HTN Flashcards
1
Q
What are the 4 levels of HTN?
A
Normal
Elevated
Stage I HTN
Stage II HTN
2
Q
Values for Elevated HTN
A
120-129 / <80
3
Q
Stage I HTN Values
A
130 - 139 / 80 - 90
4
Q
Stage II HTN values
A
> /= 140 / >/= 90
5
Q
What is the term applied to 95% of htn patients with no single cause? (Basically can’t really find a reason)
A
Essential HTN
6
Q
What is secondary HTN?
A
Has an identified cause
7
Q
What are the factors contributing to essential HTN?
A
Genetic and Environmental
Ages 22-55
8
Q
When is secondary HTN suspected?
A
- Early age HTN
- First symptoms after 50
- Meds aren’t able to control HTN
9
Q
What are the identifiable causes of Secondary HTN?
A
- Renal disease
- renal artery disease
- Pregnancy
- Cushing syndrome
- Hyperthyroidism
- Estrogen use
- drug induced
10
Q
Physical findings of essential htn?
A
usually asymptomatic
11
Q
DDx for secondary htn?
A
- Hyperthyroidism
- Stimulant (cocaine)
- Adrenal Steroids
- OTC suplements
- Anorexic Meds
- NSAIDS
- Oral contraceptives
- Alcohol withdrawal
- Obesity
12
Q
Labs for HTN
A
- UA: proteinuria, hematuria, casts
- Fasting glucose
- CBC
- Chemistry
- Lipid panel
- EKG
- 10-year atherosclerotic risk”
13
Q
Assessment of HTN?
A
Rule out causes of secondary HTN
- Must have HTN readings on 3-5 separate visits
14
Q
Treatment for HTN?
A
Lifestyle
Pharm
15
Q
Lifestyle treatments of HTN?
A
- Diets rich in fruits and vegetables, low sat fats
- Weight reduction (10 kg can lower 5-20 Systolic)
- Reduce alcohol use ( no more than 2 per day)
- Increase physical activity
16
Q
What is the pharmacological goal for HTN?
A
<140/90 or <130/90 in patients with diabetes or kidney disease
17
Q
What is your first line treatment for HTN?
A
Diuretics - HCTZ
12.5 - 25mg PO daily
ACEi - 5-10 mg daily up to 40mg daily PO
18
Q
How do diuretics help with HTN?
A
- Initially lower plasma volume
* Long term is reduction of peripheral vascular resistance
19
Q
How do diuretics help with HTN?
A
- Initially lower plasma volume
* Long term is reduction of peripheral vascular resistance
20
Q
Labs for using Diuretics
A
Initial chemistry and then follow up in 3 months to check electrolytes
21
Q
What is your first line therapy for HTN that isn’t a diuretic?
A
ACE inhibitors (lisinopril)
5 - 10mg PO max 40mg
22
Q
How do ACE inhibitors help with HTN?
A
- Stimulate synthesis of vasodilating prostaglandins
* Reduces sympathetic nervous system responses
23
Q
How is Lisinopril administered?
A
5-10 mg up to 40mg daily via titration
24
Q
Remaining meds for HTN treatment other than Diuretics and ACEi?
A
- ARBs - Angiotensin receptor blockers
- CCBs
- Alpha blockers
25
What is the suffix for ARBs?
- sartan
| * Losartan 50mg daily
26
If a pt is responding well to ACEi but develops a cough, what can we switch them to?
ARB - Losartan 50mg daily PO
27
How do CCBs work?
Prevent calcium from entering the muscle which prevents contractions
28
Contraindications for CCBs?
Causes heart issues
29
Dosing for CCBs?
Diltiazem - 180mg daily PO up to 360mg
Amlodapine - 2.5mg PO up to 10mg
30
When should you re-evaluate pt's for when prescribing HTN meds?
1 month after any med change and allow 3 months before adjusting dosing
31
What are the long term complications due to sustained HTN?
* Cardiovascular Disease
* Renal failure
* Aortic dissection
* Cerebrovascular disease
* Peripheral vascular disease
* Eye - retinal damage
32
What is the big difference between HTN urgency and HTN Emergency?
Pt will have symptoms, specifically signs of end organ damage ( mental status changes, etc.)
33
What is the BP on the TG for HTN urgency?
> 220 / > 125
34
What is the BP of the TG for HTN emergency?
Diastolic > 130
35
How fast does urgent HTN need to be reduced?
Within a few hours
36
How fast does Emergent HTN need to be reduced?
15-25% within 1 hour, THEN <160/110 within 24 hours
* Slowly after 25% because you want to prevent ischemia
37
What are the 3 big exams you're doing to identify end organ damage?
* Neuro
* Cardio/Pulmonary
* Fundoscopic (papilledema)
38
Labs for urgent for emergent HTN?
* UA - proteinuria or hematuria
* Metabolic panel
* Troponins
* EKG
* CXR
* CT head or aorta
39
Medication route difference between HTN urgency and Emergency?
```
Urgency = PO
Emergency = IV
```
40
What is the goal for PO meds regarding HTN urgency?
Reduce DBP <110 over 24 hours
41
How do you treat HTN urgency?
* Goal is for DBP to be <110
* Continue diuretic of HCTZ 25mg PO
OR
* Begin anti-hypertensives:
- Alpha Blocker (Clonidine) 0.1mg PO
- Beta Blocker (Labetalol/Metoprolol)
42
Adverse reaction for Alpha Blockers
Rebound HTN, Tachycardia, and other cardiac issues
43
When do we provide O2?
Sats <94%
44
Full treatment for HTN Emergency?
* IV access and O2 for <94%
to 160/100
* Begin Labetalol 20mg IV over 10 minutes, then 40-80mg every 10 min
* Reduce BP by 25% within 1 hour
* Slow reducing of BP over 24 hour period
* Once stable start Metoprolol 25-50mg PO bid
45
What does atherosclerotic disease usually effect?
Primarily the arterial endothelium
46
What arteries are commonly affected by atherosclerotic disease?
```
Coronary
Aorta
Carotid
Cerebral
Lower Extremity
```
47
What are big ticket items that cause atherosclerotic disease
Smoking
Immune issues
Dyslipidemia
48
What is happening in atherosclerotic disease?
Plaques are invading the tunica intima of arteries and then cause thickening of the tunica media which cause the arteries to narrow
49
What is the number one killer in the U.S.?
CAD
50
What are the physical findings of CAD?
They look like shit and have chest pain
51
Labs for CAD?
* Lipids (Dyslipidemia?)
* EKG (Chest pain, S3 heart sounds)
* Fasting Glucose (diabetes?)
* Troponin (cardiac markers for MI)
52
How is CAD treated?
* Lifestyle changes
* Low fats
* STOP FUCKING SMOKING
* Alcohol reduction
* Control HTN, Diabetes, cholesterol
53
Meds for CAD treatment?
*HMG-CoA reductase inhibitors (STATINs)
lowering the lipids
10mg before bed PO
* Aspirin 81mg with >10% 10 year risk
54
What is CAD?
Coronary Artery Disease
* Coronary arterial narrowing
55
What is PAD?
Peripheral Vascular Disease
* occlusive atherosclerotic lesions that develop in the peripheral regions (legs and arms)
- this causes decreased perfusion of the extremities
56
What are signs of claudication?
Cramping pain or tiredness in the thigh, calf, or foot with walking or exercise
57
So what's a hallmark of PAD?
Basically poor perfusion to the lower extremities. Claudication is a good indication. Just think of the cardio exam involving the arteries and veins.
CHESS
CVES
58
Labs for PAD?
Lipids
Chemistry for renal dysfunction
CT
59
What is acute arterial occlusion of a limb?
Embolism that gets thrown and occludes a vessel.
* Most from the heat go to the lower extremities.
60
What is the common cause of arterial occlusions of limbs from embolisms?
A Fib or valvular heart disease
61
Claudication is usually a precursor of what condition?
Acute arterial occlusion
62
What is the hallmark of an acute occlusion?
Sudden onset of extremity pain with loss or reduction of pulses
63
Along with acute arterial occlusions, what are the 6 p's that signify severe arterial ischemia?
* Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermia (coolness)
64
Go to meds for acute arterial occlusions?
Anticoagulants
* Enoxaparin 1mg/kg SC
* Heparin 5k-10K IV
65
What is the revascularization goal for acute arterial occlusions?
3 hours immediately
** Irreversible damage in 6 hours
66
What causes stroke or TIAs?
Emboli from either A Fib or proximal carotid artery
67
How long does a TIA last?
Neurological deficits for less than 24 hours
68
What is a stroke that lasts longer than 24 hours
CVA
69
What is a sound you may here when auscultating for TIA/CVA?
Carotid bruits
70
What labs are you running for TIA/CVA?
* Blood glucose
* CBC
* Lipids
* CT head
* MRI brain
71
Meds for TIA/CVA?
* Aspirin
* STATINS
* Thrombolytics for within 6 hours of onset
* Long term anticoagulation for A FIB patients
72
How can you rule out hypoglycemoa?
Glucose levels
73
Other labs/rads for CVA/TIA
* Ok to keep SBP at 180 for perfusion
* Head CT
* Blood work
74
What is dyslipidemia?
* Elevated total or LDL
| * Low HDL
75
What is hyperlipidemia?
High concentrations of fats or lipids in the blood
* High LDL
or
* Low HDL
76
What is cholesterol used for>
* Hormone production
* Fat-soluble vitamins
* Bile acids to digest foods
77
Triglycerides are used for what?
Energy between meals
78
What is cholesterol carried primarily on?
Lipoproteins;
* VLDL
* LDL
* HDL
79
What is the primary lipoprotein targeted to reduce plaque formation?
LDL
80
What is your primary prevention for dyslipidemia?
(Someone that has never had an atherosclerotic event)
* Use the ASCVD Risk calculator for 10 year risk of having an MI
81
What is your secondary prevention for preventing dyslipidemia?
(Someone already diagnosed with atherosclerotic plaques (CHD) )
* They already have issues so now you're just going to treat the underlying conditions
82
What are your 2 indicators for people aged 40-79 to initiate drug therapy in reducing the risk of MI?
Using the ASCVD 10 year risk calc;
* >5% risk = start STATINs
* * >10% risk start STATINS for 20-39yos
* >10% risk = start aspirin
83
What is a symptoms if a pt has triglycerides >1000mg/dl?
Eruptive Xanthomas (redish yellow papules, on the butt usually)
84
What is a symptom of triglycerides >2000mg/dl?
Lipemia retinalis (cream colored blood vessels in the fundus of the eye)
85
What can high triglycerides precipitate
Acute pancreatitis
86
Labs for suspected dyslipidemia?
Lipid panel
| A1C?
87
Non_Pharm treatments for high cholesterol?
* low fat diet (fat 25-30%)
* med diet (no sat fats)
* high fiber (40-45 grams)
* aerobic exercise (40 min 3-4x a week)
* Weight loss
* Alcohol down to 1-2 drinks/day
88
Drugs for dyslipidemia?
STATINs 5-10mg at bedtime
89
So what age should you start screening patients?
20
90
What follow ups are required for dyslipidemia?
* Lipids and ASCVD yearly
| * LFTs yearly if on STATINs
91
What labs are you perfoming yearly if on STATINs?
LFTs
