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CMT-uno > HTN > Flashcards

HTN Flashcards

1
Q

Primary HTN

general

A

Genetic predisposition
Onset is usually between ages 30 and 50 years
Environmental factors – overweight & obesity, OSA, diet (↑ salt intake, ↓ potassium intake), physical inactivity, excessive alcohol, smoking

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2
Q

Secondary HTN

general

A

Secondary may be curable…
Suspect if:
Onset of HTN at early age (< 30 yo)
Abrupt onset of HTN
Exacerbation of previously
drug resistant HTN

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3
Q

Stages of BP according to ACC

A

ACC/AHA
Normal < 120/80mmHg
Elevated 120-129/80mmHg
Stage 1 130-139/80-89mmHg
Stage 2 > 140/90mmHg

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4
Q

HTNs

First line med

A

ACE or ARB

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5
Q

Complications of HTN

A

Coronary heart disease, heart failure, LVH, ischemic and hemorrhagic stroke, CKD, end-stage renal disease, and acute hypertensive emergencies such as hypertensive encephalopathy and acute aortic dissection, etc.

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6
Q

Symptoms of HTN

A

Head ache, blurred vision, dizziness, nausea, fatigue, chest pain, shortness of breath, confusion

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7
Q

HTN

PE findings: (5)

A

abn eye exam, left ventricular heave, abdominal bruit, radial-femoral delay, pulsatile abd mass

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8
Q

What is the most frequent symptom of HTN?
A) nausea
B) headache
C) somnolence
D) chest pain

A

B) headache

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9
Q

HTN Diagnostic findings (2)

A

LVH on ECG or echocardiogram

proteinuria on UA

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10
Q

HTN nutshell

1- What is BP goal

A

Is this primary or secondary?
Goal < 130/80 unless hx Chronic Kidney Disease (then < 120/80)
Calculate 10-year risk (high-risk patients start rx BP > 130/80; lower-risk start rx BP > 140/90)

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11
Q

HTN

Work Up:

A

BMP (sodium/potassium/calcium)
Serum creatinine & GFR
Fasting glucose or A1C
Urinalysis (if + protein consider UACR)
CBC
Lipid profile
TSH
Calculate 10-year ASCVD risk
*consider sleep apnea
*consider echocardiogram

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12
Q

Secondary Hypertension

common causes(5)

A
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13
Q

secondary HTN

OCRAPH3

A
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14
Q

Fantastic 4 for HTN

A

1st line: ace or arb 2nd line: add on calcium channel blocker 3rd line: Thiazide diuretic 4th line: spironolactone; next step refer

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15
Q

Steps

A

1- check BP and define
2- if > 120/80 TLCs 3-6 months
3-if >130/80:
Calculate 10-year ASCVD risk
+ Dx: CAD, DM, CKD, PAD, CVA, age > 65?
If “yes” or > 10% risk 1-month, TLCs then Rx
If “no” or < 10% 3-6 months TLCs
4- >140/90 TLCs 3-6 months then Rx (2 drugs)

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16
Q
A
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17
Q

TLC

A

therapeutic lifestyle change

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18
Q

ACE/ARB compelling indications 4

A

DM, CKD, Cardiomyopathy, proteinuria

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19
Q

Beta Blockers compelling indications

A

post-ACS, Cardiomyopathy

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20
Q

HTN

Clonidine compelling indications

A

indicated for CKD and ESRD
can cause rebound HTN

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21
Q

Calcium Channel Blockers:

A

preferred for black pts, Raynaud’s, vasospastic angina

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22
Q

10 year risk

Very high Risk

A
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23
Q

10 year risk

High Risk

A
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24
Q

10 year risk

Moderate and Low Risk

A
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25
Q

38 yo Female
PMH: Type 2Diabetes, HTN presents for Office Visit.

What is BP goal?
10 year risk?
Drugs compelling indication?

A

< 130/80
High
Ace and arb

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26
Q

55 yo Male; 148/90
PMH: CAD, HTN, hyperlipidemia, presents in office.
What is his bp goal?
Do you need to calculate 10 year risk?
Drugs compelling indication?
What Rx consider?

A

Bp goal < 130/80
Do NOT need to calculate risk bc has ASCVD
Compelling indication for cad- ace/arb/bb
Consider he is > 140/90 so possible two drug tx

27
Q

what is the benefit of Ca channel blocker

Contraindications

A

work well for black pts

Contraindicated In CHF

28
Q

HTN

Lifestyle modifications

A
29
Q

Initial monotherapy in uncomplicated HTN

A
30
Q

What drugs what disease?

A

End Stage Renal Disease

31
Q
A
32
Q

HTN

Thiazide Diuretics meds

A

Hydrochlorothiazide (HCTZ)12.5-25 mg po daily
Chlorthalidone 12.5-25 mg po daily

Drug of choice: 1st line Tx HTN (if no compelling indications)

33
Q

HTN

Thiazide diuretics MOA

A

Inhibits sodium reabsorption in distal renal tubules, resulting in increased excretion of water and of sodium, potassium, and hydrogen ions

34
Q

HTN

Thiazide Adverse effects

A

Hypokalemia, Hyperglycemia, Hyperuricemia, Hypercalcemia, hypocalciuria, Hyponatremia, Hypomagnesemia

Do not use if GFR < 30, NA < 130, gout

35
Q

ACE-Inhibitors MOA

A

Prevent the conversion of angiotensin I to angiotensin II (potent vasoconstrictor), inhibit bradykinin degradation, stimulate the synthesis of vasodilating prostaglandins, and can reduce sympathetic nervous system activity

36
Q

ACE/ARB Adverse effects

A

Dry cough (↑ bradykinin levels) tickle in back of throat
Hyperkalemia
Skin rash, headache, renal impairment, angioedema
*contraindicated in pregnancy

37
Q

ACE prefered for

A

prefered in heart failure, DM, CKD

38
Q

Calcium Channel Blockers meds

A

For HTN use dihydropyridines!!
Amlodipine (Norvasc) 5-10 mg po daily
Nicardipine (adalact/Procardia) 15-180 mg po daily

39
Q

Ca channel blocker MOA

A

Inhibits transmembrane influx of extracellular calcium that inhibits cardiac and vascular smooth muscle contraction

40
Q

Ca channel blocker Adverse effects

A

Constipation
Peripheral edema
Headache, Heart block, Gingival overgrowth

41
Q

Ca channel blockers are contra for

A

CHF

42
Q

Beta-blockers MOA

A

Blocks response to beta-adrenergic stimulation; reduce cardiac output and decrease release of renin from kidney

43
Q

Beta blockers drug of choice for

A

Drug of Choice: CM EF < 45%, aortic dissection, SVT, MI, hyperthyroid

44
Q

Cardioselective (beta-1 receptors)

A

Atenolol 25-50 mg po BID
Metoprolol 12.5 -100 mg po BID (IV)
Bisoprolol 2.5-10 mg po BID
Nebivolol 5-20 mg po daily

45
Q

Noncardioselective (beta-2 receptors)

A

Propranolol 40-180 mg po BID
Carvedilol 3.125-25 mg po BID
Labetalol 5-150 mg po BID (IV)- strongest for HTN

46
Q

beta blockers do NOT use

A

Do NOT use cocaine MI or pheochromocytoma until alpha blockage established

47
Q

beta blocker adverse effect

A

Fatigue
Can mask hypoglycemia S/Sx
Depression, sexual dysfunction, insomnia
Decreases HR

48
Q

Special population Patient

A

Pregnancy
Drug of choice HTN: labetalol, nifedipine, HCTZ, methyldopa

Black patient
Respond more favorably to CCB and hydralazine/isosorbide than whites

Advance CKD ( hyperK, creatinine > 2.0)
Calcium channel blocker, clonidine, hydralazine, alpha blocker

49
Q

when do you treat pregnant pts?

A

In pregnancy do not treat unless symptomatic or BP > 150/90

50
Q

if you start pt on ACE or ARb and kidney function drops

A

think about renal artery stenosis

51
Q

55 yo black male reports to office for primary HTN. No PMHX. What is most appropriate first line anti HTN for this patient?

A) metoprolol (BB)
B) valsartan (ARB)
C) amlodipine (CCB)
D) lisinopril (ACE)

A

C) amlodipine (CCB)

52
Q

48 yo Female presents f/u HTN.
Meds:
lisinopril 20 mg po BID,
amlodipine 5 mg po daily
BP 138/88, HR 55

A) increase amlodipine 10 mg/d
B) continue current rx
C) add metoprolol 25 mg po BID
D) add HCTZ 25 mg qd

A

A) increase amlodipine 10 mg/d

BP goal < 130/80

53
Q

Black patient withhyperkalemia and HTNpresents in office withelevated BP. What is mostappropriate add ontherapy?
A) diltiazem ( non-dihydropyridine ccb)
B) amlodipine ( dihydropyridine ccb)
C) spironolactone ( MRA)
D) atenolol ( bb)

A

Amlodipine- good bp reduction, will not affect K, counsel side effect edema
Diltiazem not good for BP reduction side effect GI
Spironolactone contraindicated hyperK
Atenolol poor choice for HTN esp in black patient

54
Q

Resistant Hypertension possible causes

A
55
Q

Hypertensive Crises

A
56
Q

HTN crisis classification

A
57
Q

Hypertensive Crises

In emergency ( + end-organ damage) Tx

A

admit and treat with IV rx goal reduce BP 10-20% first hour

In urgency ( no evidence end-organ damage) treat outpatient, close follow up, oral rx. Usually start/titrate “baseline” rx :

Amlodipine/HCTZ
Clonidine ( transdermal, po)
ACE/ARB
hydralazine (IV,PO)

58
Q

A patient presents to EDwith agitation/HA bp210/110
a. What diagnosis is this ?
b. HTN urgency
c. HTN emergency
d. Malignant HTN

A

Pt has evid of end organ damage. This is htn emergency.

59
Q

A patient presents to EDwith agitation/HA bp210/110
a.your goal is to reduce BP_ % in first hour
a.10%
b.10-20%
c.25%

A

Goal is to reduce BP 10-20% in 1 hour

60
Q

A patient presents to EDwith agitation/HA bp210/110

Which of the following is best choice for this patient?
Clonidine 0.1 mg po
Amlodipine 10 mg po
Labetalol 10 mg IVP
Enalapril 5 mg IVP

A

Labetalol 10 mg IVP

61
Q

Blood Pressure (BP) =

A

Blood Pressure (BP) = CO x SVR
Cardiac Output (CO)
Systemic Vascular Resistance (SVR)

62
Q

BP considered elevated if

A

Elevated BP on three separate occasions ( > 120/80)

63
Q

HTN Nutshell

4

A

1- What is BP goal
Is this primary or secondary?
Calculate 10 year risk
2- TLCs +/- Rx
3-Drugs w compelling indications
4-Drug/dose/side effects/follow up

CMT-uno (54 decks)

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