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Renal II, Exam 3 > HTN > Flashcards

HTN Flashcards

1
Q

definitions of hypertension?

A

Normal:
Systolic <80

Prehypertension
Systolic 120-139 OR Diastolic 80-89

Stage 1 hypertension
Systolic 140-159 OR Diastolic 90-99

Stage 2 hypertension
Systolic ≥160 OR diastolic ≥100*

**Calculation of seated blood pressure is based on the mean of two or more readings on two separate office visits.

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2
Q

contributing factors to developing HTN?

A 
Genetic predisposition
Abdominal Obesity
Salt intake
Alcohol intake
Age
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3
Q

HTN is a risk factor for?

A 
Stroke
Myocardial Infarction
Heart Failure
ESRD
Atrial Fibrillation
Aortic Dissection
PVD
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4
Q

why do most young people develop HTN?

A

due to increased peripheral resistance and vasospasm (on the elvel of small arterioles see spasms due to increased symp output)

  • the heart has to work harder to push blood against the resistance
  • both systolic and diastolic will be elevated b/c problem is in periphery in small arteerioles
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5
Q

why do most older people have HTN?

A

develop HTN usually due to aging of arteries. Aorta becomes stiff and larger aa. are stiff - this results in high stystolic BP and normal or low diastolic HTN

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6
Q

what defines cardio exercise

A

minimum of 30 minutes, most day of the week - HR elevation to at least 70% maximal (max = 220-age)

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7
Q

initial HTN tx for non-black populations?

A

ACEI’s, ARBs, CCBs, Thiazide diuretics

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8
Q

HTN tx for black population?

A

CCBs, Thiazide diuretics

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9
Q

see increased weight gain over 2 mos. of 30 lbs, h/a, increased thirst, mm. weakness, high glucose levels, HTN, striae

A

= secondary hypertension

Cushings disease: increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary. This is most often as a result of a pituitary adenoma or due to excess production of hypothalamus CRH (Corticotropin releasing hormone) that stimulates the synthesis of cortisol by the adrenal glands.

sx: weight gain
high blood pressure
poor short-term memory
irritability
excess hair growth (women)
red, ruddy face                                    
extra fat around neck
moon face
fatigue
red stretch marks

test: do dexamethasone suppression test or 24 hours urine collection for cortisol

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10
Q

when to suspect secondary HTN?

A

Compelling finding on initial evaluation
Hard to control HTN (either new onset or well controlled HTN becoming hard to control)
Atypical age of diagnosis (less than 30)
Absence predisposing factors

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11
Q

what to use for ddx of renovascular HTN?

A 
Captopril Test 
DSA
MRI – angiography
Arteriography
Renal vein renin ratio
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12
Q

two main causes for renal artery stenosis?

A
  1. atherosclerosis:
    - more common in older males above 50 years
    - 33% bilateral
    - very progressive
    - assoc. w/ tobacco, lipids, diabetes
  2. fibromuscular dysplasia: nonatherosclerotic non-inflammatory vascular disease that causes abnormal growth w/in the wall of an artery
    - more common in females under age 40
    60% are bilateral
    - not as progressive and less associated w/ risk factors
    - good response to angioplasty
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13
Q

what to be careful to prescribe to someone w/ renal aa. stenosis?

A

ACEI’s and ARBs - will decrease perfusion pressure and kidney may become ischemic

  • avoid in pt. w/ one kidney, or bilateral stenosis
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14
Q

unilateral renal artery stenosis?

A

decreased IV volume
more renin mediated
- BP usually falls w/ ACEIs

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15
Q

bilateral renal stenosis and single kidney?

A

increased IV volume

  • renin mediation varied
  • ACE response is unpredictable, may worsen HTN
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16
Q

c/o anxiety, tremors, weight loss, exopthalmos, HTN present

A

Grave’s disease: hyperthyroidism

Hyperthyroidism in Graves’ disease is confirmed by measuring elevated blood levels of free (unbound) T3 and T4.

thyroid-stimulating hormone (TSH, usually low in Graves’ disease due to negative feedback from the elevated T3 and T4)

What tx to use? Betablockers, nonselective (propanolol) - help with tremors, BP and anxiety

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17
Q

HTN emergency/crisis?

A

can occur at any BP - but involves acute damage to at least one organ: acute or chronic

cardiovascular:
MI (A), Angina (A), Aortic dissection (A), Aneurysmal dilatation of large vessels (C), LVH (C),CHF (A)

Renal:
Hematuria (C), Proteinuria (C), ARF (A)

CNS: 
Cerebral edema (A), Altered mental status (A), Bleed (A), Stroke (A) or TIA (A)

Opthalmologic?
Retinal hemorrhages or exudates (A or C), Papilledema (A)
A-V nicking (C)

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18
Q

primary hyperaldosteronism

A
  • Located in adrenal gland without exogenous stimulus.
  • Elevated aldosterone and low renin levels < Potassium
Types
Aldosterone producing adenoma
Idiopathic Hyperaldosteronism
Bilateral adrenal hyperplasia
Aldosterone producing Ca
Aldosterone producing renin-responsive adenoma
Ectopic aldosterone producing tumor
Dexamathasone suppressible hyperaldosteronism
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19
Q

secondary hyperaldo

A

Elevated aldosterone and elevated renin levels

Causes are:

	1. Diuretics
	2. CHF
	3. Cirrhosis
	4. Ascites
	5. Nephrosis
	6. Others
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20
Q

medication to treat hyperaldosteronism?

A

spironolactone = ARB

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21
Q

causes of secondary HTN?

A 
Sleep apena
Drug induced causes
Chronic kidney disease
Primary aldosteronism
Renovascular disease
Steroid therapy or Cushing’s syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid disease
Parathyroid disease
Pain induced
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22
Q

coarctation of aorta

A

1) Narrowing of medial layer of aorta.

2) Commonly at ligamentum arteriosum.

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23
Q

ddx or coarctation?

A
  1. Differences in upper and lower extremities
  2. Blood Pressure
    systolic hypertension in an infant
    20mm hg between arms
  3. Heart Sounds – if isolated a systolic ejection murmur in the aortic outlet and between scapulae.
  4. Radiology –
    Cardiomegaly
    Rib notching
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24
Q
  • pril
A

ACEI’s

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25
Q

-lol

A

Beta blockers

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26
Q

-pine

A

Dihydropyridine CCB

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27
Q

-sartan

A

ARB

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28
Q

-zosin

A

alfa blocker

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29
Q

thiazide diuretics?

A

HCTZ, Chlorthalidone

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30
Q

direct vasodilators?

A

Hydralazine, Minoxidil

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31
Q

central sympatholytics

A

clonidine, methyldopa

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32
Q

DRI

A

aliskiren

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33
Q

non-hydropyridine CCB

A

Verapamil, diltiazem

34
Q

cough side effect?

A

ACEI’s: Lisinopril -pril

35
Q

heart block when combined with beta blocker?

A

non DHP CCB: verapamil, diltiazem

36
Q

hyperkalemia?

A

ACEI’s or ARBs: Valsartan

37
Q

This medication is a drug of choice for treatment of blood pressure for patients with mild to moderate kidney disease (especially with proteinuria), but in patients with severe kidney disease it may tip patient into the ESRD.

A

ACEIs: ex. rampipril

vasodilate efferent and decrease GFR and reduce glomerular pressure.

38
Q

patients w/ severe sulfa allergies should avoid this BP med?

A

HCTZ

39
Q

what helps alcoholic w/drawal symptoms?

A

clonidine

40
Q

what don’t you use in patient’s with gout?

A

chlorathalidone, increases uric acid (thiazide)

41
Q

This medication may help with symptoms of prostate enlargement, but may cause reflex tachycardia

A

terazosin, alpha blocker

42
Q

what does not cause lower extremity edema?

A

metoprolol, Beta blocker

43
Q

drug induced lupus?

A

hydralazine - direct vasodilator

44
Q

worsened blood sugar control in diabetic patients?

A

HCTZ

45
Q

also used as hair growth product for alopecia, should be used in caution in women not desiring hursitism?

A

minoxidil

46
Q

used in patients w/ systolic heart failure and in patients w/ secondary HTN - though may cause gynecomastia in men

A

spironolactone - potassium sparing

47
Q

recommended for initial tx in non-black population

A

Ace inhibitors

48
Q

best choice for pt. w/ diabetes

A

lisinopril - Ace inhibitors

49
Q

patient w/ heart attack should be on?

A

metoprolol - B1 selective

50
Q

systolic CHF which should not be prescribed?

A

nifedipine - use ACEI’s or ARBs

51
Q

combo pill that cancels out effects on potassium level?

A

zestoretic: lisinopril, HCTZ

52
Q

pregnant patients?

A

methyldopa

53
Q

angioedema is rare but scary and life threatening side effect of this medication, esp. in patients with C1 esterase deficiency?

A

ramipril = ACEI

54
Q

cocaine addict should not be treated with what medication alone?

A

propanolol

55
Q

patient w/ HTN emergencies can be treated with what drugs?

A

nitroprusside, labetalol, hydralazine, enalapril

not losartan

56
Q

thiazide decrease which electrolytes in blood?

A

cl, mg, K, na

don’t deplete Ca2+

57
Q

abruptly stopping leads to rebound hypertension?

A

clonidine

58
Q

after MI use?

A

beta blockers, ACEI’s

caution with direct vasodilators

59
Q

CHF use?

A

ACEI, Diuretics, beta blockers (no pulmonary edema)

caution: beta blockers, CCBs

60
Q

hypertrophic cardiomyopathy use?

A

beta blockers, CCBs

caution: diuretics, ACEIs, direct vasodilators

61
Q

bradycardia and heart block

A

don’t use beta blockers and CCBs together

62
Q

Tachyarrhythmias

A

use beta blockers or verapamil

63
Q

angina

A

use beta blockers, CCBs, nitroglycerin

don’t use direct vasodilators (may decrease afterload leading to coronary decreased coronary perfusion)

64
Q

COPD

A

use CCBs

don’t use beta blockers

65
Q

aortic dissection

A

use nitroprusside of beta blockers

don’t use drugs that increase CO (will increase shear stress)

66
Q

bilateral renal artery stenosis

A

dont’ use ACEIs or ARBs (may worsen renal fn)

67
Q

chronic renal insufficiency

A

use: ACEIs, loop diuretics or CCBs
caution: ACEIs and ARBs

68
Q

renal transplants

A

don’t use ACEIs

69
Q

migraine headaches

A

use beta blockers and CCB

70
Q

stroke or TIA

A

use ACEIs

don’t use vasodilators which may increase intracranial pressure

71
Q

diabetes

A

use ACEI (delays renal failure, decreases proteinuria)

72
Q

pregnancy

A

use methyldopa, hydralazine and beta blockers with caution

don’t use: ACEIs, ARB (renal agenesis) and diuretics

73
Q

gout

A

don’t use diuretics (worsen joint pain or precipitate gout)

74
Q

cocaine use

A

treat with labetolol or clonidine

don’t use selective beta blockers - results in unopposed cocaine induced alpha agonism

75
Q

GI bleed

A

use non-selective beta blocker (lowers portal bp)

caution with beta blockers (may mask signs of acute bleeding)

76
Q

pheochromocytoma

A

use alpha blocker then beta blocker

caution w/ selective beta blocker, may result in unopposed alpha agonism

77
Q

BPH

A

use alpha-1 antagonist

don’t use selective beta blocker, results in unopposed alpha agonism

78
Q

angioedema, hyperkalemia, dry cough

A

ACEI’s

79
Q

raise blood sugars in diabetics, cause sulfa allergies, don’t take at night time or will have to urinate

A

thiazide diuretics

80
Q

non-DHPs

A

slow down the heart

DHPs cause swelling

Renal II, Exam 3 (9 decks)

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