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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
Primary Hyperaldosteronism
Suppressed renin w/ high Aldosterone; aldo/renin ratio >/=30 --> high Na/K exchange --> hypokalemia; Metabolic alkalosis; refractory HTN
26
Causes of Primary Hyperaldosteronism
Adrenal adenoma or bilateral adrenal hyperplasia
27
Pheochromocytoma relates to abnormal levels of
Norepinephrine
28
Pheochromocytoma Sx
Headaches, anxiety, palpitations, tremors and nausea are present; +/- chest pain, pulmonary edema
29
What enzyme is deficient in Mineralcorticoid Excess?
11 beta-hydroxysteroid dehydrogenase
30
rise in creatinine with ACE-inhibition indicates?
Renal Vascular HTN (>25% rise from baseline) | -Renal A. Stenosis
31
Gold Standard for ruling out Renal A. Stenosis
Angiogram
32
aldo/renin ration >/=30 indicates
Primary Hyperalosteronism
33
What tests rule out Primary Hyperaldosteronism
Imaging for adenoma
34
#1 cause of risk for MI, ischemia, etc
HTN
35
2mmHg increase in SBP can raise risk of stroke by _____% and risk of MI by____%
10%; 7%
36
HTN treatment is
life-long; not curable
37
Normal BP =
120/80
38
Pre-hypertension =
120-139/80-89
39
Stage 1 hypertension =
140-159/90-99
40
Stage 2 hypertension =
>160/>100
41
Staging must be based on
2 or more readings taken at 2 or more visits
42
Treating HTN is difficult bc
compliance is an issue
43
If a patient's systolic and diastolic BP fall into different stages
the higher stage applies
44
Consider ambulatory BP monitoring in pts w/
episodic HTN, HTN resistant to meds, Hypotensive episodes while on BP meds, autonomic dysfunction
45
Possible mechanism for Essential HTN
Increased sympathetic activity Increased angiotensin II activity Heredity
46
Risk factors for Essential HTN
``` Ethnicity Heredity Na+ intake EtOH intake Obesity and weight gain Physical inactivity Dyslipidemia ```
47
If a patient is considered to be high risk, the BP goal should be
<130/90
48
High risk factors
DM, Kidney disease, Prior CV event, LVH, >55 M, >65 F, FMHx of CVD, Tobacco use, LDL >130, Metabolic syndrome, Sedentary
49
Metabolic Syndrome
``` Waist circumference High triglycerides Low HDL Fasting glucose (>110mg/dL) BP >130/85 mmHg ```
50
Indication for Secondary HTN
Persistent HTN despite use of adequate doses of three antihypertensives from different classes
51
HTN of a Young (<30) non-obese patient w/ negative FMHx indicates
Secondary HTN
52
Most common cause of secondary HTN
Renal Parenchymal disease
53
Mechanism of Renal Parenchymal disease
High RAAS activity -> increased volume, vasoconstriction, inhibition of vasodilation
54
Testing for Renal Parenchymal disease
Renal U/S, Elevated Creatinine (>1.2 F, >1.4 M), GFR < 60, Proteinuria
55
Main cause of Renal A. Stenosis
Atherosclerosis
56
Elevation of creatinine while taking an ACE-I or ARB rx
Renovascular disease
57
Fibromuscular dysplasia on imaging appears
"string of beads"
58
Fibromuscular dysplasia is a cause of HTN in
Younger females or young pts
59
Medications that may cause BP elevation
oral BC, NSAIDs, decongestants, antidepressants, EtOH
60
Pheochromocytomas are often misdiagnosed as
panic attacks
61
Hyperparathyroidism results in
Increased calcium has a direct vasoconstrictive effect
62
Hyperthyroidism results in
increased basal metabolic rate and increased HR and CO
63
Obstructive Sleep Apnea is considered a cause of
Essential HTN
64
Consider Obstructive Sleep Apnea if patient has the following Sx
loud snoring, somnolence, obesity
65
Treatment for Hyperparathyroidism
Ca2+ channel blocker
66
Suspects for Secondary causes of HTN
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
Complication of untreated HTN
CVD, HF, LVH, CVA, Intracerebral Hemorrhage, renal insufficiency
68
First line of Tx for all patients w/ HTN
Lifestyle modifications
69
Lifestyle modifications include
Weight loss, DASH diet, reduced Na+, exercise, decrease EtOH intake, Smoking cessation
70
If baseline BP is 140/90 and lifestyle modifications are unsuccessful, then
try 1 anti-hypertensive med first
71
If baseline BP is 160/100 and lifestyle modifications are unsuccessful, then
Always start w/ 2 anti-hypertensive med first
72
Which drugs to use w/ Uncomplicated HTN –
thiazide diuretic, ACE-I, ARB, long-acting calcium channel blocker (dihydropyridine)
73
Why is it better to give a pt 2 anti-HTN meds rather than increasing the dose of 1?
Minimizes side effects, meds work synergistically
74
Which drugs to use w/ a CHF patient?
diuretic, ACE-I, ARB, beta-blocker (metoprolol, bisoprolol, carvedilol)
75
Which drugs to use w/ a diabetic patient?
ACE-I, ARB, loop diuretic
76
Which drugs to use w/ a Coronary artery disease/post MI patient?
beta-blocker, ACE-I, dihydropyridine calcium channel blocker
77
Which drugs to use w/ a Afib/flutter patient?
beta-blocker, nondihydropyridine calcium channel blocker
78
Most anti-HTN meds are contraindicated during pregnancy, which drugs should you use?
methyldopa, Labetalol (ACE/ARB Contraindicated)
79
Which drugs to use w/ a Chronic Kidney Disease patient?
ACE-I, ARB
80
Which drugs to use w/ a Migraine patient?
β-blocker, Ca2+ channel blocker
81
What drugs are NOT as effective for HTN in African American patients?
ACE-I, ARB
82
What drugs should you use for HTN in African American patients?
calcium channel blocker or diuretic
83
How should you approach a patient in a hypertensive emergency?
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
Rapidly lowering the BP of a severely HTN pt puts them at risk for?
worsening cerebral, cardiac and renal ischemia
85
What drug is used in acute coronary syndrome and decompensated heart failure?
Nitroglycerin
86
What drugs may be used in hypertensive emergencies
NO, CCB, beta-blockers
87
What drugs may be used in post-operative patients and renal failure patients?
Calcium channel blockers | -Nicardipine
88
What drugs may be used in myocardial ischemia patients with preserved left ventricular function?
Beta-blockers | -Labetolol (alpha and beta)
89
If angioedema, do not use?
ACE-I
90
If asthma/COPD, do not use?
beta-blocker
91
If liver disease, do not use?
methyldopa
92
If pregnant, do not use?
ACE-I or ARB
93
If heart block, do not use?
beta-blocker or nondihydropyridine calcium channel blocker
94
If gout, do not use?
diuretic, especially thiazide
95
If hyperkalemia, do not use?
aldosterone antagonist, ACE- I or ARB
96
If hyponatremia, do not use?
thiazide diuretic
97
If renovascular disease, do not use?
ACE-I or ARB

CSI Exam 4 (11 decks)

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