HTN

Question 1

htn lab work up

Answer 1

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

Question 2

black pt bp meds

Answer 2

thiazide or CCB

Question 3

CAD or CHF bp mdes

Answer 3

beta blocker

Question 4

DM or kidney disease bp med

Answer 4

ace or arb

Question 5

trmt hypertensive emergency

Answer 5

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

Question 6

trmt cardiogenic shock

Answer 6

dopamine

Question 7

trmt dist shock

Answer 7

NE

Question 8

sx hypotension shock

Answer 8

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

Question 9

how do we stabilize in hypotensive shock

Answer 9

Fluids and oxygen
ACLS protocol with electrical intervention
Temporary pacer

Question 10

how do we find the cause of hypotensive shock

Answer 10

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

Question 11

how do we treat hypotensive shock

Answer 11

Treat based on the cause

Lytes? Antidotes? Cath? Pacer? CABG>

Question 12

risks aa

Answer 12

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

Question 13

causes aa

Answer 13

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

Question 14

trmt PAD

Answer 14

ASA, cilostazol, clopidogrel, statins

Stent or bypass ex fem pop bypass

Question 15

anginal equivalents in women

Answer 15

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

Question 16

More women started dying from CAD than men around

Answer 16

1985

Question 17

causes of CAD in women

Answer 17

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

Question 18

_____ is more predictive for CAD in men

______ are more predictive for CAD in women

Answer 18

High LDL ; Low HDL and high triglycerides

Question 19

______ best identify postmenopausal women at CV risk

Answer 19

Inc waist size and inc triglycerides

Question 20

betablockers in pregnancy

Answer 20

Category C

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

Question 21

ace arb in preg

Answer 21

Category D

Cause cough and alopecia

Question 22

thiazide diuretics in preg

Answer 22

Category B but controversy

Good for bone health- ⅓ dec in hip fx

Question 23

Trmt options for decreasing lipids/LDL

Answer 23

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

Question 24

xanthomas

Answer 24

fat cholesterol growth, a sign of high triglycerides

Question 25

Heterozygous familial hypercholesterolemia (FH)?

Answer 25

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

Question 26

trmt FH

Answer 26

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

Question 27

PCSK9 inhibitors

Answer 27

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

Question 28

High intensity statin therapy:

Answer 28

Atorvastatin (lipitor)- 40 to 80 mg | Rosuvastatin (crestor)- 20 to 40 mg

Question 29

AHA ACC lipid guidelines

Answer 29

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

Question 30

Primary prevention of CV event

Answer 30

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

Question 31

Sec prevention of CV event

Answer 31

Means you had a cv event and want to prevent another | Pts with ACS and CV disease Get high intensity statin therapy

Question 32

what can Hypertriglyceremia lead to

Answer 32

pancreatitis

Question 33

Hypertriglyceremia trmt

Answer 33

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

Question 34

High sensitivity CRP (hs-CRP)

Answer 34

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

Question 35

Phase 1 cardiac rehab

Answer 35

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

Question 36

trnasition Phase cardiac rehab

Answer 36

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

Question 37

Phase 2 cardiac rehab

Answer 37

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

Question 38

Phase 3 cardiac rehab

Answer 38

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

Question 39

Who gets cardiac rehab?

Answer 39

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

Question 40

short term goals of cardiac rehab

Answer 40

Control cardiac sx Enhance functional capacity Boost esteem

Question 41

long term goals of cardiac rehab

Answer 41

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

Question 42

Every inc in bp ___mmHg doubles risk of CV disease

Answer 42

20/10

Question 43

___ is a strong predictor of events from CAD

Answer 43

sbp

Question 44

htn dx

Answer 44

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

Question 45

high bp causes

Answer 45

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

Question 46

nonpharmacologic trmt for bp

Answer 46

``` 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 ```

Question 47

minoxidil is a _____ in the _____

Answer 47

direct vasodilator in the capillaries

Question 48

hydralazine is a _____ in the _____

Answer 48

direct vasosilator; peripheral arteries

Question 49

amlodipine is a _____ in the _____

Answer 49

direct vasodilator and CCB; peripheral veins

Question 50

Good for pts with mild bradycardia

Answer 50

Hydralazine- causes reflex rise in HR