Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

646 Test 2 > HTN > Flashcards

HTN Flashcards

(61 cards)

Start Studying
1
Q

What is BP?

A

Cardiac Output
x
Peripheral Resistance

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

Who should you screen for HTN and why?

A

All adults >18 y/o

If you don’t detect early, can lead to MI, stroke, renal failure, death

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

What is primary HTN?

A

“essential HTN”

Unknown cause, likely the result of genetic and environmental effects on CV and renal structure and function

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

What are risk factors for primary HTN?

A 
Age
Race
Family history (genetics)
Obesity
Diet: ETOH, sodium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is secondary HTN?

A

Medical problems may contribute to elevated BP and may also co-exist with primary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are causes of secondary HTN? (ABCDE)

A 
A - Apnea, Aldosteronism
B - Bruit, Bad kidney
C - Catecholamine, Coarctation, Cushing
D - Drugs (ETOH)
E - Endocrine disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Isolated Systolic HTN?

A

> 140 mmHg systolic elevation that is related to significant cardiac risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is Isolated Systolic HTN bad?

A
  • Widening pulse pressure is a significant risk factor for CV event (esp in older adults)
  • Elevated SBP is a much more important risk factor for CV events than elevated DBP
  • Most common form of high BP in older Americans!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is White Coat HTN?

A

“Labile” HTN

  • BP is persistently >120/80 at Dr’s office, but normal on home measurements
  • SBP is especially high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risks with White Coat HTN?

A

CV risks are less than people with sustained HTN, but may increase risk of stroke and LV remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

I10 Essential (primary) HTN Diagnoses

A

I11 - Hypertensive heart disease (w/wo HF)
I12 - Hypertensive CKD (what stage)
I13 - Hypertensive heart and CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

I15 Secondary HTN Diagnoses

A 
I15.0 Renovascular HTN
I15.1 HTN 2/2 renal disorders
I15.2 HTN 2/2 endocrine disorders
I15.8 Other secondary HTN
I15.9 Secondary HTN, unspecified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you take an accurate BP?

A

Prepare patient:
-Relaxed in chair with feet on floor for >5 min
-No caffeine, exercise, smoking for at least 30 min
-Empty bladder
-No talking
-No clothes under cuff
Technique:
-Support pt’s arm and use correct size cuff
Measurements:
-At first visit, record b/l findings
-Note BP meds taken before reading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the BP Ranges according to 2017 ACC/AHA Guideline?

A

Normal: <120/80
Elevated: 120-129/<80
Stage 1: <120/80-89 or 120-129/80-89 or 130-139/<80 or 130-139/80-89
Stage 2: everything else

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you do when BP >130/80 (Stage 1)?

A

1) Assess ASCVD 10-year risk
2) If <10%, lifestyle changes and reassess in 3-6 months
3) If >10% or CVD, DM, CKD –> start BP-lowering medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do you do when BP >140/90 (Stage 2)?

A

Begin 2 BP-lowering medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do you do when BP >120/80?

A

Lifestyle modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the diagnostic workup for HTN?

A

CMP (liver fxn, glucose, kidneys/GFR, BUN, potassium, calcium) - repeat q3-6 mos
12 lead EKG (electrical changes and ischemia)
FBG
Fasting cholesterol panel (to assess ASCVD 10 year risk)
Urinalysis (proteinuria? in AKI?)
TSH
CBC (anemia?)

Consider: Echo (structural heart), uric acid (increased levels in HTN), urinary albumin to creatinine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a normal and abnormal urinary albumin to creatinine ratio?

A

<30 is normal

Ratio of 30-300 indicates microalbuminuria, which is sometimes present in DM and HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you evaluate secondary HTN?

A 
Sleep study (for OSA)
Hormone levels (aldosterone, cortisone)
Urine drug screen (cocaine?)
Renal ultrasound (polycystic, blood flow, obstruction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are lifestyle modifications?

A 
Exercise
DASH diet
Salt restriction (no salt added <4 grams; low salt <2 grams)
Weight reduction
Reduce excess ETOH consumption
Limit NSAIDs
Stress reduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the DASH diet?

A

Dietary Approaches to Stop HTN
Standard- 2,300 mg
Lower sodium- 1,500 mg

Goals: 2,000-calorie-a-day DASH diet.
Grains: 6 to 8 servings a day
Vegetables: 4 to 5 servings a day
Fruits: 4 to 5 servings a day
Dairy: 2 to 3 servings a day
Lean meat, poultry and fish: 6 servings or fewer a day
Nuts, seeds and legumes: 4 to 5 servings a week
Fats and oils: 2 to 3 servings a day
Sweets: 5 servings or fewer a week
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are first line BP meds for the general (non-black) population (including those with DM)?

A
  • Thiazide-type diuretic
  • CCB
  • ARB or ACEi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the first-line tx in the general black population (including those with DM)?

A
  • Thiazide-type diuretic

- CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
In >18 y.o with CKD, what is the first-line initial or add-on treatment?
Should include an ACEi or ARB to improve kidney outcomes | REGARDLESS of race or DM
26
What is the MOA of thiazide-like diuretics?
Enhance sodium excretion --> reduce intravascular volume --> reduce peripheral resistance
27
What are side effects of thiazide-type diuretics?
``` Potassium-wasting (hypokalemia?) Hyperglycemia/hypercalcemia/hyperuricemia Sexual dysfunction Urinary frequency Transient increase in LDL ```
28
What are all the anti-HTN meds?
Centrally Acting Alpha Agonists: Clonidine Vasodilators: Hydralazine, Monoxidil Loop Diuretics- Furosemide, Bumetanide Potassium-Sparing Diuretics: Spironolactone, Amiloride Beta Blockers: Atenolol, Metoprolol, Nadalol Alpha-Adrenergic blockers: Terazosin, Prazosin, Doxazosin Alpha/Beta Blocker: Carvedilol, Labetalol Nitrates: Nitroglycerin, Isosorbide dinitrate
29
Considerations with thiazide-type diuretics
- Sulfa allergy cautions (ok to use if sulfa allergy is mild) - Gout (can increase uric acid levels so d/c if recurrent gout flares) - Monitor hypokalemia, uric acid, and calcium - Chlorthalidone is 2x more potent than HCTZ but much more expensive
30
When to use CCBs?
- AA patients (specific focus when single agent) - Nondihydropyridines: (verapamil, diltiazem) used to rate control in patients with A fib or for control of angina - Preferred over BB for tx patients with airway disease
31
What is the MOA of CCB?
Block entry of Ca in the heart and vascular smooth muscle --> reduces smooth muscle contraction --> reduces PVR
32
What are SE of CCBs?
``` Edema!! (Not a sign of HF and may be immediate or delayed sx) Reflex tachycardia/bradycardia Headache Constipation Dizziness ```
33
When should you not use CCB?
NOT recommended first-line after MI
34
When are CCBs good?
May improve GFR in pts with renal insufficiency | May be helpful in pts who have DM/CKD and history of angioedema with ACE/ARB
35
When and why to use ACE inhibitors?
First line in CKD and DM Use after MI to reduce HF and mortality Reverse LVH and remodeling due to HTN (post MI) Low cost Different dosages for use in HTN vs. renal protection (renal protection 2.5-5 mg and HTN 10-40 mg)
36
What is the MOA of ACEis?
Block conversion of angiotensin I to angiotensin II --> reduces vasoconstriction --> reduces aldosterone Inhibits breakdown of bradykinin (vasodilator)
37
What are SE of ACEis?
``` Dry (benign) cough (because of inhibition of bradykinin breakdown in lungs) Hyperkalemia Elevated Creatinine (AKI) ```
38
What are dangers of ACEis?
Angioedema (can't use ARB either if this occurs) | Must be avoided in pregnancy
39
When and why to use ARBs?
Same indications as ACEis Comparable to ACEis in BP control (but no cough!...but more expensive) Do NOT use ACEi with ARB together
40
What anti-HTN med would you use in a black patient?
CCB or thiazide diuretic
41
What anti-HTN med would you use in a nonblack patient <60?
ARB or ACEi
42
What anti-HTN med would you use in a nonblack patient >60?
CCB, thiazide, ARB, or ACEi
43
What anti-HTN med would you use in CKD?
ARB or ACEi
44
What anti-HTN med would you use in CAD?
BB and ARB or ACEi
45
What anti-HTN med would you use in DM?
ARB or ACEi
46
What anti-HTN med would you use in HF?
ARB or ACEi and BB
47
What anti-HTN med would you use in patient with hx of CVA?
ARB or ACEi
48
What does angiotensin II do?
Vasoconstriction
49
What does aldosterone do?
Acts on the renal tubules and influences sodium and water reabsorption
50
What are examples of the first-line anti-HTN meds?
Thiazide-type diuretics: HCTZ, chlorthalidone CCBs: amlodipine, diltiazem, nifedipine ACEis: lisinopril, enalapril ARBs: losartan, valsartan (not now, has NMDA)
51
What are the titration guidelines for stage 1 HTN with >10% ASCVD risk or known clinical CVD, DM, or CKD?
Lifestyle modifications (for all) Start 1 BP lowering med... (Most meds take 2 weeks to begin working) If goal is met after 1 month, titrate medication, reassess in 3-6 months If goal is not met after 1 month, consider different med or titration Continue monthly follow-up until control is achieved
52
What are the titration guidelines for stage 2 HTN?
Lifestyle modifications for all Start 2 BP lowering medications of different classes If goal is met after 1 month, titrate medications, reassess in 3-6 months If goal is not met after 1 month, consider different med or titration Continue monthly follow-up until control is achieved
53
What are some standard practices in HTN treatment?
- Do not use an ACEi and ARB together - If BP goal can't be reached 2/2 contraindications or the need to use >3 drugs, anti-HTN drugs from other classes can be used - Referral to specialist may be indicated for pt if goal BP can't be achieved
54
What do you do for resistant HTN?
Confirm resistance, exclude environmental factors, screen for secondary causes, maximize pharmacologic therapy, and refer to specialist
55
What are some considerations in treating HTN in the older adult (>65)?
Start low and go slow Carefully consider diuretics Monitor renal function closely Review risk of postural hypotension and patient teach (slow to get out of bed)
56
Affordability of HTN meds
HCTZ $4 (thiazide-type diuretic) Lisinopril $4 (ACEi) Amlodipine $40-50 (CCB) Losartan $40-60 (ARB)
57
Safest to least safe for pregnancy:
Labetalol (BB) Nifedipine (CCB) HCTZ (thiazide-type diuretic) Lisinopril (ACEi)
58
How do you treat HTN in pregnancy?
Use methyldopa, nifedipine, or labetalol | No ACEs or ARBs
59
Easiest to hardest dosing regimen:
Chlorthalidone Benzapril HCT- combo med Metoprolol Hydralazine (QID dosing!)
60
What are considerations in maintaining BP control?
- Requires partnership to improve adherence - Education is key! (Med regimen, goals of treatment) - Encourage pt to check BP at home and write down numbers - Bring meds to each visit - Increase frequency of f/u on BP with visits or phone calls - Assess barriers to care
61
What are potential barrier to care?
Lack of understanding of the disease Lack of access (transportation, etc.) Side effects Cost Lack of appropriate f/u by provider, like not following up on missed appointments Confusion re: meds, language/reading barriers, pharmacy confusion Therapeutic/clinical inertia

646 Test 2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions