HTN Flashcards
What is the medical term used to describe high blood pressure?
Hypertension
Hypertension is a significant health concern as untreated high blood pressure can lead to various medical problems.
What are the two numbers in a blood pressure reading called?
Systolic blood pressure and diastolic blood pressure
For example, in a reading of 120/80 mm Hg, 120 is the systolic and 80 is the diastolic.
What is the worldwide prevalence of hypertension?
Around 26%, totaling 1 billion people
Of these, 1% to 2% will suffer a hypertensive crisis in their lifetime.
What is the most common cause of hypertensive crisis?
Essential hypertension that is either undiagnosed or uncontrolled
Other causes include renal disease and pregnancy-related eclampsia.
What is a major barrier to medication adherence in hypertensive patients?
Cost of the medicine prescribed
Other factors include misunderstanding the need for medication and fear of side effects.
What defines a hypertensive emergency?
Severe elevations in blood pressure (usually greater than 180/120 mm Hg) with evidence of new or worsening target-organ damage
Acute target-organ damage can include conditions like hypertensive encephalopathy or acute myocardial infarction.
What is the recommended blood pressure reduction in the first hour for hypertensive emergencies?
25% reduction in mean arterial pressure (MAP)
This is to prevent further organ damage.
What is the treatment approach for hypertensive urgency?
Resume oral medications and lower BP gradually over 24-48 hours
Adjusting chronic oral therapy or adding a new agent may be appropriate.
Which medication is no longer recommended for hypertensive urgency due to risks?
Sublingual nifedipine
It was associated with severe hypotension and organ ischemia.
What is the goal for treating hypertensive emergencies?
Minimize target-organ damage by early initiation of appropriate antihypertensive treatment
This includes lowering blood pressure safely and effectively.
What is the most common type of stroke?
Ischemic stroke
87% of strokes are ischemic strokes, which occur due to interrupted blood flow.
What is the NIHSS used for?
To assess neurological deficit and identify patients for fibrinolytic or mechanical intervention
It is an 11-item assessment scale with scores ranging from 0 to 42.
What is the initial treatment goal for a patient experiencing a hypertensive emergency?
Lower BP by no more than 25% in the first hour
Then reduce SBP to 160 mm Hg and DBP to 100-110 mm Hg over the next 2-6 hours.
What pharmacological agent is contraindicated in patients with advanced aortic stenosis?
Nicardipine
It is a potent calcium channel blocker with marked vasodilator action.
Fill in the blank: The most important risk factor for stroke is _______.
Hypertension
What is a significant complication of hypertensive emergencies?
Stroke
Stroke is a leading cause of death and disability in the United States.
What are some common risk factors for stroke?
- Hypertension
- Atrial fibrillation
- Gender (females > males)
- Atherosclerosis
- Diabetes
- Prior stroke or TIA
These factors significantly increase the risk of stroke.
True or False: All patients with hypertensive urgency should be reevaluated within 7 days.
True
What is intracerebral hemorrhage (ICH)?
A type of stroke characterized by bleeding within the brain.
What is the score range of the 11 item assessment scale for ICH?
Scores range from 0 to 42 (0 - lowest severity, 42 - highest severity).
Name three neuroimaging techniques used for assessing ICH.
- CT
- MRI
- Other imaging techniques
List three lab tests included in the diagnostic workup for ICH.
- Blood glucose level
- Coagulation profile (INR, APTT, PT)
- ECG
What is the most important risk factor for ICH?
Hypertension
What are two other risk factors for ICH?
- Atrial fibrillation
- Atherosclerosis
What is the recommended time frame for thrombolysis with tPA in ischemic stroke?
Within 4.5 hours after onset.
What is the role of antiplatelet therapy in ischemic stroke management?
Aspirin is recommended within 24 to 48 hours after onset.
What is the maximum dose of Alteplase (t-PA) for treating stroke?
90 mg
What is the mechanism of action of Alteplase (t-PA)?
Binds to fibrin in the thrombus and converts plasminogen to plasmin leading to fibrinolysis.
Fill in the blank: The primary endpoint in the EXTEND-IA-TNK study was __________.
reperfusion of greater than 50% of the involved ischemic territory.
True or False: Tenecteplase resulted in a better 90-day functional outcome than Alteplase.
True
What is the goal blood pressure recommended for hypertension management after a stroke?
Less than 130/80 mmHg.
List two secondary prevention measures for ischemic stroke.
- Treatment of modifiable risk factors
- Aspirin administration
What are the two types of hemorrhagic stroke?
- Intracerebral hemorrhage (ICH)
- Acute subarachnoid hemorrhage (SAH)
What is the primary complication in ICH?
Increased intracranial pressure (ICP).
What treatment is used to prevent cerebral artery vasospasm after SAH?
Oral nimodipine.
What is the dose of nimodipine for SAH?
60 mg PO Q4H for 21 days.
What is the role of the pharmacist in stroke management?
- Assessment and treatment of blood pressure and glucose
- Review of inclusion/exclusion criteria for fibrinolysis
- Patient education and counseling
What is the contraindication for using anticoagulants during a hemorrhagic stroke?
Anticoagulants should not be used while a patient is bleeding.
Fill in the blank: The treatment for hemorrhagic strokes is largely __________.
supportive.
What is a common symptom of acute subarachnoid hemorrhage (SAH)?
Severe headache.
What is the main cause of SAH?
Cerebral aneurysm rupture.
