz?
Beta Blocker
92
What classes are not ok to prescribe pregnant woman?
1. ACE-1
2. ARB
3. DRI
93
What is the classification or hypertensive emergency
SBP > or equal to 180 and/or DBP > or equal to 120
