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Primary Care 1 > HTN > Flashcards

HTN Flashcards

1
Q

Increases risk for HTN

A

older age, obesity, sedentary, high fat high sodium diet, family history, race, type A/depression, dyslipidemia, alcohol, smoking

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2
Q

Secondary Caues of HTN

A

chronic NSAID use, birth controll pills, renal artery stenosis, pheochromocytoma, illegal drug use, cushings syndrome, coarction of aorta, primary hyperaldosteronism, OSA, SSRIS and tricyclic antidepressants, decongestants, weight loss meds, endocrine disorders, low vitamin D

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3
Q

Target Organ Damage from HTN

A

Heart: CHF, MI, LVH, angina. Stroke. CKD. Retinopathy. PAD.

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4
Q

Screening

A

120 annual

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5
Q

PAD s/s

A

BP >15 in arms d/t subclavian stenosis

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6
Q

Postural hypotension

A

20 or > drop from supine to standing

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7
Q

Diagnosis of HTN

A

> 140/>90 on repeated exam, 3 readings at least 1 week apart

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8
Q

prehypertension

A

120-139/80-89

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9
Q

stage 1

A

139-159/89-90

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10
Q

stage 2

A

> 160/>100

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11
Q

HTN History

A

Duration: when was your last known normal blood pressure? Prior treatment? Any intake causing this like NSAIDs, estrogen, adrenal steroids, cocaine, high na. Family History: HTN, pheochromocytoma, cardiac disease, DM, kidney disease. S/S secondary causes: muscle weakness, headache, palpitations, fatigue, sleeping through out the day. S/S Target organ damage: decreased vision, headache, chest pain, dyspnea, claudication. Psychosocial: family, work, stress Risk: smoking, drinking, inactivity, diet

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12
Q

Physical Exam HTN

A

General: fatigue, body fat, strength, alertness.
Palpate pulses femoral and brachial same time to r/o COA.
Eyes: fundoscope - hemorrhage, papilledema, cotton wool spots
Neck: listen and palpate carotid. Thyroid.
Heart. Lungs.
Abdomen: renal masses, bruits
Extremities: edema

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13
Q

Labs HTN

A

CBC, Lipids, TSH, UA, ECG, Plasma Renin Activity, Albuminuria, BUN, Serum Creatinine, fasting blood glucose, electrolyte panel

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14
Q

Treat - Black

A

Thiazide, CCB

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15
Q

Treat - not black

A

ACE/ARB

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16
Q

Treat not black > 60

A

thiazide, CCB. If

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17
Q

CKD and HTN

A

ACE ARB

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18
Q

Renal Artery Stenosis, what it causes, how to control it, how to diagnosis it

A

blocked renal artery –> renin angiotensin system –> increased bp. treat w/ angioplasty. control with beta blockers. dx abdominal bruits

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19
Q

Pheochromocytoma: s/s, treatment, diagnosis

A

tumor on adrenal gland. Bilateral headache, hypertension, hyperhydrosis, hyperglycemia. Need alpha blocker and surgery. dx w CT scan.

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20
Q

Primary Aldosteronism: s/s, treatment

A

caused by adrenal adenoma symptoms are muscle cramps and fatigue. can be surgically corrected.

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21
Q

COA: s/s, diagnosis

A

claudication, pulse delay brachial and fem, lower blood pressure in lower extremities. Need CXR.

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22
Q

Cushings

A

hirutism, edema, buffalo hump, moon face, truncal obesity. Adrenal cortex hypersecretion of glucocorticoids leading to HTN.

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23
Q

OSA

A

Morning headache, daytime sleepiness, snoring, gasping

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24
Q

HTN treatment w Renal or Heart Failure

A

loop diuretics

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25
Q

Monitor these labs after starting BP mgmt

A

glucose, k, lipids, renal function

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26
Q

treatment with CAD and HTN

A

beta blockers, cardioprotective post MI, good with anxiety

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27
Q

Beta Blockers contraindicated in

A

asthma and bronchocontriction

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28
Q

good for DM with HTN

A

ace/arb/ccb

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29
Q

amlodipine s/e

A

leg edema

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30
Q

LDL goal

A

if DM, ACS, CVD less than 70.

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31
Q

LDL does

A

brings cholesterol into the plasma

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32
Q

HDL does

A

prevents the oxidation of the LDL into the arterial wall. Brings the free cholesterol to the liver to be reprocessed

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33
Q

how to decrease LDL and increase HDL

A

weight reduction, diet, exercise

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34
Q

Saturated fats lead to

A

increased lipids

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35
Q

Physical Exam with Hyperlipidemia

A

height/weight BMI. heart rate and rhythm. BP. Xanthomas fatty deposits. Corneal arcus white ring.

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36
Q

Labs with Hyperlipidemia

A

fasting: full lipid profile. not fasting: total cholesterol, HDL-C.
Total > 240 high
200-239 borderline
HDL 200 high

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37
Q

Before starting a statin need these labs

A

need liver enzymes d/t may lead to hepatic impairment. draw CK if c/o myalgias.

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38
Q

if myalgias

A

use bile acid sequestrants or cholesterol absorption inhibitors

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39
Q

treat hypertriglyceridemia

A

fibric acid, tri > 400. must monitor LFTs.

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40
Q

TDAP

A

one dose then q10years

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41
Q

varicella

A

2 doses four weeks apart

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42
Q

HPV

A

3 doses through age 26. 2 through 21 for males, 3 for gay men

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43
Q

pneumonia

A

> 65

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44
Q

hep a

A

two doses 6 months apart

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45
Q

hep b

A

3 doses. 2nd one months after 1st, third is 2 months after second

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46
Q

HR for Hep C

A

1945-1965. injection drug users, blood transfusions

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47
Q

HIV screening

A

drug use, gay, STIs, unprotected sex, HIV partners, exchange sex for money

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48
Q

Causes of Renal Artery Stenosis

A

fibromuscular dysplasia causing tight renal bands usually found in those younger than 30. atherosclerosis in those greater than 50

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49
Q

hyperaladosteronism symptoms

A

weakness, headache, fatigue, hypertension, hypokalemia

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50
Q

neurovascular s/s of target organ damage

A

transient weakness, blindness, loss of vision, severe headache, confusion, lethargy, seizures

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51
Q

vascular target organ damage

A

COA, impotence, claudication

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52
Q

cardiovascular target organ damage

A

chest pain, dyspnea, palpitations, syncope

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53
Q

renal s/s target organ damage

A

oliguria, hematuria, dysuria

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54
Q

peripheral circulatory changes w HTN

A

thinning skin, loss of extremity hair, decreased or absent pulses

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55
Q

eye changes with HTN

A

arteriolar narrowing, av nicking, hemorrhages, papilledema

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56
Q

CAD markers

A

c reactive protein, interleukin6, monocyte-macrophage colony stimulating factor

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57
Q

s1

A

heard at apex. systole. mitral and tricuspid are closed, semilunar are open, blood is flowing through during contraction

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58
Q

s2

A

closure of aortic and pulmonic, mitral and tricuspid are open and filling during diastole best heard at base

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59
Q

s3

A

rapid filling of left ventricle. heard in CHF, normal in pregnancy

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60
Q

s4

A

found in MI, LVH, chronic HTN

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61
Q

Systolic HF

A

decreased ability to contract –> decreased EF and decreased cardiac output. caused by left ventricular dilated cardiomyopathy

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62
Q

Diastolic HF

A

cant relax and fill, caused by LVH from uncontrolled HTN. EF normal.

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63
Q

L sided HF

A

sob, wheezing, frothy cough, S3, coarse rales

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64
Q

R sided HF

A

jvd, hepatomegaly, splenomegaly, dependent edema

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65
Q

triglyceride range

A

> 150 high

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66
Q

hdl range

A

> 40 good

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67
Q

cholesterol total level range

A

> 200 high

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68
Q

ABI normal range

A

0.9-1.3 – abnormal = PVD

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69
Q

Risk factors for atherosclerotic disease

A

smoking, htn, low HDL, family history of CHD, male >45, female >55 if two or more need 10 year risk

70
Q

Labs to draw with HTN

A

UA, CBC, serum K, BUN, Cr, fasting blood glucose, lipoprotein, serum uric acid, calcium

71
Q

bladder of BP cup is this % of arm & where

A

80, 1 cm above AC fossa, support level with heart, average of at least two measures, feet on the floor,

72
Q

peripheral circulatory impairment

A

pulses diminished or absent, skin thinning, loss of extremity hair

73
Q

how many office visits to diagnose htn

A

3

74
Q

cant give diuretics with these comorbidities

A

dm and renal insufficiency

75
Q

diuretics good if pt also has…

A

CHF

76
Q

beta blockers good if pt also has..

A

MI, angina, migraines, hyperthyroidism, tachycardia or a fib, CAD, anxiety

77
Q

ace/arb good for…

A

chf, dm, renal insufficiency

78
Q

can’t do calcium channel blockers with

A

CHF

79
Q

Why we should not lower blood pressure in hypertensive crisis too quickly

A

loss of autoregulation, decreases cerebral perfusion

80
Q

triglycerides > 500 risk for

A

acute pancreatitis. treat with niacin or a fibrate, once controlled move to lowering LDL

81
Q

Risk factors of heart disease

A

HTN. Family hx of young age MI. DM. Dyslipidemia. Low HDL. Age. Cigarettes. Obesity. Microalbuminuria. CAD. PVD.

82
Q

Lifestyle changes for Hyperlipidemia

A

Weight loss, exercise, low sat fat diet

83
Q

best agents to decrease LDL

A

Statins.

84
Q

Statin drug interactions

A

Graperfruit juice, fibrates, antifungal, macrolide antibiotics, amiodarone, caridem, norvasc, verapamil

85
Q

Fibric acid

A

Gemfibrozil, Fenofibrate, reduces production of triglyceridese by the liver and increases HDL. Side effects dyspepsia, gallstones, myopathy

86
Q

Pt education: high triglycerides

A

Reduction of simple carbs, junk food and fried food

87
Q

Pt education: low HDL

A

increase exercise, OTC niacin

88
Q

Bile Acid Sequestrants

A

Questran Light. Colestid, Welchol. Works in the intestines to interfere with fat absorpion. Good if can’t tolerate statin. Take w a multivitamin. Side effects bloating, abd pain, gas. Start at low dose.

89
Q

Zetia

A

Combo of simvastatin and vytorin. Can cause rhabdo. Side effects diarrhea, joint pain, tired

90
Q

When to recheck lipids levels

A

3 months then every 6 months during first year also check LFTs

91
Q

S/s Rhabdo

A

muscle pain, weakness, dark urine. Will cause renal failure. Ck markedly elevated 10,000-25,000. Urine red brown from myoglobinuria, proteinuria

92
Q

Dietary sources of calcium

A

low fat dairy

93
Q

Potassium sources

A

fruits and veggies

94
Q

Mg sources

A

dried beans, whole grains, nuts

95
Q

Obesity waist circumference

A

men 40 women 35

96
Q

Medicare wellness visit

A

BMI, full physical exam, visual acuity

97
Q

Colorectal cancer screening

A

Start at age 50. flex sigmoid every 5, colonoscopy every 10. FOBT annual. If HR begin age 40. If you have significant polyps colonoscopy is annual

98
Q

Prostate exam

A

annual digital rectal exam

99
Q

Mammogram

A

every other year starting at age 50

100
Q

Breast exam

A

yearly at age 40, every 3 years 20-30s

101
Q

Cervical Ca

A

Start at 21. Pap q3years

102
Q

Gonorrhea and Syphilus

A

start screen at age 18 if sexually active

103
Q

Chlamydia

A

start at 24 if sexually active

104
Q

Bp screening if 120/80

A

every 2 years

105
Q

Bp screening if >120

A

every year

106
Q

BP if >140

A

discuss treatment

107
Q

Comprehensive Geriatric Assessment

A

Medical: medications, hearing and vision, contence, nutrition, intregrity, pain, abuse. Psychosocial: depression, social support, home environment. Cognitive w mini mental exam. Functional: ADLs, falls, time up and go test

108
Q

BEERS criteria

A

age 65+ screen of medications that may be inappropriate

109
Q

Herpes Zoster

A

1 dose > 60 years

110
Q

Tetanus

A

booster every 10 years

111
Q

BP 160/100 or greater

A

combo with CCB/Thiazide + ACE/ARB’

112
Q

Resistant

A

add aldoactoe, beta or alpha or vasodilator

113
Q

ace and arb together causes

A

decreased GFR, hypotension, hyperkalemia

114
Q

needs hospitalization

A

180/120 and s/s target organ damage - retinopathy, dizzy, AMS, blurry vision, chest pain, SOB, oliguria

115
Q

statin w liver disease

A

pravastatin

116
Q

statin w kidney disease

A

lipitor

117
Q

labs before starting a statin

A

LFTs, CK, TSH

118
Q

Therapeutic Inertia

A

failure of providers to increase therapy in the setting of identified poor blood pressure control

119
Q

Top two causes of HTN prevalence

A

age and obesity also main reason is high salt

120
Q

BP =

A

systemic vascular resistance x cardiac output

121
Q

factors determining blood pressure

A

sympathetic nervous system, renin angiotensin aldosterone system, plasma volume (mediated by the kidneys) – feelings,, patho process, blood

122
Q

Aging and blood pressure

A

systolic rises, diastolic decreases after age 50. from progressive arterial stiffing. major risk factor for cardiac, stroke, and kidney disease in the older population

123
Q

EF dialstolic v systolic

A

diastolic preserved, decreased ef in systolic, HF increases w increased blood pressure.

124
Q

risk for htn complications is lowest at this blood pressure

A

115/75. for every 20mm in systolic or 10mm diastolic above this the risk for cardiac/stroke events doubles

125
Q

to diagnosis htn

A

140/90 on at least two visits over a period of at least 1 week apart.

126
Q

nonpharm therapy to decrease blood pressure according to US Preventative Task Force

A

1) Decrease sodium
2) Supplement K
3) Increase activity/lose weight
4) Mgmt stress
5) Decrease alcohol

127
Q

USPSTF other guidelines with screening for htn pts

A

also screen for DM, hyperlipidemia, smoking, aspirin prevention for those at increased risk.

128
Q

bp screening in >65… who else needs this evaluated?

A

include orthostatic hypotension. 20mm or greater fall in systolic pressure from rising from supine. Also needs to be screened in diabetic and those w complaints of dizziness, weakness. 5 minutes supine then immediately and 2 mins after standing.

129
Q

Mild hypertension

A

no end organ damage. need 3 readings >140 or/

130
Q

advise patients not to do this before taking blood pressure

A

have coffee 1 hr before, smoke 1/2 hour before, no decongestants or pupillary dilators before,

131
Q

length/width of bladder of bp cuff

A

L 80/ W 40. 20mm above systolic pulse as estimated from loss of radial pulse. deflate 3mmhg per second

132
Q

blood pressure in african americans

A

occurs 1) younger age and 2)more severe. salt increases more than white people. more vulnerable to strokes and hypertensive kidney disease. 3-5x more likely to have kidney complications and CKD.

133
Q

Common finding with COA

A

brachial-femoral delay

134
Q

Differential pressure

A

brachial bp (arm) vs popliteal pressure (leg)

135
Q

blood work to evaluate cardiac risk, s/s organ damage, underlying causes of htn

A

blood chemistry: blood glucose, cr/bun/gfr, electrolytes
lipid profile
UA for hematuria, albumin/cr ratio
ECG
serum uric acid – pathogenic factor of htn
plasma renin – for those with mineralocorticoid excess causing htn
albumineria -

136
Q

Best test for LVH

A

2d echo

137
Q

When to do a ekg

A

htn w CHF, Left vent dysfunction, CAD

138
Q

> 60 goal HTN w/ out DM/CKD

A
139
Q

> 18 goal HTN

A
140
Q

goal HTN w DM/CKD

A
141
Q
A

60 and not black use CCB/thiazide and add ace/arb if not at goal.

142
Q

black htn for stage 1/stage 2

A

stage 1 - 140-159, ccb or thiazide, add an ace or arb or combine ccb with thiazide. stage 2 >160, combine both ccb and thiazide and add ace or arb

143
Q

CKD bp mgmt

A

ace or arb add ccb/diuretic if not at goal

144
Q

DM bp mgmt

A

ace or arb - if black use ccb thiazide – add opposite if not at goal.

145
Q

CAD and bp mgmt

A

beta blocker AND ace or arb add ccb or thiazide if not at goal

146
Q

Stroke Hx w HTN mgmt

A

ace or arb, add thiazide or ccb if not at goal

147
Q

CHF hx w htn mgmt

A

ace or arb plus a beta blocker plus diuretic and aldactone, add CCB if needed

148
Q

Resistant htn

A

need to add spironolactone, beta or alpha, or direct vasodilator

149
Q

Why you can’t combine ace/arb

A

hypotension, hyperkalemia, decreased GFR

150
Q

If unable to acheive bp goals

A

refer to htn specialist

151
Q

only 51% of htn are adequately mgmt because

A

1) access to care/meds 2) resistence to meds because they are asymptomatic, immediate benefits are not obvious 3) therapeutic inertia

152
Q

180/110

A

the history of prior treatment for hypertension and nonadherence to antihypertensive medications is a common finding

153
Q

“when was the last time you were told your bp was normal” will tell you

A

how long the pt has had undiagnosed htn

154
Q

ace+arb –>

A

angioedema

155
Q

cholesterol % by liver

cholesterol % from food

A

75 - liver

25 - food

156
Q

causes of dyslipidemia

A

diet - will increase LDLs w transfats, weight gain, anorexia nervosa…. increase tris with weight gain, low fat diets, high carbs, excessive alcohol. certain drugs like diuretics, cylosporins, glucocorticoids, amoidarone, estrogen, bile acid sequestrants, PIs. Liver and kidney disease. Hypothyroid. Obesity. Pregnancy. Poorly controlled DM.

157
Q

Who gets treated for hyperlipidemia

A

1) ASCVD 2) LDL > 190 3) DM 40-75 w LDL 70-189 w/ pit ASCVD 4) 70-189 10 year risk 7.5 5) family hx of young ASCVD dad

158
Q

Statin for DM and 10 year risk

A

moderate intensity

159
Q

seen in those with insulin resistance

A

skin tags, acanthosis nigricans

160
Q

ATP III

A

1) Determine labs 2) determine ASCVD risk 3) Risk factors: smoking, low hdl, age >45m >55w, family hx CHD, htn 4) if 2+ risk factors get 10 year risk 5) determine risk 6) TLC 7) after 3 months get drug 8) id metabolic syndrome 9) treat high tris

161
Q

myopathy

A

any disease of the muscle

162
Q

myalgia

A

muscle ache or weakness w out CK elevation

163
Q

myositis

A

muscle ache w increased CK

164
Q

rhabdo

A

10x normal ck w muscle ache

165
Q

conditions that can increase risk for myopathy

A

hypothyroidism, vitamin D insufficiency, kidney or hepatic dysfunction, rheumatologic disorders such as polymyalgia rheumatica, corticosteroid myopathy, or primary muscle disease

166
Q

statin therapy w renal impairment

A

atorvastatinor fluvastatin

167
Q

liver disease and a statin

A

low dose pravastatin

168
Q

least likely to cause myalgia

A

pravastatin and fluvastatin

169
Q

hypothyroid and dyslipidemia

A

can cause it. can lead to worse myopathy. need tsh before starting a statin

170
Q

metabolized by CYP3A4 should not give w fibrates (gemfibrozil) , dilatazem, verapamil, amlodipine, HIV PI, amiodarone, grapefruit juice, niacin

A

simvastatin, lovastatin, atorvastatin

Primary Care 1 (6 decks)

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