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Foundations II (Cholley) > HTN > Flashcards

HTN Flashcards

1
Q

When does CVD risk double?

A
  • Beginning at 115/75

- For each increment of 20/10

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2
Q

Primary HTN accounts for how many cases?

A

90-95%

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3
Q

What controls BP?

A
  • SNS
  • RAAS
  • Plasma volume
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4
Q

Neural MOA

A

Overactive SNS

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5
Q

Renal MOA

A

Renal sodium retention

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6
Q

Vascular MOA

A
  • Inflammation
  • Oxidative stress
  • Vascular remodeling
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7
Q

Hormonal (RAAS) MOA

A
  • Aldosterone
  • Angiotensin II
  • Renin
  • Prorenin activate pathways damaging vascular health
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8
Q

Secondary HTN indications

A
  • Young age of onset
  • Diastolic HTN at age older than 50
  • Poor response to generally effective therapy
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9
Q

HEENT eval

A
  • Narrowing of arterial diameter
  • Cotton wool spots
  • Hemorrhages
  • Papilledema
  • Exudates (3+)
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10
Q

Abdomen eval

A
  • Renal masses
  • Renal bruits
  • Femoral pulses
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11
Q

Neuro eval

A
  • Visual disturbance
  • Focal weakness
  • Confusion
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12
Q

Cardio eval

A
  • Left ventricular hypertrophy
  • S4 gallop
  • Edema
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13
Q

Screening according to USPSTF?

A

Adults 18+

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14
Q

At what value do we dx HTN?

A

Depends on what guideline we are following

- Based on avg of 2 or more BP readings at 2 or more office visits

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15
Q

JNC 7 BP goal for general population

A

140/90

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16
Q

JNC 7 BP goal for pts w/ diabetes

A

130/80

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17
Q

JNC 8 recommendations

A
  • < 140/90 for ALL adults up to age 59

- < 150/90 for age 60+

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18
Q

ADA recommendations

A
  • < 140/90

- Risk-based individualization

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19
Q

Special considerations

A
  • White coat HTN: 20-25% of stage 1 HTN in office

- Masked HTN: 10%, increased cardiovascular risk

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20
Q

When do you initiate anti-hypertensives according to ACC/AHA?

A
  • Stage 2
  • Stage 1 w/ 1 or more of the following:
    1. Established ASCVD
    2. Type 2 DM
    3. CKD
    4. 10 year calculated ASCVD risk of 10%
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21
Q

What is BP goal according to ACC/AHA?

A
  • < 130/80 if on meds

- < 140/90 for low-risk stage 1 who don’t qualify for meds

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22
Q

What caution should you be aware of in pts > 60 yo?

A

Not to lower DBP < 55-60

*Associated w/ increased risk of MI & stroke

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23
Q

Non-pharmacologic tx

A
  • Salt restriction
  • DASH diet
  • Alcohol reduction
  • Weight loss
  • Exercise
  • Smoking cessation
24
Q

Pharmacologic tx

A
  • Diuretics
  • Calcium channel blockers
  • ACE Inhibitors
  • Beta blockers
  • Direct renin inhibitor
  • Central alpha agonists
  • Alpha blockers
25
Q

What are the types of diuretics?

A
  • Thiazide (ex. hydrochlorothiazide)
  • Loop (ex. Furosemide)
  • Potassium sparing (ex. Triamterene)
  • Aldosterone antagonists (ex. Spironolactone)
26
Q

Diuretics: MOA

A

Inhibits sodium reabsorption in the nephron, increasing sodium & water excretion

27
Q

Diuretics: Important notes

A
  • Controls BP in 50%
  • Can be used in combo w/ other agents
  • More potent in blacks, elderly, obese, smokers
28
Q

Hydrochlorothiazide side effects

A
  • Hypokalemia
  • Hypomagnesemia
  • Hypercalcemia
  • Hyponatremia
  • Sexual dysfunction
  • Hyperuricemia (gout)
  • Glucose disturbance
  • Dyslipidemia
29
Q

Hydrochlorothiazide contraindications

A

Hypersensitivity to sulfonamide derived drugs

30
Q

Furosemide (Lasix) side effects

A
  • Hypokalemia* Should supplement potassium
  • Hyponatremia
  • Hypomagnesemia
  • Hypocalcemia
  • Sexual dysfunction
  • Hypercholesterolemia
  • Glucose disturbance
31
Q

Furosemide contraindications

A
  • Poor antihypertensive

- Reserved for pts w/ kidney disease or fluid retention

32
Q

Triamterene (Dyrenium) side effects

A
  • Hyperkalemia (esp w/ CKD, DM)
  • Nephrolithiasis
  • Renal dysfunction
33
Q

Triamterene contraindications

A
  • Weak antihypertensives
  • Caution combining w/ ACE-I, ARB, DRI, K supplements
  • Hepatic disease
  • Renal failure
  • Hyperkalemia
34
Q

Spironolactone (Aldactone, Aldactazide) side effects

A
  • Hyperkalemia

- Gynecomastia

35
Q

Spironolactone contraindications

A
  • Renal impairment
  • DM w/ proteinuria
  • Hyperkalemia
36
Q

Calcium channel blockers: MOA

A

Inhibition of calcium influx into myocardial & vascular smooth muscle cells

  • Decreased calcium inhibits the contractile process –> vasodilation
  • Increased efficacy in blacks, elderly
37
Q

Types of calcium channel blockers

A
  • Non-dihydropyridines (verapamil, diltiazem) *Cardiac depressants
  • Dihydropyridines *Selective vasodilators
38
Q

Calcium channel blocker medication names end w/ what?

A
  • dipine
39
Q

Non-DHP side effects

A
  • Bradycardia
  • Constipation
  • Gingival hyperplasia
  • Worsening HF
40
Q

DHP side effects

A
  • Peripheral edema
  • Headache
  • Flushing
41
Q

Non-DHP contraindications

A
  • Acute MI
  • AV block
  • Cardiogenic shock
  • HF
  • Hypotension
  • Sick sinus syndrome
  • Ventricular dysfunction or Vtach
  • WPW syndrome
42
Q

DHP contraindications

A
  • Acute MI

- In urgent/emergent HTN, immediate release nifedipine is contraindicated

43
Q

ACE inhibitors: MOA

A
  • Inhibit RAAS system
  • Stimulate bradykinin (vasodilator effect)
  • Less effective in blacks, elderly, predominant systolic HTN
44
Q

ACE-I medication names end w/ what?

A

-pril

45
Q

ACE-I side effects

A
  • Cough
  • Hyperkalemia
  • Angioedema
  • Acute renal failure
46
Q

ACE-I contraindications

A
  • Pregnancy
  • Angioedema
  • Renal artery stenosis
47
Q

ARBs: MOA

A

Inhibit RAAS system

*Helpful in pts w/ CKD, diabetes, HF

48
Q

ARBs medication names end w/ what?

A

-sartan

49
Q

ARBs side effects

A
  • Hyperkalemia
  • Angioedema
  • Acute renal failure
50
Q

ARBs contraindications

A
  • Pregnancy

- Renal artery stenosis

51
Q

Direct renin inhibitors MOA

A

Inhibit enzyme activity of renin, reducing activity of angiotensin I/II & aldosterone

52
Q

Example of DRI

A

Aliskiren (Tekturna)

53
Q

DRI side effects

A
  • Hyperkalemia
  • Renal impairment
  • Hypersensitivity rxns
54
Q

DRI contraindications

A
  • Use w/ ACE-I or ARB

- Pregnancy

55
Q

Beta blockers MOA

A

Blocks activity of catecholamines at β adrenoreceptors –> decreased CO, some decreased PVR, & decreased renin activity

56
Q

Types of beta blockers

A
  • Cardioselective (β1 receptors)

- Noncardioselective (β1 & β2 receptors)

Foundations II (Cholley) (25 decks)

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