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Foundations-HTN > Foundations-HTN > Flashcards

Foundations-HTN Flashcards

1
Q

List the systemic diseases HTN is a precursor to (4)

A
  1. Hypertensive Retinopathy
  2. Cerebrovascular Dz
  3. Renal failure
  4. Cardiovascular dz
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2
Q

What is the number one attributable risk factor for death worldwide?

A

Suboptimal BP

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3
Q

How many Americans have HTN?

A

75 million= 1 in 3 adults

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4
Q

Approximately how many American adults have pre-hypertension?

A

1/3

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5
Q

How many death in 2013 included BP as a primary or contributing cause of death?

A

36,000= 1,000 deaths/day

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6
Q

What increases the cardiovascular risk for women @ age 55-64?

A

Endogenous Estrogen

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7
Q

What race/ethnicity has the highest rate of HTN?

A

African Americans

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8
Q

At what pressure does the CVD risk DOUBLE? And @ what increment?

A

BP= 115/75

@ increments of 20/10

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9
Q

List the signs of secondary HTN causes (4)

A
  1. Hypokalemia
  2. Abdominal bruit–>renal artery stenosis
  3. Labile pressures w/ tacky, sweating, tremor
  4. Family Hx of kidney dz
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10
Q

When would you suspect secondary HTN?

A
  1. Young age of onset
  2. Onset of diastolic HTN @ age older than 50 years (usu. systolic increases in the elderly)
  3. Target oran damage @ presentation
  4. Poor response to generally effective therapy
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11
Q

What isa S4 (presystolic) gallop due to?

A

Decreased compliance of the left ventricle

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12
Q

What is the USPSTF screening recommendation for adults age 18-39

A

Every 3-5 yrs IF:

  • normal BP
  • No risk factors
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13
Q

What is the USPSTF screening recommendation for adults age 40+ OR @ high risk?

A

Annually

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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

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15
Q

What is the JNC 7 classification for normal BP?

A

<120 AND <80

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16
Q

What is the JNC 7 classification for pre-HTN?

A

120-139 OR

80-89

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17
Q

What is the JNC 7 classification for Stage 1 HTN?

A

140-159 OR

90-99

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18
Q

What is the JNC 7 classification for Stage 2 HTN?

A

> or equal to 160 OR

> or equal to 100

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19
Q

Based on JNC 7, what is the goal BP for the general population?

A

140/90

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20
Q

Based on JNC 7, what is the goal BP for pt’s with DM or Renal dz?

A

130/80

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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

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22
Q

What is the JNC 8 BP criteria for adults age 60+

A

<150/99

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23
Q

What is the ADA target BP?

A

<140/90
Risk-Based individualization to lower targets
–>130/80

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24
Q

What is the 2017 ACC/AHA normal BP?

A

<120 AND

<80

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25
Q

What is the 2017 ACC/AHA elevated BP?

A

120-129 AND

<80

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26
Q

What is the 2017 ACC/AHA Stage 1 HTN category?

A

130-130 OR

80-89

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27
Q

What is the 2017 ACC/AHA Stage 2 HTN category?

A

> or equal to 140 OR

> or equal to 90

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28
Q

What percentage of stage I office HTN can be attributed to white coat HTN?

A

20-25%

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29
Q

What is the percentage of patients with masked HTN?

A
  • 10%

- @ increased CV risk!

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30
Q

What diagnostic test would your order to check for chronic kidney dz?

A

Estimated GFR

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31
Q

What diagnostic test would your order to check for coarctation of the aorta?

A

CT angiography

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32
Q

What diagnostic test would your order to check for Cushing’s syndrome?

A
  • History

- Dexamethasone suppression test

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33
Q

What diagnostic test would your order to check for Pheochromocytoma

A

24-hr urinary metanephrine and normetanephrine

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34
Q

What diagnostic test would your order to check for Primary aldosteronism and other mineralocorticoid excess state

A

24-hr urinary aldosterone level or specific measurements of other mineralocorticoid

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35
Q

What diagnostic test would your order to check for renovascular HTN?

A
  • Doppler flow study

- Magnetics resonance angiography

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36
Q

What diagnostic test would your order to check for Thyroid/parathyroid dz?

A
  • TSH

- Serum PTH

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37
Q

According to ACC/AHA 2017 Tx goals, What stage of HTN do you initiate anti-hypertensive meds?

A

stage 2 HTN

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38
Q

According to ACC/AHA 2017 Tx goals, When do you initiate anti-hypertensive meds with patients who have stage 1 HTN?

A

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
Q

Why do you need to caution lowering a patient’s DBP <55 to 60 in a patient over 60 w/ isolated systolic HTN

A

Low DBP is associated with increased risk of MI and stroke

40
Q

How many people with HTN have their blood pressure under control?

A

54%

41
Q

How much does salt restriction (<1500 mg/day) decrease your BP?

A

5/3 mmHg

42
Q

How much does the DASH diet decrease your BP?

A

6/4 mmHg

43
Q

How much does alcohol reduction decrease your BP?

A

2-4 mmHg in SBP

44
Q

How much does exercise decrease your BP?

A

4-6/3 mmHg

45
Q

How much does 1 lb of weight loss decrease your BP?

A

1 mmHg per 1 lb lost

46
Q

What percentage of pt’s will diuretic medications control their BP?

A

50% with pt’s with mild-to-moderate HTN

47
Q

What are the main side effects of Thiazide Type Diuretics?

A
  • Hypokalemia
  • Hyponatremia
  • Dyslipidemia
48
Q

What are the contraindications to Thiazide Type Diuretics?

A

-Hypersensitivity to sulfonamide derived drugs

49
Q

What patients would you prescribe Furosemide (Lasix) for?

A

Pt’s with kidney dz or fluid retention

50
Q

What are the main side effects of Furosemide(Lasix)

A
  • Hypokalemia
  • Hypocalcemia
  • Hypercholesterolemia
51
Q

What drug do you supplement with potassium?

A

Furosemide (lasix)

52
Q

What are the side effects of Triamterene (Dyrenium)

A
  • Hyperkalemia–>esp. w/ CKD, DM
  • Nephrolithiasis
  • Renal Dysfunctoin
53
Q

What are the side effects of Spirnolactone (Aldactone, Aldactazide)

A
  • Hyperkalemia

- Gynecomastia

54
Q

What are the contraindications of Spirnolactone (Aldactone, Aldactazide)

A
  • Renal impairment
  • DM w/ proteinuria
  • Hyperkalemia
55
Q

What are the two types of calcium channel blockers

(-dipine)?

A
  1. Non-Dihydropyridines= cardiac depressant affect

2. Dihydropyridines= selective vasodilators

56
Q

What are the contraindications for non-DHP?

A

Acute MI

  • AV block
  • Cardiogenic shock
  • Heart failure
  • Hypotension
  • Sick sinus syndrome
  • Ventricular dysfunction or V tachycardia
  • WPW syndrome
57
Q

What are the contraindications for DHP?

A
  • Acute MI

- In urgent/emergent HTN, immediate release nifedipine is contraindicated

58
Q

Side effects of non-DHP

A

Bradycardia
Constipation
Gingival hyperplasia
Worsening heart failure

59
Q

Side effects of DHP

A

Peripheral edema
Headache
Flushing

60
Q

What anti-hypertensive is less effective in blacks, elderly or in predominant systolic HTN?

A

ACE inhibitors

61
Q

What are the contraindications of ACE inhibitors?

A

Pregnancy
Angioedema (also a side effect)
Renal artery stenosis (acute renal failure is a side effect)

62
Q

What is the MOA in ACE inhibitors?

A

Inhibit the RAAS system

Stimulate Bradykinin=vasodilator effect

63
Q

What is the MOA in ARBS?

A

Inhibit the RAAS system

64
Q

What is the suffix in ARBS?

A

-sartan

65
Q

What is the suffix in ACE inhibitors?

A

-pril

66
Q

What is the suffix in calcium channel blockers?

A

-dipine

67
Q

What is MOA of calcium channel blockers?

A

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
Q

What anti-hypertensive has an increased efficacy in blacks and elderly?

A

Calcium channel blockers

69
Q

What are the contraindications for ARBS?

A
  • Pregnancy

- Renal artery stenosis

70
Q

What are the side effects of ARBs?

A
  • Hyperkalemia
  • Angioedma
  • Acute renal failure
71
Q

Give an example of a direct renin inhibitor?

A

Aliskiren (Tekturna)

72
Q

What is the MOA of direct renin inhibitors?

A

Inhibit enzyme activity of renin–>reducing the activity of Angiotensin I and II, and Aldosterone

73
Q

What are the side effects of Direct Renin Inhibitors?

A

Hyperkalemia
Renal Impairment
Hypersensitivity Reactions= anaphylaxis, Angioedema

74
Q

What are the contraindications of Direct Renin Inhibitors?

A
  • Use with Ace-1 or ARB

- Pregnancy

75
Q

What is the suffix of Beta Blockers?

A

-lol

76
Q

What ist he MOA of Beta Blockers

A

Blocks the activity of catecholamines at β adrenoreceptors–>leads to decreased:

  • Cardiac output
  • PVR
  • Renin activity
77
Q

What are the contraindications of Beta Blockers?

A 
AB block
cardiogenic shock
heart failure
hypotension
asthma
COPD
78
Q

What are the side effects of Beta Blockers?

A 
Exercise intolerance
Fatigue
Bradycardia
Sexual dysfunction
Depression
Exacerbate reactive airway disease
Exacerbate peripheral vascular disease
79
Q

List the two types of Central Alpha Agonists

A
  1. Clonidine

2. Methyldopa

80
Q

What anti-hypertensive are safe for pregnant woman?

A
  1. Methyldopa
  2. Nifedipine
  3. Labetalol
81
Q

What is the MOA of central alpha agonists?

A

Stimulate α2 adrenergic receptors in the brain= reduces CNS sympathetic outflow

82
Q

What are the side effects of central alpha agonists?

A 
Anticholinergic side effects
Bradycardia
Orthostatic hypotension
Dizziness
Rebound HTN
83
Q

What are the side effects of methyldopa

A

Hepatitis
Hemolytic anemia
Fever

84
Q

What are the contraindications of central alpha agonists?

A

Methyldopa in liver disease

85
Q

List the Alpha Blockers

A

Doxazosin (Cardura)
Terazosin (Hytrin)
Prazosin (Minipress)

86
Q

What is the suffix of Alpha Blockers

A

-zosin

87
Q

What is the MOA of Alpha Blockers

A

Targets α1 receptors on vascular smooth muscle, causing peripheral vascular resistance to decrease, thus decreasing blood pressure

88
Q

What are the side effects of Alpha Blockers?

A

Orthostatic Hypotension
Reflex tachycardia
Dizziness

89
Q

If albuminuria is present in CKD or Diabetic pt’s, what anti-hypertensive would you use?

A
  1. ACE-1

2. ARB

90
Q

What anti-hypertensive med helps prevent A-fib recurrence?

A

ARBs

91
Q

What is the preferred anti-hypertensive in thoracic aortic dz?

A

Beta Blocker

92
Q

What classes are not ok to prescribe pregnant woman?

A
  1. ACE-1
  2. ARB
  3. DRI
93
Q

What is the classification or hypertensive emergency

A

SBP > or equal to 180 and/or DBP > or equal to 120

Foundations-HTN (1 decks)

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