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RRCCPA Clin Med Exam 4 > HTN (Exam 4) > Flashcards

HTN (Exam 4) Flashcards

1
Q

How Often should adults => 40 y/o be screened for HTN?

A

Annually

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2
Q

How often should adults 18-39 w/o risk factors and last BP < 130/80 should be screened for HTN??

A

Every 3 Years

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3
Q

What is the Blood pressure equation?

A

BP = Cardiac output x Systemic Vascular Resistance

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4
Q

What is Primary (essential) hypertension?

A

Thought to be from interaction between multiple genetic and environmental factors

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5
Q

How many antihypertensive medications does a patient need to be on with persistent HTN for it to be classified as Resistant HTN?

A

3 concurrent Antihypertensives

Think Secondary hypertension

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6
Q

What is secondary hypertension?

A

Elevated BP with a specific cause, accounts for 5% to 10 % of hypertension in adults.

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7
Q

What patients would you suspect secondary hypertension based on their presentation/history??

A
  • Severe/resistant HTN
  • acute rise in BP in a previously stable BP
  • HTN in patient <30 w/o risk factors or FH of HTN
  • Pt’s > 55 w/ New onset HTN
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8
Q

What is the most common cause of Secondary HTN?

A

Renovascular HTN

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9
Q

What are some causes of Renovascular HTN?

A
  • Activation of renin-angiotensin system w/ renal artery occlusive disease
  • Renal artery stenosis

-Renal dysfunction

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10
Q

Renal Artery Stenosis (RAS)

A

Usually from atherosclerosis or fibromuscular dysplasia, Suspect w/ ACEI or ARB- induced renal dysfunction

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11
Q

What are some possible lab findings in Renovascular HTN?

A
  • Hypokalemia
  • Renal dysfunction (BUN creatnine)

-Elevated Aldosterone

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12
Q

What is the gold standard imaging for Renovascular HTN?

A

Renal angiography

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13
Q

What is the preferred treatment for Unilateral Renal Artery Stenosis (RAS)?

A

ACE inhibitors

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14
Q

What is the tx for bilateral Renal Artery Stenosis RAS?

A

Calcium Channel Blockers are safe and effective. CCB

NO ACEI, can drop GFR

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15
Q

What type of hypertension can Coarctation of the aorta cause?

A

Secondary HTN

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16
Q

What is the 1st choice of imaging study to determine coarctation of the Aorta site?

A

Echo,

Ligumentum Arteriosum & L subclavian artery common

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17
Q

How do patients with hypertension usually present?

A
  • Asymptomatic “the silent killer”

- early morning HA’s

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18
Q

How does hypertensive retinopathy look on exam?

A
  • AV nicking
  • Copper Wire
  • Papilledema
  • Hemorrhages
  • Cotton wool patch
  • Exudates
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19
Q

Can you measure BP in the thigh and wrist?

A

Yes

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20
Q

What is masked hypertension?

A

Normal in office high outside of office (ambulatory - 10%)

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21
Q

What are BP goals for all patients??

A

<130/80

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22
Q

What are first line hypertensives?

A

Thiazide diuretics
CCB
ACEI / ARB

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23
Q

In Stage 2 hypertension how many first line agents is recommended to initiate therapy?

A

2 different first line agents in Stage 2 hypertension

-if average BP > 20mmHg above target

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24
Q

What are the thiazide diuretics mechanism of action?

A

Initially: reduction in plasma volume and cardiac output

Later: Vasodilation leading to decreased vascular resistance

Hydrochlorothiazide 12.5-25 mg PO

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25
Q

What is a thiazide diuretic and its dose?

A

Hydrochlorothiazide HCTZ

12.5-25 mg PO daily

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26
Q

What are potential side effects of Thiazide diuretics?

A
  • Hyponatremia

- Hyperuricemia (gout)

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27
Q

What are ACEI mechanism of action?

A

Inhibition of Angiotensin II formation

28
Q

What is an example of an initial ACEI and dose that Sean da Paulson wants us to know??

A

Lisinopril 10 mg PO daily

29
Q

What are potential side effects of ACEI?

A

Hyperkalemia (BNP)

Angioedema

Chronic Dry Cough

ARF

30
Q

What are ARBs mechanism of action?

A

Impair binding of Angiotensin II to the AT-1 receptor on cell membrane –> action of angiotensin II is inhibited.

31
Q

When would you use a ARB over an ACEI

A

Used for pt’s with cough on ACEI

32
Q

What are two ARB medications and example of initial dosing that Sean da Paulson wants us to know?

A

Losartan 50 mg PO daily

Valsartan 40-80 mg PO daily

33
Q

What are potential Side effects of ARBs?

A

Hyperkalemia

34
Q

What two hypertensive drugs should you never combine??

A

ARBs and ACEI

35
Q

What is (CCB) Dihydropyridine’s mechanism of action?

A

Vasodilation

36
Q

What is an example of a CCB Dihydropyridine and dosing that Sean da Paulson wants us to know?

A

Amlodipine 2.5 mg PO daily

37
Q

What is (CCB) Nondihydropyridine’s mechanism of action?

A

Decreases Cardiac conduction and Contractility

38
Q

What is an example of a CCB NonDihydropyridine and dosing that Sean da Paulson wants us to know?

A

Diltiazem ER 120-180 mg

39
Q

What are side effects of CCB vasodilators?

A

Headache

Edema

40
Q

What are side effects of CCB nondihydros?

A

Constipation

Bradycardia

HA

41
Q

What are beta blockers mechanism of action?

A

Blockage of beta-adrenergic activity (block receptor sites for Epi and Norepi)

  • Nonselective; Blocks B1 and B2
  • Cardioselective; Blocks B1
42
Q

What receptors do Nonselective Beta-blockers block?

A

B1 and B2 receptors

43
Q

What receptors do Cardioselective Beta-blockers block?

A

B1 receptors das it mang

44
Q

In which patients would you use Beta blockers for HTN control?

A

Pt’s w/ Hx of

  • Post MI
  • Heart Failure
  • Afib

Dont use it to treat HTN from cocaine!

45
Q

What is an example of a Beta-blocker and dosing that Sean da Paulson wants us to know?

A
  • Metoprolol tartrate 50mg PO BID

- Metoprolol succinate 25 mg PO daily (long acting)

46
Q

What are some potential side-effects from Beta blocker use?

A
  • Increased airway resistance

- Exacerbation of PAD

47
Q

When are Alpha blockers often used?

A

In older men w/ BPH and HTN

Not recommended for initial mono therapy

48
Q

What are some side effects of alpha blockers?

A

Dizziness

Orthostatic Hypotension

49
Q

What are alpha blockers mechanism of action?

A

Block A1 receptors

50
Q

What is clonidine’s mechanism of action?

A

A2 adrenergic agonist

51
Q

What is a side effect from clonidine?

A

Dizziness

52
Q

What is hydralazine’s mechanism of action?

A

Direct vasodilation of arterioles

53
Q

What is the initial dosing of Hydralazine in HTN pt’s?

A

10 mg PO QID

54
Q

What are potential side effects of Hydralazine?

A

Dizziness

55
Q

What is the mechanism of action for Aldosterone Antagonists?

A

Competes w/ Aldosterone for receptor sites in DISTAL RENAL TUBULE

Increases Na+ and Water excretion

56
Q

When would you use Aldosterone Antagonists in patients w/ HTN?

A

PT’s with;

  • Resistant HTN
  • Heart failure w/ reduced EF
  • Cirrhosis
57
Q

What is an example of aldosterone antagonists and dosing that Sean da Paulson wants us to know?

A
  • Spironolactone 25-50 mg PO daily

- Eplerenon 50mg PO daily

58
Q

What is a side effect of aldosterone antagonists?

A

Hyperkalemia

59
Q

What is the mechanism of action for Furosemide (Lasix)?

A

Inhibits reabsorption of sodium and chloride in kidneys

Increased excretion of water, sodium, chloride, magnesium, and calcium

60
Q

What patients do you use furosemide (lasix) for HTN?

A

Pt’s w/

  • Heart failure
  • edema
  • cirrhosis w/ Ascites
  • Pulmonary edema
61
Q

What is a potential side effect of Furosemide (lasix)

A

Hypokalemia

62
Q

What is a Hypertensive urgency?

A

Severe HTN in asymptomatic patients

Systolic > 180

Diastolic > 110

NO END ORGAN DAMAGE

63
Q

Does Hypertensive urgency present with End organ damage?

A

NOOO

64
Q

Is there proven benefit to lower BP in a hypertensive urgency rapidly?

A

NO, its okay to lower within 24-48 hours using oral meds

65
Q

What is Hypertensive Emergency?

A

Severe HTN with end-organ damage

Something is damaged as a result of HTN

66
Q

Do you lower BP rapidly in a Hypertensive emergency?

A

No, too fast can cause ischemic complications

RRCCPA Clin Med Exam 4 (20 decks)

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