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Clin Med II - Exam 2 > HTN > Flashcards

HTN Flashcards

1
Q

1st line medications

A

thiazide-type diuretics, CCBs, ACEIs, ARBs

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2
Q

pts of AA descent

A

CCBs or thiazides
80% higher stroke mortality
50% higher HD mortality
320% higher HTN-related, ESRD

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3
Q

pts w/ HTN and CKD

A

ACEIs or ARBs seperately

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4
Q

pts> 75 yo w/ impaired renal fc and HTN

A

CCBs and thiazide diuretics

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5
Q

hypertensive emergency

A

HTN presentation with evidence of life-threatening, end-organ damage
damage: unstable angina, acute MI, acute retinopathy, encephalopathy, nephropathy, LV failure, dissecting aneurysm, AMS, intracranial bleed
goal tx: substantial BP reduction - reduce MAP by 25% in 1-2 hrs
then titrate towards goal - 160/100 over first 6 hrs
ex: nitroprusside, labetalol, NTG, nicradipine, hydralazine, diazoxide

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6
Q

hypertensive urgency

A

BP>220/125 w/o life-threatening, end-organ damage
OR HTN with end-organ damage (non-life threatening)
oral agents used w/o damage -> CCB, alpha-agonist, ACEI
goal - partial BP reduction, relief of xs’x

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7
Q

BP goals

A

> 60 yo w/o DM or CKD, 150/90

<60 yo or have DM or have CKD, 140/90

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8
Q

important BP effect on CV risk <60 yo

A

DBP

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9
Q

important BP effect on CV risk >60 yo

A

SBP

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10
Q

lifestyle changes for BP

A

DASH eating plan, wt loss, exercise 30 min most days of the week, reduce NA intake to <2.4 g/day, limit EtOH, limit fat intake, get enough K+, Ca+, Mg+, stop smoking, limit caffeine

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11
Q

when to use ambulatory BP measurement

A

white coat syndrome, apparent drug resistance, hypotensive symptoms w/ anti-hypertensive, autonomic dysfunction
helps improve patient’s adherence to Tx and can help reduce cost

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12
Q

Medical Hx for HTN

A

known duration, any past meds
personal hx/symptoms of CHD, CHF, CVA, PVD, DM
family hx
symptoms - weight change, lack of physical activity, smoking/tobacco
diet: sodium alcohol, saturated fat, caffeine
All prescribe meds, OTC, herbals, illicit drugs
psychosocial and environmental factors

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13
Q

Labs and tests for HTN

A 
urinalysis
CBC
CMP
EKG
chest x-ray
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14
Q

primary HTN

A 
95% of cases
no clear cause
genetics and environmental
10-15% whites
20-30% AA
onset btwn 25-55 yo
uncommon <20 yo
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15
Q

HTN post stroke

A

don’t reduce BP rapidly because increased pressure required for brain perfusion S/P CVA
avoid clonidine, hydralazine, and other centrally acting meds
ischemic - withhold tx
hemorrhagic - MAP < 130 mm HG due to risk of expanding CVA

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16
Q

thiazide diuretics - facts

A

aka loop diuretics
act on kidneys
best proven efficiency except w/ CHR, S/P MI, DM, CKD
good until Creatinine clearance <20 ml/min and some loop diuretics work lower with sodium restriction
avoid in pts w/ gout, high lipids, orthostatic hypotension
adverse side effects: electrolyte abnormalities - hyponatremia, hyperkalemia, increase in uric acid, glucose, LDL and TGs
loop diuretics: shorter acting, more volume depletion/ electrolyte (only use w/ impaired renal function)

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17
Q

thiazide diuretics - drugs

A

clorthalidone & HCTZ

furosemide& bumetanide &ethacrynic acid

18
Q

CCBs - facts

A

calcium channel blockers
cause peripheral vasodilation w/o reflex tachycardia and fluid retention comparitively
prevent CHD, major CV events, total mortality
non-dihydropyridines & dihydropyridines - more sx’s of vasodilation
SE: HA, peripheral edema, bradycardia, constipation (verapamil in elderly pts)

19
Q

CCBS - dihydropyridines

A

nifedipine, felodipine, amlodipine

20
Q

CCBs- non-dihydropyridines

A

diltiazem, verapamil

21
Q

ACEIs and ARBs - facts

A

most effect w/ normal renin levels, contra-indicated when low
drug of choice for diabetic pts w/ HTN (not severe)
teratogenic
contraindicated in b/l renal artery stenosis and severe CHF - can worsen azotemia -> acute renal failure
SE: hyperkalemia, kidney dysfunction, angioedema (rare for ARBs)
SE of ACEIs only: cough, dizziness, hypotension

22
Q

ACEIs

A

angiotensin converting enzyme inhibitors
benazepril
enalapril

23
Q

ARBs

A

angiotensin I Receptor Blocker

losartan, valsartan

24
Q

aldosterone antagonists

A

save K+, lose Na+
SE: hyponatremia, hyperkalemia, metabolic acidosis, gynecomastia ( breast enlargement in men)
drugs: spironolactone
amiloride

25
Q

BBs

A

beta-blockers
non-cardio selective
drugs: atenolol, metoprolol, carvedilol
SD: bronchospasm, fatigue, sleep disturbance, nightmare, bradycardia, AV blocks, worsen CHR, impotence, incr. in TG, lowering of HDL, mask hyopglycemia warning signs, decrease CO

26
Q

alpha-adrenergic antagonists

A

drugs: prazosin, terazosin, doxazosin
SE: syncope, postural hypotension, dizziness, paplitations, sexual dysfunction
used to treat BPH as well

27
Q

centrally-acting alpha agonist agents

A

aka central sympatholytics
stimulate alpha adrenergic receptors in CNS and inhibit sympathetic outflow
result: decr. peripheral resistance and lowers BP
clonidine, methyldopa
SE: sedation, dry mouth, HA, bradyarrhythias, sexual dysfunction

28
Q

arteriolar dilators

A

direct vasodilators by relaxing vascular smooth m.
hydralazine, minoxidil
SE: alone - reflex teachycardia, increased heart contractility and fluid retention
giver w/ diuretic or BB in pts with resistant HTN

29
Q

resistant HTN

A

adherent pts with HTN who fail to respond to Rx w/ appropriate 3-drug regimen, including a diuretic
exclude secondary causes including aldosterone - ARBs
send to nephrologist/HTN specialist

30
Q

secondary HTN

A

identifiable cause of HTN - 5%
include: renal parencymal disease, CKD, primary aldosteronism, sleep apnea, drug-induced, renal artery stenosis, cushing’s syndrome, long-term steroid use, pheochromocytoma, aorta coarctation, thyroid or parathyroid disease
consider when - age, hx, pe, severity suggests it, BP respond poorly to meds, initially well-controlled with marked increases, stage 2 HTN, sudden onset,

31
Q

primary aldosteronism

A

unprovoked, marked hypokalemia

32
Q

hyperparathyroidism

A

hypercalcemia

33
Q

elevated creatinine or abnormal urinalysis

A

renal parenchymal disease

34
Q

drug considerations

A 
start low, go slow
one-daily long-acting dose ideal - better adherence, may lower cost, smoother control, less risk due to increase in BP when waking
combine with other meds:
BPH - alpha-antagonist
CAD - beta-blocker
S/P MI - beta blocker
35
Q

pts > 55 yo

A

diuretic or CCB
half the dose when elderly
higher risk for hypotension, orthostatic changes in BP

36
Q

HTN in pregnancy

A

before 20 weeks -> chronic hypertension
goal- minimize risk to mother while avoiding therapy that may compromise fetal well-being
after 20 wks and with incr. proteinuria - pre-elampsia
cure- deliver fetus and placenta
eclampsia- pre-eclampsia progresses rapidly to a convulsive state

37
Q

HTN & LVH

A

anti-hypertensives, wt reduction, decreasing Na - reduce LV mass and wall thickness
ACEI + diuretic should be considered

38
Q

HTN & CHF

A

ACEIs - reduced episode, and M&M s/p MI

39
Q

preop considreations

A

BP >180/110 is a risk for peri-operative ischemia events
- don’t clear for elective surgery until lowered
those w/o prior tx - cardioselective BB decrease MA risk and lessen tachycardia perioperatively

40
Q

hypotension and shock

A

SBP <100 mmHg plus diminished perfusion - low urine output, cold extremities, confusion
tx- successive IVF boluses with NS if hypovolemia
consider pressors - DA w/ nitroprusside or dobutamine
if not hypovolemia, high mortality rate

41
Q

orthostatic hypotension

A

SBP falls >20 , DBP falls >10
supine 10+ min
then have pt stand up and repeat BP and HR w/in 3 minutes
causes: drugs, prolonged bedrest, bleeding, ANS diseases

Clin Med II - Exam 2 (4 decks)

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