HTN Flashcards
بسم الله مجريها ومرساها إن ربي لغفور رحيم
عليك توكلنا وإليك أنبنا وإليك المصير
ارفع صوت النداء عاليا : الحمد لله رب العالمين
IV- Physical examination الربو General Examination Nose: Rhinitis, Polyps, Mucosal Edema, Increased Secretions Skin: Eczema Adventitious sounds.(Rhonchi)الأهم
first choice dierutic in case of HF : especially in
loop
refractory edema
or acute pulmonary edema
Used cautiously with ACEI or in renal impairment to avoid risk of
hyperkalemia?
Spironolactone
↓ diuretic induced hypokalemia → ↓ arrhythmia and sudden death
↓ Myocardial hypertrophy & fibrosis induced by local aldosterone?
sprionolactone
↓ mortality rate by 30% by antagonizing systemic and local effect of
excess aldosterone
Spironolactone
Mortality rate in HF (30% per year) is ↓ by using
ACEIs, ARBs, βBs & spironolactone
Inspection : in asthma ?
The Thoracic movement, shape ,
Respiratory Rate, Use of Accessory Muscles,
Palpation and percussion : often Normal
Ausculation :The most frequent finding is«
wheezing
, especially on forced expiration
Wheezing may be absent during severe asthma
exacerbations (‘silent chest’
مشكلة ارتفاع ضغط الدم انه ملوش اعراض بس ليه مضاعفات !
يدخل في تدمير الأعضاء كلية قلب اورطي العين
الهدف الرئيسي هو منع تدمير الاعضاء
لازم تقيسه 3 مرات علي الاقل و عنده ضغط دم مرتفع مستمر
120-129/80-84 normal BP
130-139/85-89 High normal
above is hypertension
SO what are grades of hyper tension ?
grade 1: 140-159/90-99
grade2:160-179/100-109
grade3 >180/110 hypertensive emegency cerebral encephalopathy sevre hemorrhage
Hypertension is
an abnormal sustained rise in arterial blood
pressure “BP
Hypertensive emergencies?
: acute severe rise of BP that may result
in serious complications ( H M O D ) e.g., cerebral hemorrhage
what is isolated systolic hypertenison
لما الضغط الانقباضي بس يعلي والانبساطي واطي
systolic >140 diastolic < 90
2ry HTN CAUSES?
Kideny diseases Renal artery stenosis, Cushing
syndrome & Pheochromocytoma اهمهم
coarctaion neurogeinc genertic endocaranial pregnancy women polychythemia
ولا تيأسوا من روح الله إنه لا ييأس من روح الله إلا القوم الكافرون …!!!
والله ما يهديك الا هو والله
هو اضحك وابكي !!
Iatroogenic HTN DISCUSS
NESC2L نثقل الهمم و العزائم في سبيل الله ابتغاءا لمرضاته وطلبا لرحمته وكرمه واحسانه طمعا في جنته
Coticosteroids cortisol na water retenion
contraceptives progerstone hyperlipidemia estrogen inc pressure
Liquorice like aldosterone
sympatomimetics as vasoconstrictors ..
NSAIDS INCREASE NA WATER REABSORPTION FROM PROXIMAL CONVOUTED TUBULE S
HMOD ?
Hypertension mediated organ damage IHD STROKE Heart failure renal failure aortic aneurysm retinal damage blindeness
Treatment STRATEGY of the HTN ?
life style advice
drug therapy
tip
omega 3 decraes platelt aggregation
olive oil treats hyperlipidemia
Mention ways of life style advice.
Avoid Salt sodium
Avoid smoking and alcohol
regular physcial exercise
weight loss
Dietary changes?
Eat unsatureated fatty acids and omeg3 frome fish and olive oil
less satured fatty acid like that of red meat
يأكل فاكهة وخضار وحبوب كاملة ويقلل الدهون
Drug therapy of the HTN ?>
ACEI ARBS CCB BB diuretics
When do you add the drug therapy to the life style advice in case of high normal blood pressure patients?
When there is Highnormal blood pressure + CVS disease
when do you give drug treatment to grade 1 hypertensive?
@LOW RISK PATIENTS this in case you adivsed him of life style modification for 3/6 month with persistant grade 1hypertension
@HIGH TISK PATEINTS immediate drug therapy in case of CVS disease CVD RENALDISEASES HMOD
Mention grade2 and grade 3 strategy ?
Life style advice
immediate drug therapy for all patients aiming at improving blood pressure in 3 months
tip
diurteic in essential hypertenison is >? thiazide ,, t like drugs
Uncomplicated hypertension strategy describe ?
Two-drug combination therapy is preferred for the initial treatment of most people with uncomplicated hypertension
• Step 1: Initial therapy (Dual combination in one pill): ACEI (or ARB) + CCB or diuretic.
• Step 2: (Triple combination in one pill): ACEI (or ARB) + CCB + diuretics.
• Step 3: Resistant hypertension: (Triple combination + Other drug): Add spironolactone, other diuretic, ἀ-blocker or β-blocker
واعلم أن ما أخطأك لم يكن ليصيبك، وما أصابك لم يكن ليخطئك
Consider monotherapy only in “?
Low risk grade 1 patients or in elderly
لن يغلب عسر يسرين
When is BB added?
in case of resistant HTN GRADE 1 Or ! systolic Heart failure ischemic heart diseas angina MI يمنع الرينين انجيوتنسن سيستم Atrial fibrillation فيونكة منه فيه and young women planing for pregnanvy
it is not initial theapy
يا غلام، إني أعلمك كلمات: احفظ الله يحفظك، احفظ الله تجده تجاهك، إذا سألت فاسأل الله، وإذا استعنت فاستعن بالله، واعلم: أن الأمة لو اجتمعت على أن ينفعوك بشيء لم ينفعوك إلا بشيء قد كتبه الله لك، وإن اجتمعوا على أن يضروك بشيء لم يضروك إلا بشيء قد كتبه الله عليك، رفعت الأقلام وجفت الصحف
واعلم أن ما أخطأك لم يكن ليصيبك، وما أصابك لم يكن ليخطئك
واعلم أن النصر مع الصبر، وأن الفرج مع الكرب، وأن مع العسر يسراً
Decribe drug therapy of HTN in case of coronary heart disease ?”:
4 Drugs : ACEI(ARBS) CCB BB DIURETICS
Step one dual combination of any of the drus
step 2 triple combination
step 3 triple combination + spironolactone =alpha blockers
2>3>4
الشريان التاجي شغله مشكل
describe drug therapy in case of chronic renal failure ?
Step 1 : ACEI ARBS + CCB
الفرق بينها وبين ال UNCOMPLICATED
ان الخطوة الاولي ممكن فيها تدي مدرات البول
Step2: add diuretics ACEI ARBS + CCB +diuertics
step 3: add spironolactone ACEI ARBS + CCB +diuretics +spironolactone
DIURTICS = loop or metolazone or Indapamide
ايه مشكلة ACEI
ARBS
مع مرض الكلي المزمن عند علاج الضغط ؟
انه بيقللوا الفلترة في الكلية وبالتالي يزودوا
SERUM CREATININE
لو زاد فوق 30% مرة واحدة فلتقطع !
حالة ارتفاع ضغط بتبدا فيها ب 3 ادوية ؟
HTN+HFrEF
drug therapy of HTN with HF ?
Step 1: ACEI + DIURTICS +BB !
STEP 2 ADD spironolactone !
diurtics loop in referactory edema and volume overload
thiazide HF NO volume overload
The treatment in case of HTN + Atrial fibrillation ?”:
ACEI OR ARBS + BBS OR NON DHP CCB
Never give BB AND CCB simltunanuously
هما الاتنين فيونكات ياعمر @@
anticoaguloants are given to reduce risk of thrombosis and stroke unless contraindicated
Avoid combination of Beta-blocker with Non-DHP CCBليه ؟
for fear of marked reduction in heart rate and AVN conduction
Drug therapy in HTN + DM?
ACEI+ CCB OR DIURTICS
زي UNCOMPLICATED
LOW DOSE THIAZIDE FOR NO HYPERGLYCEMIA
BB Is not recommeended
SGLT 2»_space; help control BP منع امتصاص الصودويم من الانيبيات القريبة
BB Is not recommended in case of DM ?
Delayed recovery from hypoglycemia in type 1
Glucose intolerance type II
Prediabetic > diabetic
ادوية مياخدهاش عيان ضغط عنده سكر؟
Nonselective β-blockers increase risk of new onset
غير مستحب في السكر اال في وجود أمراض تحتم استخدمهمdiabetes
- High dose thiazides induce hyperglycemia
Avoid decrease BP < 120/70 during treatment
ليه تعطي
ARBS
احلي في حالة
COPD?
Because ACEI INCREASE BRADYKININ AND COUGHIN REFELX
COPD + HTN pateint treratment strategy?
ARBS ! better than ACEI (COUGHING )+CCB زي الكلي
STEP 2 ADD DIURTICS (THIAZIDE0
- Avoid nonselective beta-blocker BRONCHOSPASM
- ACEI → dry cough
TIP ECLAMPSIA تسمم الحمل
What are drug preferred in HTN pregnant woman ?
alpha methyldopa
Labtalol alpha and betea blocker
CCB
What are drug PREVENTED in HTN pregnant woman ?
RAS Inhibitors :
renin inhibitor Alisikerin
ACEI
ARBS
Magnisum sulphate has»»>effect ?
Anti arryhtmic
anti convulsant eclampsia!
anti HTN effect
RAS inhibitors (ACE inhibitors, ARBs, or direct renin inhibitor: Aliskiren) are not recommended during pregnancy ?why \
1-teratogenic in 1st tirmeset
2-fetotoxic in 2nd and 3rd trimester
Hypertensive crisis (e.g. eclampsia) what do u give ?
IV labetalol
or Necardipine intermediate DHP CCB + Magniusm sulphate
تم الجزء الأول بحمد الله
