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CVS Pharma > HTN > Flashcards

HTN Flashcards

1
Q

بسم الله مجريها ومرساها إن ربي لغفور رحيم
عليك توكلنا وإليك أنبنا وإليك المصير
ارفع صوت النداء عاليا : الحمد لله رب العالمين

A 
IV- Physical examination الربو 
General Examination
Nose: Rhinitis, Polyps, Mucosal Edema,
Increased Secretions
Skin: Eczema 
Adventitious sounds.(Rhonchi)الأهم
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2
Q

first choice dierutic in case of HF : especially in

A

loop
refractory edema
or acute pulmonary edema

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3
Q

Used cautiously with ACEI or in renal impairment to avoid risk of
hyperkalemia?

A

Spironolactone

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4
Q

↓ diuretic induced hypokalemia → ↓ arrhythmia and sudden death
↓ Myocardial hypertrophy & fibrosis induced by local aldosterone?

A

sprionolactone

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5
Q

↓ mortality rate by 30% by antagonizing systemic and local effect of
excess aldosterone

A

Spironolactone

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6
Q

Mortality rate in HF (30% per year) is ↓ by using

A

ACEIs, ARBs, βBs & spironolactone

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7
Q

Inspection : in asthma ?

A

The Thoracic movement, shape ,
Respiratory Rate, Use of Accessory Muscles,

Palpation and percussion : often Normal

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8
Q

Ausculation :The most frequent finding is«

A

wheezing
, especially on forced expiration
Wheezing may be absent during severe asthma
exacerbations (‘silent chest’

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9
Q

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 ?

A

grade 1: 140-159/90-99
grade2:160-179/100-109
grade3 >180/110 hypertensive emegency cerebral encephalopathy sevre hemorrhage

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10
Q

Hypertension is

A

an abnormal sustained rise in arterial blood

pressure “BP

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11
Q

Hypertensive emergencies?

A

: acute severe rise of BP that may result

in serious complications ( H M O D ) e.g., cerebral hemorrhage

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12
Q

what is isolated systolic hypertenison

A

لما الضغط الانقباضي بس يعلي والانبساطي واطي

systolic >140 diastolic < 90

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13
Q

2ry HTN CAUSES?

A

Kideny diseases Renal artery stenosis, Cushing
syndrome & Pheochromocytoma اهمهم

coarctaion 
neurogeinc 
genertic 
endocaranial
pregnancy
women 
polychythemia
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14
Q

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

A

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

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15
Q

HMOD ?

A 
Hypertension mediated organ damage 
IHD 
STROKE
Heart failure
renal failure
aortic aneurysm
retinal damage blindeness
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16
Q

Treatment STRATEGY of the HTN ?

A

life style advice
drug therapy

tip
omega 3 decraes platelt aggregation
olive oil treats hyperlipidemia

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17
Q

Mention ways of life style advice.

A

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

18
Q

Drug therapy of the HTN ?>

A 
ACEI 
ARBS 
CCB
BB
diuretics
19
Q

When do you add the drug therapy to the life style advice in case of high normal blood pressure patients?

A

When there is Highnormal blood pressure + CVS disease

20
Q

when do you give drug treatment to grade 1 hypertensive?

A

@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

21
Q

Mention grade2 and grade 3 strategy ?

A

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

22
Q

Uncomplicated hypertension strategy describe ?

A

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

23
Q

واعلم أن ما أخطأك لم يكن ليصيبك، وما أصابك لم يكن ليخطئك

Consider monotherapy only in “?

A

Low risk grade 1 patients or in elderly

24
Q

لن يغلب عسر يسرين

When is BB added?

A 
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

25
Q

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 ?”:

A

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

26
Q

describe drug therapy in case of chronic renal failure ?

A

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

27
Q

ايه مشكلة ACEI
ARBS
مع مرض الكلي المزمن عند علاج الضغط ؟

A

انه بيقللوا الفلترة في الكلية وبالتالي يزودوا
SERUM CREATININE
لو زاد فوق 30% مرة واحدة فلتقطع !

28
Q

حالة ارتفاع ضغط بتبدا فيها ب 3 ادوية ؟

A

HTN+HFrEF

29
Q

drug therapy of HTN with HF ?

A

Step 1: ACEI + DIURTICS +BB !
STEP 2 ADD spironolactone !
diurtics loop in referactory edema and volume overload
thiazide HF NO volume overload

30
Q

The treatment in case of HTN + Atrial fibrillation ?”:

A

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

31
Q

Avoid combination of Beta-blocker with Non-DHP CCBليه ؟

A

for fear of marked reduction in heart rate and AVN conduction

32
Q

Drug therapy in HTN + DM?

A

ACEI+ CCB OR DIURTICS
زي UNCOMPLICATED
LOW DOSE THIAZIDE FOR NO HYPERGLYCEMIA

BB Is not recommeended

SGLT 2&raquo_space; help control BP منع امتصاص الصودويم من الانيبيات القريبة

33
Q

BB Is not recommended in case of DM ?

A

Delayed recovery from hypoglycemia in type 1
Glucose intolerance type II
Prediabetic > diabetic

34
Q

ادوية مياخدهاش عيان ضغط عنده سكر؟

A

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

35
Q

ليه تعطي
ARBS
احلي في حالة
COPD?

A

Because ACEI INCREASE BRADYKININ AND COUGHIN REFELX

36
Q

COPD + HTN pateint treratment strategy?

A

ARBS ! better than ACEI (COUGHING )+CCB زي الكلي
STEP 2 ADD DIURTICS (THIAZIDE0

  • Avoid nonselective beta-blocker BRONCHOSPASM
  • ACEI → dry cough
37
Q

TIP ECLAMPSIA تسمم الحمل

What are drug preferred in HTN pregnant woman ?

A

alpha methyldopa
Labtalol alpha and betea blocker
CCB

38
Q

What are drug PREVENTED in HTN pregnant woman ?

A

RAS Inhibitors :
renin inhibitor Alisikerin
ACEI
ARBS

39
Q

Magnisum sulphate has»»>effect ?

A

Anti arryhtmic
anti convulsant eclampsia!
anti HTN effect

40
Q 
RAS inhibitors (ACE inhibitors, ARBs, or direct renin inhibitor: Aliskiren) are not recommended during 
pregnancy ?why \
A

1-teratogenic in 1st tirmeset

2-fetotoxic in 2nd and 3rd trimester

41
Q

Hypertensive crisis (e.g. eclampsia) what do u give ?

A

IV labetalol

or Necardipine intermediate DHP CCB + Magniusm sulphate

42
Q

تم الجزء الأول بحمد الله

A

CVS Pharma (6 decks)

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