HTN Flashcards
WHAT CAN FALSELY INCREASE BP?
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
GOAL BP IN PT WITH +HTN
<130/80
WHAT CAN FALSELY DECREASE BP?
STANDING WHILE TAKING BP READING
RAISING ARM ABOVE THE LEVEL OF THE HEART WHILE TAKING BP READING
BEST POSITION TO GET ACCURATE BP READING
SITTING WITH BOTH FEET FLAT ON THE GROUND WITH THE ARM AT THE SAME LEVEL OF THE HEART WITH SUPPORT.
PT COMES IN FOR ROUTINE PE AND NO COMPLAINTS OR PMHX
VS- BP 130/80
PE+S4 HEARD
NEXT STEP?
WHY?
NEXT - DO AMBULATORY OR HOME BP MONITORING
TO RULE OUT MASKED HTN
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?
NEXT - DO AMBULATORY BP MONITORING FOR 24HOURS TO R/O WHITE COAT SYNDROME
BP IS >141/90
NEXT?
STARTE RX WITH
*ACEI OR
* CCB
BP IS >141/90 IN AFRICAN AMERICAN PT NEXT?
STARTE RX WITH
* #1 TOC -CCB–PREFERRED IN AFAM PATIENTS
**#2 WILL BE ACEI
BP IS >141/90
+LVH(S4+)
ON CHLORTHALIDONE CURRENTLY NEXT?
ADD ACEI
BP IS >141/90 WITH ESKD
NEXT?
1 TOC - LASIX
2ND TOC ADD ACEI
BP IS >141/90 WITH ESKD
AND HYPERKALEMIA
NEXT?
TZD OR LOOP DIURETIC(FUROSEMIDE)
BP IS >151/90 IN AFRICAN AMERICAN
ON CCB
WITH PEDAL EDEMA+, BP>140/92
NEXT?
CONTINUE CCB AND ADD ACEI
BP IS >151/90
RX WITH 1 COMBO RX
NEXT?
CCB+ACEI
HTN WITH CHF
TOC?
ACEI
DIURETICS
CARVEDILOL
HTN WITH MI
TOC?
BB+ACEI
HTN WITH PREGNANCY
TOC?
LABETOLOL
METHYLDOPA
HYDRALAZINE
ACEI ARE CI!!!
HTN WITH GOUT
TOC?
LOSARTAN(ARB)—IT HAS URICOSOURIC ACTION
ONLY ARB YOU CAN USE IN GOUT IS LOSARTAN
ALL OTHER ARBS INCREASE RISK OF GOUT ATTACKS.
TZD ADV EFFECTS?
-HYPER:
*CALCEMIA
*URICEMIA
*GLYCEMIA
-HYPO:
*KALEMIA
*NATREMIA( TZD USE MCC OF HYPONATREMIA)
** INCREASE LEVELS OF LITHIUM AND DIGOXIN
- PANCREATITIS
*PSORIASISM
ARBS
DO NOT CAUSE COUGH
DO NOT CAUSE ANGIOEDEMA
PT WITH BP 148/90 AND YOU WANT TO GIVE A TZD. WHICH DO YOU START?
CHLORTHALIDONEMG QD( 2X MORE POTENT THAN HCTZ)
PT ON CHLORTHALIDONE 25MG QD
BP 135/85
NEXT STEP?
RESTRICT FLUID AND SALT IN DIET( THIS WILL DECREASE BO MORE WITH CHLORTHALIDONE)
PT ON CHLORTHALIDONE 25MG QD ..BP DROPS FROM 160/90 TI 148/86
PE+S4
NEXT STEP?
ADD ACEI TO CHLORTHALIDONE
18YO FEMALE
BP 170/105
NEXT STEP?
URINE FOR TOXICOLOGY
BP MEDICATIONS THAT INCREASE RISK OF GOUT ATTACKS?
TZD
ACEI
BB
ALL ARBS EXCEPT LOSARTAN
BP MEDS THAT DECREASE RISK OF GOUT ATTACKS
LOSARTAN #1 ( ONLY ARB YOU CAN USE IN GOUT PTS
CCB-AMLODIPINE
BP>151/90
MUST START RX WITH 2 MEDICATIONS
BEST CCOMBO TO USE:
CCB AND ACEI
BEST MEDICATION IN ESKD AND HTN
LOOP DIURETICS ARE THE PREFERRED RX IN ESKD- EVEN IF YOU DOUBLE OR TRIPPLE THE DOSE.
WHAT DO YOU ALWAYS CHECK WHEN ON TZD AND WANT TO START ANOTHER MEDICATION?
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
PT HAD VALVE REPLACEMENT WITH PORCINE VALVE.
ANTICOAGULATION RX?
NONE
PT WITH MECHANICAL PROSTHETIC VALVE REPLACEMENT OF AV
ANTICOAGULATION RX?
INR GOAL?
ASA+ WARF
INR 2-3
NO DOAC
PT WITH MECHANICAL PROSTHETIC VALVE REPLACEMENT OF MV
ANTICOAGULATION RX?
INR GOAL?
ASA + WARF
INR 2.5-3.5
NO DOAC
what other conditions requiring anticoag rx and must use warf and no doacs
+ anti-phospholipid ab
+ms with afib
TEE TEST OF CHOICE FOR?
ENDOCARDITIS WITH ANY HEART BLOCK
DESCENDING AORTIC ANERYSM
LA THROMBUS, PFO
