Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CM I - Exam 1 (Cardio) > HTN > Flashcards

HTN Flashcards

1
Q

AHA HTN classifications

A

normal: <120/80
elevated: 120-129/<80
Stage 1: 130-139 or 80-89
Stage 2: 140+ or 90+
HTN crisis: >180 and/or >120 (concern for end organ damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What age ranges are there more complications with diastolic or systolic HTN

A

-diastolic HTN has more complications in pt <50yo
-systolic HTN has more complications in pt >60yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

epidemiology of HTN

A

-more common in Blacks than Whites
-more common in economically disadvantaged
-75% of pt >70yo have HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Requirements for diagnosis HTN

A

elevated BP on at least 2 office visits with at least 2 BP measurements each time
-ambulatory BP monitoring (at home) to r/o white coat HTN
-ID lifestyle factors
-Assess target organ injury or clinical CV dz (heart, lungs, kidneys, eyes)
-primary HTN is MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when to consider secondary HTN

A

-if pt is <30 or >50yo
-BP >180/110 at dx
-significant target organ injury at dx
-renal insufficiency
-LVH
-poor response to multi-drug regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Possible sx and hx associated with HTN

A

*most are asymptomatic
-HA is MC
-FH
-lifestyle habits (sedentary, high Na, alcohol, tobacco)
-sx that suggest end organ dx (angina, edema, TIA)
-review meds
-hx of prior BP meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HTN: PE

A

-at least 2 BP measurements
- BMI
-waist circumference
-retinal exam (AV nicking, “wiring”, hemorrhages)
-edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

HTN labs/imaging

A

-CBC
-lipid panel (common comorbidity is HLD)
-serum creatinine, fasting blood sugar, BUN, uric acid, K, Ca (meds can affect K & Ca levels)
-UA
-Renal fxn
-TSH (concern for hyperthyroidism, TSH would low)
-EKG
-CXR (heart enlargement, LVH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HTN tx goal is

A

<130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nonpharm tx for HTN

A

-wt loss (most significant effect)
-exercise
-decrease Na
-increase K (dietary, NOT supplement)
-decrease alcohol
-decrease tobacco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when to initiate medication to tx HTN

A

-individualized to each pt
-pt w/ out-of-office BP > or = 135/85
-pt w/ avg office BP > or = 140/90
-pt w/ out-of-office or in-office BP > or = 130/80 who have 1 or more of the following features: established CVD, T2DM, CKD, 65yo+, estimated 10yr risk of atherosclerotic CVD of at least 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ACEI/ARBs

A

-more effective in younger (<60yo) whites
-less effective in Blacks and older patients
-drug of choice in DM/CKD
-check K and Cr prior to starting; recheck 2 weeks
-ACEI/ARB will vasodilate efferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should you avoid ACEI/ARBs

A

-Blacks and elderly
-any pt who has renal a. stenosis (ACEI will decrease BF to kidney)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ACEI side effects (CAPTOPRIL)

A

Cough (MC)
Angioedema (like hives of oral mucosa in airway)
Pregnancy problems (teratogenic)
Taste changes
Other (Rash, fatigue)
Proteinuria
Renal insufficiency
Increased K
Low BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does aldosterone affect K and Na

A

aldosterone increases Na and decreases K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Renin inhibitors

A

-Aliskiren is rarely used; often unavailable
-lowers BP, reduces albuminuria, and limits LVH
-do NOT combine renin inhibitors with ACEI/ARBs in DIABETICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ca Ch blockers

A

-equally effective in all ages and demographic groups
-preferable to ACEI/ARBs in Blacks and elderly
-MOA: prevent vasoconstriction by blocking Ca channels
MC se: HA, peripheral edema, bradycardia, constipation
ex. Amlodipine, nifedipine (Dihydropyridines end in “ine and non-dihydropyridines don’t)

can combine w/ thiazide diuretics

18
Q

Diuretics to tx HTN

A

-often used in mild-moderate HTN
-more effective in Blacks, elderly, obese
-SE: hypokalemia, hyponatremia, increased urate (uric acid reabsorption so avoid in pt w/ gout)
-Thiazides (chlorthialidone, HCTZ, indapamide) are superior to loop diuretics

19
Q

MOA of diuretics

A

decreases total volume
keeps Ca out of kidneys and in the body (can prevent kidney stones, good for pt w/ osteoporosis or at risk of osteoporosis)

20
Q

Aldosterone Receptor Blockers

A

-spironolactone and eplerenone
-mostly used in pts w/ CHF
-SE: gynecomastia; hyperkalemia

21
Q

Beta blockers

A

-decrease HR and CO
-most commonly used post-MI
-SE: bradycardia and hypotension are MC

22
Q

Alpha blockers

A

-relaxes arteries, lowers peripheral vascular resistance
-may use in pts with BPH
-orthostatic hypotension is a concern (so have pt take medication before bedtime)
-ex. prazosin, terazosin, doxazosin

23
Q

What is a drug that reduces sympathetic outflow in CNS and is the first choice HTN drug in pregnancy (works on sympathetic NS)

A

Methyldopa

24
Q

When should you initiate 2 HTN drugs and how to decide drugs

A

when BP is >20mmHg above goal
-drugs must be from DIFFERENT classes
-usually some combination of an ACEI, CCB, or thiazide
-single pills are idea; no single pill for CCB + thiazide available

25
Q

when should you reassess BP after initiating BP medication

A

2-4 weeks

26
Q

types of hypertensive crisis

A

hypertensive emergency and hypertensive urgency

27
Q

Hypertensive Emergency

A

-BP >180/120 WITH organ injury
-hemorrhages, exudates, and papilledema on retinal exam
-encephalopathy (i.e. HA, confusion, somnolence, stupor, visual loss, focal neurologic deficits, seizure, coma)
-oliguria (decreased urine) & azotemia (waste build up in kidneys)
-N/V
-Chest pain
-Back pain (could be aortic dissection)

28
Q

PE findings of hypertensive crisis

A

similar to CHF

29
Q

HTN Crisis: Labs/imaging

A

-CBC
-blood smear to look for fragmented RBCs
-serum creatinine and BUN
-UA
-serum Na, K, glucose
-CXR
-EKG

30
Q

Hypertensive Urgency

A

BP >180/120 WITHOUT organ injury

31
Q

Tx of Hypertensive Urgency

A

-lower pressure to <160/100 over hours/days (long term goal is lower)
-provide a quiet room
-Clonidine, captopril

32
Q

Tx of Hypertensive Emergency

A

-depends on particular emergency (stroke - TPA, aortic dissection - surgery)

33
Q

most common cause of secondary HTN

A

renovascular HTN

34
Q

Renovascular HTN

A

-stenosis lesion of renal circulation
-stimulates RAAS (renin-angiotensin-aldosterone system)

35
Q

when should you suspect renovascular HTN

A

-onset before age 20 or after age 50
-HTN resistant to 3 or more drugs
-abdominal bruits
-atherosclerotic dz of the aorta or peripheral arteries
-abrupt increase in creatinine >25% after taking ACEI
-episodes of pulmonary edema assoc w/ abrupt surges in BP

36
Q

Imaging to dx renovascular HTN and what is gold standard

A

-duplex renal US
-MRA (with renal disease exposure to gadolinium may lead to nephrogenic systemic fibrosis)
-spiral CT angiography
*gold standard is renal angiograms

37
Q

Causes of secondary HTN

A

Renovascular HTN
Primary aldosteronism
Pheochromocytoma
Cushing syndrome
Coarctation of the aorta

38
Q

pheochromocytoma (SE)

A

tumors of adrenals
-produce catecholamines (epi stimulates sympNS)
-SE: HA, diaphoresis, palpitation, and pallor associated with HTN

39
Q

S/S of Cushing syndrome

A

-Central obesity
-skin atrophy
-striae
-acne
-slow wound healing
-proximal m. wasting and weakness
-osteoporosis
-menstrual irregularity
-hyperpigmentation
-glucose intolerance
-hypokalemia
-HTN

40
Q

Sx and PE findings of coarctation of the aorta

A

-Sx: HA, cold feet, claudication
-PE findings: >20mmHg difference in BP btwn arms and legs; weak pulses in the legs

*constriction along aorta (s/s will depend on where constriction is)

CM I - Exam 1 (Cardio) (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions