HTN

Question 1

WHAT CAN FALSELY INCREASE BP?

Answer 1

SITTING WITH LEGS CROSSED WHILE TAKING BP READING

RAISING ARM TO THE SAME LEVEL AS HEART WITHOUT SUPPORT WHILE TAKING BP READING

HAVING THE ARM BELOW THE LEVEL OF THE HEART WHILE TAKING BP READING

Question 1

GOAL BP IN PT WITH +HTN

Answer 1

<130/80

Question 2

WHAT CAN FALSELY DECREASE BP?

Answer 2

STANDING WHILE TAKING BP READING

RAISING ARM ABOVE THE LEVEL OF THE HEART WHILE TAKING BP READING

Question 3

BEST POSITION TO GET ACCURATE BP READING

Answer 3

SITTING WITH BOTH FEET FLAT ON THE GROUND WITH THE ARM AT THE SAME LEVEL OF THE HEART WITH SUPPORT.

Question 4

PT COMES IN FOR ROUTINE PE AND NO COMPLAINTS OR PMHX
VS- BP 130/80
PE+S4 HEARD
NEXT STEP?
WHY?

Answer 4

NEXT - DO AMBULATORY OR HOME BP MONITORING

TO RULE OUT MASKED HTN

Question 5

PT COMES IN FOR ROUTINE PE AND NO COMPLAINTS OR PMHX

BP 120-140/80 @ HOME

BP IN OFFICE VARIES TO 150/80

NEXTG STEP?

Answer 5

NEXT - DO AMBULATORY BP MONITORING FOR 24HOURS TO R/O WHITE COAT SYNDROME

Question 6

BP IS >141/90
NEXT?

Answer 6

STARTE RX WITH
*ACEI OR
* CCB

Question 7

BP IS >141/90 IN AFRICAN AMERICAN PT NEXT?

Answer 7

STARTE RX WITH
* #1 TOC -CCB–PREFERRED IN AFAM PATIENTS

**#2 WILL BE ACEI

Question 8

BP IS >141/90
+LVH(S4+)
ON CHLORTHALIDONE CURRENTLY NEXT?

Answer 8

ADD ACEI

Question 9

BP IS >141/90 WITH ESKD
NEXT?

Answer 9

1 TOC - LASIX

2ND TOC ADD ACEI

Question 10

BP IS >141/90 WITH ESKD
AND HYPERKALEMIA
NEXT?

Answer 10

TZD OR LOOP DIURETIC(FUROSEMIDE)

Question 11

BP IS >151/90 IN AFRICAN AMERICAN
ON CCB
WITH PEDAL EDEMA+, BP>140/92
NEXT?

Answer 11

CONTINUE CCB AND ADD ACEI

Question 12

BP IS >151/90
RX WITH 1 COMBO RX
NEXT?

Answer 12

CCB+ACEI

Question 13

HTN WITH CHF
TOC?

Answer 13

ACEI
DIURETICS
CARVEDILOL

Question 14

HTN WITH MI
TOC?

Answer 14

BB+ACEI

Question 15

HTN WITH PREGNANCY
TOC?

Answer 15

LABETOLOL
METHYLDOPA
HYDRALAZINE

ACEI ARE CI!!!

Question 16

HTN WITH GOUT
TOC?

Answer 16

LOSARTAN(ARB)—IT HAS URICOSOURIC ACTION

ONLY ARB YOU CAN USE IN GOUT IS LOSARTAN
ALL OTHER ARBS INCREASE RISK OF GOUT ATTACKS.

Question 17

TZD ADV EFFECTS?

Answer 17

-HYPER:
*CALCEMIA
*URICEMIA
*GLYCEMIA
-HYPO:
*KALEMIA
*NATREMIA( TZD USE MCC OF HYPONATREMIA)

** INCREASE LEVELS OF LITHIUM AND DIGOXIN

• PANCREATITIS
  *PSORIASISM

Question 18

ARBS

Answer 18

DO NOT CAUSE COUGH
DO NOT CAUSE ANGIOEDEMA

Question 19

PT WITH BP 148/90 AND YOU WANT TO GIVE A TZD. WHICH DO YOU START?

Answer 19

CHLORTHALIDONEMG QD( 2X MORE POTENT THAN HCTZ)

Question 20

PT ON CHLORTHALIDONE 25MG QD
BP 135/85
NEXT STEP?

Answer 20

RESTRICT FLUID AND SALT IN DIET( THIS WILL DECREASE BO MORE WITH CHLORTHALIDONE)

Question 21

PT ON CHLORTHALIDONE 25MG QD ..BP DROPS FROM 160/90 TI 148/86
PE+S4
NEXT STEP?

Answer 21

ADD ACEI TO CHLORTHALIDONE

Question 22

18YO FEMALE
BP 170/105
NEXT STEP?

Answer 22

URINE FOR TOXICOLOGY

Question 23

BP MEDICATIONS THAT INCREASE RISK OF GOUT ATTACKS?

Answer 23

TZD
ACEI
BB
ALL ARBS EXCEPT LOSARTAN

Question 24

BP MEDS THAT DECREASE RISK OF GOUT ATTACKS

Answer 24

LOSARTAN #1 ( ONLY ARB YOU CAN USE IN GOUT PTS

CCB-AMLODIPINE

Question 25

BP>151/90

Answer 25

MUST START RX WITH 2 MEDICATIONS
BEST CCOMBO TO USE:

CCB AND ACEI

Question 26

BEST MEDICATION IN ESKD AND HTN

Answer 26

LOOP DIURETICS ARE THE PREFERRED RX IN ESKD- EVEN IF YOU DOUBLE OR TRIPPLE THE DOSE.

Question 27

WHAT DO YOU ALWAYS CHECK WHEN ON TZD AND WANT TO START ANOTHER MEDICATION?

Answer 27

CHECK POTASSIUM LEVEL AND MAGNESIUM LEVEL
TZD DECREASESPOTASSIUM AND MAG LEVELS
- OTHER DRUGS CAN ADD DECREASED MAG WHEN ADDED TO TZD
IE SOLTALOL OR METHADONE AND MANY OTHERS

SO CHECK LEVELS WHEN ADDING ON MED THAT CAN CAUSE QT PROLONGATION

Question 28

PT HAD VALVE REPLACEMENT WITH PORCINE VALVE.
ANTICOAGULATION RX?

Answer 28

NONE

Question 29

PT WITH MECHANICAL PROSTHETIC VALVE REPLACEMENT OF AV
ANTICOAGULATION RX?
INR GOAL?

Answer 29

ASA+ WARF
INR 2-3
NO DOAC

Question 30

PT WITH MECHANICAL PROSTHETIC VALVE REPLACEMENT OF MV
ANTICOAGULATION RX?
INR GOAL?

Answer 30

ASA + WARF
INR 2.5-3.5
NO DOAC

Question 31

what other conditions requiring anticoag rx and must use warf and no doacs

Answer 31

+ anti-phospholipid ab

+ms with afib

Question 32

TEE TEST OF CHOICE FOR?

Answer 32

ENDOCARDITIS WITH ANY HEART BLOCK

DESCENDING AORTIC ANERYSM

LA THROMBUS, PFO