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CSI Exam 4 > HTN > Flashcards

HTN Flashcards

1
Q

Elevated BP

A

140/90

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2
Q

Hypertensive Emergency

A

BP >180/120 + end-organ damage

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3
Q

Hypertensive Urgency

A

DBP >120 w/o organ damage

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4
Q

HTN Risk Factors

A

Smoking, EtOH, Obesity, Hyperlipidemia, Sedentary lifestyle, Metabolic Syndrome

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5
Q

90-95% of hypertensive patients have

A

Essential HTN

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6
Q

Essential hypertension due mostly to

A

genetic and environmental factors, but has no definite cause

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7
Q

Liddle Syndrome

A

increased Na+ reabsorption in distal and collecting tubules (increased activity of epithelial Na+ channel)

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8
Q

Liddle Syndrome genetics

A

Autosomal Dominant

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9
Q

Liddle Syndrome causes what effects

A

hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone and renin

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10
Q

Apparent Mineralocorticoid Excess genetics

A

Autosomal Recessive

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11
Q

Apparent Mineralocorticoid Excess

A

loss of 11 beta-hydroxysteroid dehydrogenase leading to a overly active mineralocorticoid receptor

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12
Q

Apparent Mineralocorticoid Excess causes what effects

A

Hypertension with hypokalemia and metabolic alkalosis.

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13
Q

Treatment for Liddle Syndrome

A

Amiloride

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14
Q

Treatment for Mineralocorticoid Excess

A

aldosterone antagonists (Spironolactone)

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15
Q

Testing for Liddle Syndrome

A

Renin, Aldosterone Levels and Transtubular Potassium Gradient (TTKG)

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16
Q

TTKG tests for

A

kidneys ability to handle K

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17
Q

Normally: TTKG would be _____ in hypokalemic states

A

LOW <2 - to retain K+

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18
Q

Causes of Secondary HTN

A

Liddle Syndrome, Mineralocorticoid Excess, Renal Disease, Renal Vascular HTN, Primary Hyperaldosteronism, Pheochromocytoma, Thyroid/PTH disorders, Cushing’s Syndrome

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19
Q

Renal Disease causes

A

Increased RAAS activity and Na+/H2O retention

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20
Q

Renal Disease Imaging/Tests would show

A

BUN/Creat elevation, cortical thinning, echogenic changes to the parenchyma

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21
Q

Renal Vascular HTN

A

Renal artery stenosis causing excess renin release

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22
Q

Typical patient population w/ Renal Vascular HTN

A

Women < 50 w/ fibromuscular dysplasia causing renal a. stenosis

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23
Q

Suspect Renal Vascular HTN when:

A

age of onset is young (50) and HTN is resistant to 3 or more drugs, presence of abdominal bruits, rise in creatinine with ACE-inhibition, or presentation with flash pulmonary edema

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24
Q

Tests for Renal Vascular HTN

A

Angiogram, MRI

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25
Q

Primary Hyperaldosteronism

A

Suppressed renin w/ high Aldosterone; aldo/renin ratio >/=30 –> high Na/K exchange
–> hypokalemia; Metabolic alkalosis; refractory HTN

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26
Q

Causes of Primary Hyperaldosteronism

A

Adrenal adenoma or bilateral adrenal hyperplasia

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27
Q

Pheochromocytoma relates to abnormal levels of

A

Norepinephrine

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28
Q

Pheochromocytoma Sx

A

Headaches, anxiety, palpitations, tremors and nausea are present;
+/- chest pain, pulmonary edema

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29
Q

What enzyme is deficient in Mineralcorticoid Excess?

A

11 beta-hydroxysteroid dehydrogenase

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30
Q

rise in creatinine with ACE-inhibition indicates?

A

Renal Vascular HTN (>25% rise from baseline)

-Renal A. Stenosis

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31
Q

Gold Standard for ruling out Renal A. Stenosis

A

Angiogram

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32
Q

aldo/renin ration >/=30 indicates

A

Primary Hyperalosteronism

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33
Q

What tests rule out Primary Hyperaldosteronism

A

Imaging for adenoma

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34
Q

1 cause of risk for MI, ischemia, etc

A

HTN

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35
Q

2mmHg increase in SBP can raise risk of stroke by _____% and risk of MI by____%

A

10%; 7%

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36
Q

HTN treatment is

A

life-long; not curable

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37
Q

Normal BP =

A

120/80

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38
Q

Pre-hypertension =

A

120-139/80-89

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39
Q

Stage 1 hypertension =

A

140-159/90-99

40
Q

Stage 2 hypertension =

A

> 160/>100

41
Q

Staging must be based on

A

2 or more readings taken at 2 or more visits

42
Q

Treating HTN is difficult bc

A

compliance is an issue

43
Q

If a patient’s systolic and diastolic BP fall into different stages

A

the higher stage applies

44
Q

Consider ambulatory BP monitoring in pts w/

A

episodic HTN, HTN resistant to meds, Hypotensive episodes while on BP meds, autonomic dysfunction

45
Q

Possible mechanism for Essential HTN

A

Increased sympathetic activity
Increased angiotensin II activity
Heredity

46
Q

Risk factors for Essential HTN

A 
Ethnicity
Heredity
Na+ intake
EtOH intake
Obesity and weight gain
Physical inactivity
Dyslipidemia
47
Q

If a patient is considered to be high risk, the BP goal should be

A

<130/90

48
Q

High risk factors

A

DM, Kidney disease, Prior CV event, LVH, >55 M, >65 F, FMHx of CVD, Tobacco use, LDL >130, Metabolic syndrome, Sedentary

49
Q

Metabolic Syndrome

A 
Waist circumference
High triglycerides
Low HDL
Fasting glucose (>110mg/dL)
BP >130/85 mmHg
50
Q

Indication for Secondary HTN

A

Persistent HTN despite use of adequate doses of three antihypertensives from different classes

51
Q

HTN of a Young (<30) non-obese patient w/ negative FMHx indicates

A

Secondary HTN

52
Q

Most common cause of secondary HTN

A

Renal Parenchymal disease

53
Q

Mechanism of Renal Parenchymal disease

A

High RAAS activity -> increased volume, vasoconstriction, inhibition of vasodilation

54
Q

Testing for Renal Parenchymal disease

A

Renal U/S, Elevated Creatinine (>1.2 F, >1.4 M), GFR < 60, Proteinuria

55
Q

Main cause of Renal A. Stenosis

A

Atherosclerosis

56
Q

Elevation of creatinine while taking an ACE-I or ARB rx

A

Renovascular disease

57
Q

Fibromuscular dysplasia on imaging appears

A

“string of beads”

58
Q

Fibromuscular dysplasia is a cause of HTN in

A

Younger females or young pts

59
Q

Medications that may cause BP elevation

A

oral BC, NSAIDs, decongestants, antidepressants, EtOH

60
Q

Pheochromocytomas are often misdiagnosed as

A

panic attacks

61
Q

Hyperparathyroidism results in

A

Increased calcium has a direct vasoconstrictive effect

62
Q

Hyperthyroidism results in

A

increased basal metabolic rate and increased HR and CO

63
Q

Obstructive Sleep Apnea is considered a cause of

A

Essential HTN

64
Q

Consider Obstructive Sleep Apnea if patient has the following Sx

A

loud snoring, somnolence, obesity

65
Q

Treatment for Hyperparathyroidism

A

Ca2+ channel blocker

66
Q

Suspects for Secondary causes of HTN

A

Controlled BP that suddenly increases w/o explanation, severe/resistant HTN, <30y/o w/ no risk factors, accelerated HTN + organ damage, onset prior to puberty

67
Q

Complication of untreated HTN

A

CVD, HF, LVH, CVA, Intracerebral Hemorrhage, renal insufficiency

68
Q

First line of Tx for all patients w/ HTN

A

Lifestyle modifications

69
Q

Lifestyle modifications include

A

Weight loss, DASH diet, reduced Na+, exercise, decrease EtOH intake, Smoking cessation

70
Q

If baseline BP is 140/90 and lifestyle modifications are unsuccessful, then

A

try 1 anti-hypertensive med first

71
Q

If baseline BP is 160/100 and lifestyle modifications are unsuccessful, then

A

Always start w/ 2 anti-hypertensive med first

72
Q

Which drugs to use w/ Uncomplicated HTN –

A

thiazide diuretic, ACE-I, ARB, long-acting calcium channel blocker (dihydropyridine)

73
Q

Why is it better to give a pt 2 anti-HTN meds rather than increasing the dose of 1?

A

Minimizes side effects, meds work synergistically

74
Q

Which drugs to use w/ a CHF patient?

A

diuretic, ACE-I, ARB, beta-blocker (metoprolol, bisoprolol, carvedilol)

75
Q

Which drugs to use w/ a diabetic patient?

A

ACE-I, ARB, loop diuretic

76
Q

Which drugs to use w/ a Coronary artery disease/post MI patient?

A

beta-blocker, ACE-I, dihydropyridine calcium channel blocker

77
Q

Which drugs to use w/ a Afib/flutter patient?

A

beta-blocker, nondihydropyridine calcium channel blocker

78
Q

Most anti-HTN meds are contraindicated during pregnancy, which drugs should you use?

A

methyldopa, Labetalol (ACE/ARB Contraindicated)

79
Q

Which drugs to use w/ a Chronic Kidney Disease patient?

A

ACE-I, ARB

80
Q

Which drugs to use w/ a Migraine patient?

A

β-blocker, Ca2+ channel blocker

81
Q

What drugs are NOT as effective for HTN in African American patients?

A

ACE-I, ARB

82
Q

What drugs should you use for HTN in African American patients?

A

calcium channel blocker or diuretic

83
Q

How should you approach a patient in a hypertensive emergency?

A

Lower the BP w/ IV drugs by 10% the first hour and 15% over the next 3-12 hours to a BP of no less than 160/110mmHg

84
Q

Rapidly lowering the BP of a severely HTN pt puts them at risk for?

A

worsening cerebral, cardiac and renal ischemia

85
Q

What drug is used in acute coronary syndrome and decompensated heart failure?

A

Nitroglycerin

86
Q

What drugs may be used in hypertensive emergencies

A

NO, CCB, beta-blockers

87
Q

What drugs may be used in post-operative patients and renal failure patients?

A

Calcium channel blockers

-Nicardipine

88
Q

What drugs may be used in myocardial ischemia patients with preserved left ventricular function?

A

Beta-blockers

-Labetolol (alpha and beta)

89
Q

If angioedema, do not use?

A

ACE-I

90
Q

If asthma/COPD, do not use?

A

beta-blocker

91
Q

If liver disease, do not use?

A

methyldopa

92
Q

If pregnant, do not use?

A

ACE-I or ARB

93
Q

If heart block, do not use?

A

beta-blocker or nondihydropyridine calcium channel blocker

94
Q

If gout, do not use?

A

diuretic, especially thiazide

95
Q

If hyperkalemia, do not use?

A

aldosterone antagonist, ACE- I or ARB

96
Q

If hyponatremia, do not use?

A

thiazide diuretic

97
Q

If renovascular disease, do not use?

A

ACE-I or ARB

CSI Exam 4 (11 decks)

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