Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

clinical medicine II > HTN > Flashcards

HTN Flashcards

1
Q

HTN is most prevalent in which race

A

blacks > whites > hispanics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

normal blood pressure values

A
  • systolic pressure < 120 mmHg
  • diastolic pressure < 80 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what blood pressure values classify as pre-hypertension

A
  • systolic pressure 120-139 mmHg OR
  • diastolic pressure 80-89 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what blood pressure values classify as stage 1 HTN

A
  • systolic 140-159 mmHg OR
  • diastolic 90-99 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what blood pressure values classify as stage 2 HTN

A
  • systolic > or = 160 mmHg OR
  • diastolic > or = 100 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

equation for blood pressure

A

BP = CO x systemic vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the major factors that determine BP

A
  • sympathetic nervous system
  • Renin angiotensin aldosterone system
  • plasma volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the modifiable risk factors for primary HTN

A
  • smoking
  • high sodium diet
  • excess alcohol intake
  • obesity/weight gain
  • physical inactivity
  • dyslipidemia
  • vitamin D deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

primary HTN accounts for what percentage of diagnosed HTN

A

90-95% of all HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is secondary HTN

A
  • increased BP resulting from an identifiable medication or medical condition
  • must be addressed to achieve adequate BP control
  • 5-10% of all HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the major conditions that are associated with secondary HTN

A
  • renal disease
  • medication induced: estrogen, NSAIDS, steroids
  • Thyroid, Parathyroid disease
  • Coarctation of aorta
  • primary hyperaldosteronism
  • Cushing’s syndrome
  • Pheochromocytoma (hypertensive emergency: HA, sweating, tachycardia)
  • obstructive sleep apnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

united states preventive services task force recommendation for screening for HTN

A
  • all individuals 18 or older should be screened
  • adults 40 yo or older should be measured at least annually
  • adults betwwen 18-39 should be screened annually if they have risk factors or previously measured BP was elevated
  • adults betwwen 18-39 without risk ractors and high BP should be screened at least every 3 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

gold standard for diagnosing HTN

A
  • ambulatory blood pressure monitoring
    • if BP elevated at screening, the diagnosis should be confirmed using out of office BP measurement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

general principles you should tell patient when having them check BP outside of office

A
  • serial measurements required
  • measure on both arms
  • comfortable, quiet setting
  • avoid eating, exercise, smoking, and caffeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Physical exam for a person who is hypertensive

A
  • vitals
    • BMI, waist circumference
    • BP both arms
    • pulses
  • general
    • body fat distribution
    • skin lesions
    • muscle strength
    • alertness
  • HEENT
    • fundoscopy for hemorrhage
    • cotton wool spots
  • Neck
    • carotids, thyroid
  • Respiratory: rales
  • Cardiac
    • displaced PMI or new murmur
  • Abd
    • renal masses
    • abdominal aorta
  • Neuro
    • visual disturbance
    • focal weakness
    • confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what tests should you always order when evaluating for HTN

A
  • LUBE
    • Lipid panel
    • UA
    • Basic metabolic panel
      • fasting glucose
      • creatinine, electrolytes, GFR
    • EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the first line treatment for all patients with essential HTN

A

Lifestyle modifications

  • Diet
    • lower sodium intake
    • DASH diet
    • alcohol reduction
  • Exercise
    • 3-4x/week (40 min, mod-vigorous)
  • healthy weight
  • smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the BIG FOUR medications when it comes to treating HTN

A
  • Diuretics
  • Angiotensin Converting Enzyme inhibitors (ACE-I)
  • Angiotensin II receptor blockers (ARB)
  • calcium channel blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What other four medications can be used to treat HTN if the BIG FOUR aren’t working

A
  • beta blockers
  • alpha blockers
  • central alpha agonist
  • direct renin inhibitor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is everybody’s treatment threshold/goal for BP. What is the exeption

A
  • 140/90
  • exception is people over 60 yo who don’t have kidney disease or diabetes, in which case their goal is 150/90
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include

A
  • One of BIG FOUR
    • thiazide type diuretic
    • calcium channel blocker
    • angiotensin-converting enzyme inhibitor
    • Angiotensin II receptor blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In the general black population, including those with diabetes, initial antihypertensive treatment should include

A
  • thiazide-type diuretic OR
  • Calcium channel blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Adults with chronic kidney disease should be put on which drugs regardless of race or diabetes status

A
  • angiotensin II receptor blocker (ARB)
  • angiotensin converting enzyme inhibitor (ACE-I)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Medication recommendation summary (put CKD, race recommendations all together)

A
  • if you have CKD, start with ACEI or ARB
  • if you are black, start with thiazide or CCB
  • neither? start with any one of BIG FOUR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

if a single antihypertensive drug doesn’t work, what should you do

A
  • add a second drug from another class
  • if that doesn’t work, add another from one of the remaining classes
  • **Don’t use ACEI and ARB together
  • ex:
    • ACE, thiazide, CCB
    • ARB, thiazide, CCB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If the patient is taking three out of the four BIG FOUR classes of antihypertensives and still hasn’t reached the target goal, what should you do

A
  • consider other classes of medications or refer to specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is resistant hypertension. How should you manage it

A
  • blood pressure that is not controlled despite adherence to an appropriate three drug regimen or requires at least four medications to achieve control
    • ensure adherence to lifestyle changes, medication regimen, and accurate measurement
    • consider referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How would you treat

  • 65 yo white male with BP 170/90
A
  1. lifestyle management
  2. target goal BP: < 150/90
  3. place him on ACEI, ARB, CCB, or Thiazide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How would you treat

  • 65 yo black female with DM and BP 162/98
A
  1. lifestyle modification
  2. target BP: < 140/90
  3. CCB or Thiazide
30
Q

What are the side effects of Thiazide type diuretics

A
  • Hypokalemia
  • Gout
  • Dyslipidemia
31
Q

Contraindication to taking Thiazide type diuretics

A

sulfa sensitivity

32
Q

MOA of Thiazide type diuretics

A
  • decrease body’s sodium stores by inhibiting sodium reabsorption in the nephron
  • reduces plasma volume and peripheral vascular resistance
33
Q

Name the four types of Diuretics

A
  • Thiazide type diuretics
  • Loop diuretics
  • Potassium sparing diuretics
  • aldosterone antagonist
34
Q

Hydrocholorthiazide (HCTZ) is a part of which class of drugs

A

Thiazide-type diuretics

35
Q

Side effect of ACE inhibitors

A
  • hyperkalemia
  • acute renal failure
  • angioedema
36
Q

Which patient populations greatly benefit from being put on an ACE inhibitors

A
  • DM
  • CKD
  • post MI
  • Heart failure
37
Q

contraindications to give ACE inhibitors

A
  • renal artery stenosis
  • pregnancy
  • angioedema
38
Q

The “Pril”s (e.g. lisinopril, enalapril) are a part of which drug class

A

ACE inhibitors

39
Q

MOA of ACE inhibitors

A
  • inhibit the RAAS system and stimulate bradykinin (which has a vasodilatory effect)
40
Q

MOA of angiotensin II receptor blockers

A

inhibit the RAAS system

41
Q

The “..sartan”s (e.g. Losartan, valsartan etc..) fall into which drug class

A

angiotensin II receptor blockers

42
Q

Side effects of angiotensin II receptor blockers

A
  • hyperkalemia
  • acute renal failure
  • angioedema
43
Q

which patient populations greatly benefit from being placed on an angiotensin II receptor blocker

A
  • CKD
  • DM
  • heart failure
44
Q

contraindications to give angiotensin II receptor blockers

A
  • pregnancy
  • renal artery stenosis
  • angioedema
45
Q

What are the two types of calcium channel blockers. Which is used to treat HTN?

A
  • Non-dihydropyridine
  • dihydropyridine: more selective as vasodilators, less cardiac depressant effect
46
Q

”..pine”s (e.g. amlodipine, felodipine..etc) are a part of which drug class

A

dihydropyridine

47
Q

side effects of calcium channel blockers

A
  • cardiodepressant -> bradycardia
  • dizziness
  • HA
48
Q

which patient populations greatly benefit from being put on a calcium channel blocker

A

black population

49
Q

contraindications to give calcium channel blocker

A
  • several types of cardiac dysfunction
  • acute MI
50
Q

MOA of calcium channel blocker

A

inhibit calcium influx into arterial smooth muscle cells, which reduces peripheral vascular resistance

51
Q

What are the types of Beta blockers

A
  • cardioselective (B1 receptors)
  • Noncardioselective (B1 and B2 receptors
52
Q

”..olol”s (e.g. propranolol, nadolol etc) are in which drug class

A

beta blockers

53
Q

side effects of beta blockers

A
  • bradycardia
  • bronchospasm
54
Q

which patient populations benefit from being on beta blockers

A
  • post MI
  • stable heart failure
  • high CAD risk
  • often used in pregnancy
55
Q

contraindications for beta blockers

A
  • bronchospastic disease
  • heart block
  • acute decompensation heart failre
  • **avoid abrupt cessation
56
Q

side effect of central alpha agonists

A
  • hepatitis
  • hemolytic anemia
  • anticholinergic effects
57
Q

clonidine and methyldopa are a part of which drug class

A

central alpha agonists

58
Q

MOA of central alpha agonists

A
  • stimulate a2 adrenergic receptors in the brain which reduces CNS sympathetic outflow
59
Q

what is the most commonly used anti-HTN in pregnancy

A

Methyldopa: central alpha agonists

60
Q

contraindications for central alpha agonists (specifically methyldopa)

A

liver failure

61
Q

“zosin” (e.g. doxazosin, terazosin, etc) are a part of which drug class

A

alpha blockers

62
Q

MOA of alpha blockers

A

targets alpha 1 receptors on vascular smooth muscle, causing peripheral vascular resistance to decrease, thus decreasing BP

63
Q

side effects of alpha blockers

A
  • orthostatic hypotension
  • reflex tachycardia
64
Q

which patient population benefits from being on a alpha blockers

A

BPH

65
Q

aliskiren (tekturna) is a part of which drug class

A

direct renin inhibitors

66
Q

side effects of direct renin inhibitors

A
  • hyperkalemia
  • renal impairment
  • hypersensitivity reaction (anaphylaxis, angioedema)
67
Q

contraindications for direct renin inhibitors

A
  • with ACE-I or ARB in diabetics
  • pregnancy
68
Q

Hypertensive urgency

A
  • asymptomatic severe HTN (diastolic > 120 mmHg) and NO evidence of end organ damage
    • usually nonadherence to chronic antihypertensive medication
    • nonadherence to low sodium diet and/or high salt load
69
Q

hypertensive emergency

A

severe HTN (diastolic > 120 mmHg) and evidence of acute end-organ damage

70
Q

Causes of hypertensive crisis (urgency and emergency)

A
  • abrupt d/c of BP meds
  • high salt load
  • neurological emergencies (stroke, trauma)
  • cardiac emergencies (HR,MI)
  • vascular emergencies (aortic dissection)
  • pregnancy
  • renal emergencies
71
Q

Treatment for hypertensive urgency

A
  • Goal: reduce BP < 160/120 mmHg (achieved over hours-days)
  • treatment
    • rest
    • increase dose of current meds
    • add meds
    • f/u
72
Q

treatment for hypertensive emergency

A
  • hospitalized in ICU
  • address underlying cause
  • reduce BP
    • no more than 25% within minutes to 1 hour
    • BP goal, 160/100-110 mmHg over 2-6 hours
    • *sublingual nefidipine is contraindicated

clinical medicine II (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions