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Foundations II > HTN > Flashcards

HTN Flashcards

1
Q

Elevated systolic BP, diastolic BP, or both lead to what diseases

A

Hypertensive retinopathy
Cerebrovascular disease
Renal failure
Cardiovascular disease

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2
Q

primary HTN risk factors

A 
Age
Race 
Family History
Smoking
Diet (excess sodium intake)
Excess alcohol intake

No a direct cause

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3
Q

Secondary HTN causes

A 
Renal Disease
Medication induced
Thyroid/Parathyroid disease 
Obstructive Sleep Apnea
Pheochromocytoma
Coarctation of the Aorta
Primary Aldosteronism
Renovascular Disease
Cushing’s Syndrome
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4
Q

Signs of secondary causes

A 
Hypokalemia
Abdominal bruit
Labile pressures with tachycardia, sweating, and tremor
Family history of kidney disease
Serum creatinine >1.5 mg/dL
LV hypertrophy determined by ECG
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5
Q

HTN Eval at presentation

A

Respiratory
rhonchi, rales
Abdomen
renal masses, renal bruits, femoral pulses
Neuro
visual disturbance, focal weakness, confusion

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6
Q

CVD eval HTN

A

Palpate brachial and femoral pulses simultaneously
Left ventricular hypertrophy
Displaced PMI
ECG evidence
S4 (presystolic) gallop due to decreased compliance of the left ventricle
Auscultate for carotid, abdominal and femoral bruits
Check extremities for edema

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7
Q

How does JNC 8 differ form JNC 7?

A

JNC 8: 140/90 for everyone including CKD and DM

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8
Q

ACC.AHA 2017 guide

A

Normal < 120/80
ELevated = 120-129/80
HNT 1 = 130-139/80-90
HNT 2 >140/90

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9
Q

Dx labs should include

A

CSC, Urinalysis, Glucose, GFR, creatininte, TSH, EKG

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10
Q

Know the ACA/ AHH 2017 Treatment goals

A

slide 37

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11
Q

When to start anti-HTN meds

A

All patients with stage 2 HTN

Patients with stage 1 HTN with 1 or more :
Established ASCVD
Type 2 DM
CKD
10-year calculated ASCVD risk of at least 10%

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12
Q

What are the Anti-HTN med goals

A

<130/80, 140/90 if low HTN 1 risk and arent on meds

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13
Q

Low DBP is associated with

A

MI and stoke

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14
Q

Diet modifications and their expected results

A

Salt restriction
Expected decrease of 5/3 mm Hg

DASH diet
Expected decrease of 6/4 mm Hg reduction

Alcohol Reduction
Expected decrease of 2-4 mm Hg reduction in SBP

Weight Loss (approx. 1 mmHg per 1 lb lost)

Exercise (4-6/3 mm Hg reduction)

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15
Q

Diuretics

A

Thiazide, Loops, Aldostreron antagonist, Potassium sparing. All Hyponatremia, and will control 50% of mild and HNT 1 (blacks, elderly, smokers)

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16
Q

Thiazide

A 
Hydrochlorothiazide.
Side effects:
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyponatremia
Sexual dysfunction
Hyperuricemia (gout)
Glucose disturbance
Dyslipidemia
CONTRA: Hypersensative to Sulfonamides
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17
Q

Loop diuretic

A

furosamide.
ADEs; hypocalcemia, hypokalemia, hyponaturemia, hypomagnesiumia, sex dysf, gluc, lipids,
POOR AntiHTN: Kidney disease and retention

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18
Q

Postassium Sparing

A

Triamterne. weak antiHTN
ADEs: Hyperkalemia in CKD & DM. Nephrolithiasis, Renal Dysfunction.
CAUTION: combo with ACE, ARB, DRI, K supplements.
CONTRA: Hepatic disease, renal failure, hyperkalemia.

19
Q

Aldosterone antagonis

A 
Spironolactone.
Side effects:
Hyperkalemia
Gynecomastia
Strong Anti-HTN
CONTRA: renal impair, DM with protenuria, hyperkalemia
20
Q

Non-dihydropyridines

A

Calcium Channel Blocker (-dipines): More Cardio. Verapamil/Diltiazem.
ADEs: Bradycardia, Constipation, gingival hyperplasia, worse HF.

21
Q

dihydropyridines

A

Calcium Channel Blocker (-dipines): More vasodilator. ADEs: Peripheral edema, headache, flushing

22
Q

better meds for blacks and elderly

A

CCB, THIAZ

23
Q

Ace inhibitors

A

-pril. AngI-AngII, Bradykinin = vasodilator, Dry cough.
GOOD in patients w/: CKD, DM, HF, post-MI.
ADEs: Cough, hyperkalemia, Angioedema, Acute renal failure.
CONTRA: Pregs, angioedema, renal arterial stenosis.

24
Q

ARBS

A

-sartan. Angiotension block. vasodilate.
GOOD in Pts w/: CKD, DM, HF.
ADEs: Hyperkalemia, Angioedema, Acute renal failure.
CONTRA: Preg, renal artery strenosis.

25
Q

Direct Renin Inhibitor

A

Aliskiren. Inhibits Renin.
ADEs: Hyperkalemia, Renal impared, Hypersentativity, Angioedema.
Combo: dont combine with ACE or ARB
CONTRA: Preg, ACE, or ARB

26
Q

Beta blockers

A

olol- Block adrenoreceptos and catecholamines = decrease CO, PVR, and Renin.
CONTRA: AV block, cardiogenic shock, HF, Hypotension. COPD, Astham, DM, Depression.
Avoid abrupt cessation = death after MI/HF

ADEs: exersize intolerance, fatigue, bradycardia, sex dysf. depressoin, airway blocked, PVR

27
Q

Atenolol. Metoprolol, Nabivolol

A

Cardio selective BB,

28
Q

Propranolol, Nadolol, Labetolol, Carvedilol

A

Non-cardio selective BB

29
Q

Central Alpha agonist

A

Clonidine, Methyldopa. Stim alpha = reduce sympathetics.
Avoid abrupt stop = rebound HTN.
GOOD for pregs.
ADEs: Anticholinergic, Bradycardia, Orthohypo, Dizzy, Rebound HTN.

30
Q

Methyldopa

A

Alpha agonist, decrease sympathetics. Good in Pregs. ADEs: Hepatitis, Hemolitic anemia, fever.
Contra = liver disease

31
Q

Alpha blockers

A

-zosin. Peripheral smooth muscle relax = decease PVR & BP.
No monotherapy
Good in Mild-moderate HTN.
ADEs: HF, BPH, Orthohypo, reflex tachy, dizzi

32
Q

When starting HTN meds, you must

A

reassess at 1 month, increase dose, add 2nd drug, refer. Monitor serum K and creatinine.

33
Q

AHA/ACC first line drugs

A

THIAZ, CCB, ACE, ARB

34
Q

Goal of Patients with stable ischemic heart disease

A

BP<130/80
Use BB, ACE, ARB.
IF no good + Angina. Add CCB, dihydro
IF no good w/o Angina. Add CCB - dihydro, OR THIAZ, OR Spironolactone

35
Q

Goal of Patients with DM

A

BP<130/80.

All classes useful. With albuminuria = ACE or ARB

36
Q

Goal of Patient with CKD

A

BP<130/80.
W/o albunimuria = 1st line (THZ, ACE, ARB, CCB)
W/ Albuminuria = ACE, if cant then ARB

37
Q

Goal of Preg Patient

A

Methyldopa, Nifedipine, Labetalol

NO ACE, ARB, DRI

38
Q

Poor prognosis indicators

A 
CVD
- High pulse pressure, men>55, Women>65, smoke, lipids, glucose, abnl GTT, DM, Fx CVD, abdominal obesity, LVH
Cerebralvascular disease
- carotid wall thickening/plaques, 
Kidney
- low GFR, albumenuria, 
Retinopathy
Vascular Disease, ABI>.9
39
Q

What is resistant HTN

A

max dose on 3 drugs + thiaz . Reassess secondary HTN/Specialist

40
Q

HTN emergency

A

> 180/120. Urgent if asymptomatic (non-adherence to meds, eats salt)
Emergency HTN - end organ damage

41
Q

End organ damage

A 
Cerebrovascular: -encephalopathy, brain infarct, hemorrage.
Cardiac
- Dissection, LV failure, MI
Renal
- Acute glomerulonephritis
42
Q

Overall goal of End organ failure

A

gradual reduction to <160/100
- too fast = MI, Cerebral ischimia, infacrt
No sublingual nifedipine

43
Q

resting reduces HTN by

A

10-20mm

44
Q

Emergency HTN should go to

A

ICU, and reduce 25% of HTN per hour to 160/100

Foundations II (6 decks)

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