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clin med > HTN > Flashcards

HTN Flashcards

1
Q

htn lab work up

A

EKG- ischemia and hypertrophy
CBC- anemia
BMP or CMP- tells renal function
Urinalysis- indicates microalbuminuria meaning there is renal damage
Fasting blood glucose or HBA1C- risk factor for DM
Fasting lipid profile- hyperlipidemia is a risk factor for CAD

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2
Q

black pt bp meds

A

thiazide or CCB

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3
Q

CAD or CHF bp mdes

A

beta blocker

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4
Q

DM or kidney disease bp med

A

ace or arb

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5
Q

trmt hypertensive emergency

A

In pt with IV meds- nitroprusside, nicardipine, nitro drip
Reduce BP over hrs so you dont get cerebral ischemia
Bp reduced by no more than 25% of MAP over minutes to hrs except in aortic dissection or pulm edema you can go a little faster
Note: map=(SBP+2*DBP)/3

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6
Q

trmt cardiogenic shock

A

dopamine

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7
Q

trmt dist shock

A

NE

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8
Q

sx hypotension shock

A 
tachycardia/bradycardia
Weak pulse
Chest pain/pressure
Lightheadedness
Tachypnea
Pale skin, sweating
Cool extremities
Hypotension or orthostasis
Dec urinary output
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9
Q

how do we stabilize in hypotensive shock

A

Fluids and oxygen
ACLS protocol with electrical intervention
Temporary pacer

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10
Q

how do we find the cause of hypotensive shock

A

EKG- stemi, rate rhythm
Labs- troponin, ABG, CBC, TSH, lytes, toxic screen
Procedures, CXR, echo

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11
Q

how do we treat hypotensive shock

A

Treat based on the cause

Lytes? Antidotes? Cath? Pacer? CABG>

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12
Q

risks aa

A

Tobacco, male, HTN, HLD, atherosclerosis, vasculitis, trauma, fam hx is big

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13
Q

causes aa

A 
Changes in aortic wall
Inflammation, weakening of aortic tissue
Loss of elasticity
Atherosclerosis
Immunologic, genetic, environmental, hemodynamic factors
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14
Q

trmt PAD

A

ASA, cilostazol, clopidogrel, statins

Stent or bypass ex fem pop bypass

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15
Q

anginal equivalents in women

A

SOB, sweating, dizziness, NV, pain elsewhere, extreme fatigue

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16
Q

More women started dying from CAD than men around

A

1985

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17
Q

causes of CAD in women

A

Tobacco (#1), DM, HTN, HLD, obesity, physical inactivity

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18
Q

_____ is more predictive for CAD in men

______ are more predictive for CAD in women

A

High LDL ; Low HDL and high triglycerides

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19
Q

______ best identify postmenopausal women at CV risk

A

Inc waist size and inc triglycerides

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20
Q

betablockers in pregnancy

A

Category C

Acebutolol is category B; caution for intrauterine growth retardation, bradycardia, and hypoglycemia

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21
Q

ace arb in preg

A

Category D

Cause cough and alopecia

22
Q

thiazide diuretics in preg

A

Category B but controversy

Good for bone health- ⅓ dec in hip fx

23
Q

Trmt options for decreasing lipids/LDL

A 
Statins
Bile acid sequestrants
Nicotinic acid (niacin)
Fibrates
Cholesterol absorption inhibitors
Fish oil
PCSK9 inhibitors (newer)
24
Q

xanthomas

A

fat cholesterol growth, a sign of high triglycerides

25
Q

Heterozygous familial hypercholesterolemia (FH)?

A 
Autosomal dominant
1:500 ppl
Total cholesterol over 300 mg/dL
LDL over 250 mg/dL
Premature heart disease is common
26
Q

trmt FH

A

HMG-CoA reductase inhibitors aka statins
Doubling dose lowers LDL by 5-10% and max dose can reduce 24-60%
PCSK9 inhibitors

27
Q

PCSK9 inhibitors

A 
Shots that lower LDL by 40-60%
Injectable monoclonal antibodies
Alirocumab
Evolcumab
Can be used with statins
Expensive! $5400-5850
28
Q

High intensity statin therapy:

A

Atorvastatin (lipitor)- 40 to 80 mg

Rosuvastatin (crestor)- 20 to 40 mg

29
Q

AHA ACC lipid guidelines

A

Council on exercise, weight loss, diet
Statins are good in lower risk pts
Non Statins don’t show consistent benefits

30
Q

Primary prevention of CV event

A

Means you have no hx of cv event
Calculate pts risk and use statins if 20-30% reduction risk is worth it
40 mg lovastatin, pravastatin, or simvastatin
20 mg atorvastatin
5-10 mg rosuvastatin
Use PCSK9 if statin not an option

31
Q

Sec prevention of CV event

A

Means you had a cv event and want to prevent another

Pts with ACS and CV disease Get high intensity statin therapy

32
Q

what can Hypertriglyceremia lead to

A

pancreatitis

33
Q

Hypertriglyceremia trmt

A

Omega 3 fish oil OTC
Lovaza (omega 3 acid ethyl ester)
Vascepa (prodrug)

34
Q

High sensitivity CRP (hs-CRP)

A

Protein made in liver
Nonspecific for inflammation
Linked to atherosclerosis and cad but not specific
Routine screening not widely accepted

35
Q

Phase 1 cardiac rehab

A

prevent effects of bed rest while in hospital; 5-7 METS

36
Q

trnasition Phase cardiac rehab

A

Transition: after discharge gradually inc intensity; end is graded with exercise stress test

37
Q

Phase 2 cardiac rehab

A

Phase 2: medically supervised exercise training with EKG stress test ; 7-8 mets

38
Q

Phase 3 cardiac rehab

A

Phase 3: independent lifelong maintenance with regular exercise and lifestyle modifications

39
Q

Who gets cardiac rehab?

A 
MI
Stable angina
Stent
Cabg
Heart valve repair/replacement
Heart transplant
CHF
TV or VF
SCD
40
Q

short term goals of cardiac rehab

A

Control cardiac sx
Enhance functional capacity
Boost esteem

41
Q

long term goals of cardiac rehab

A

Change hx of CAD
Reverse progression of atherosclerosis
Dec risk of sudden death

42
Q

Every inc in bp ___mmHg doubles risk of CV disease

A

20/10

43
Q

___ is a strong predictor of events from CAD

A

sbp

44
Q

htn dx

A

SBP over 129 OR DBP over 80
At rest
Confirm on 2 different occasions unless really high

45
Q

high bp causes

A 
Meds such as ephedrine, Oral contraceptives, Steroids
Ethanol
Illicit drugs
Obese
High intake of Na and cholesterol
Low exercise
Psychological stressors
46
Q

nonpharmacologic trmt for bp

A 
Lose weight- 5 to 20 mmHg
DASH diet- 8-14 mmHg
Reduce Na consumption- 2-8 mmHg
Exercise- 4 to 9 mmHg
Limit alcohol- 2-4 mmHg
47
Q

minoxidil is a _____ in the _____

A

direct vasodilator in the capillaries

48
Q

hydralazine is a _____ in the _____

A

direct vasosilator; peripheral arteries

49
Q

amlodipine is a _____ in the _____

A

direct vasodilator and CCB; peripheral veins

50
Q

Good for pts with mild bradycardia

A

Hydralazine- causes reflex rise in HR

clin med (35 decks)

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