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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
What is a thiazide diuretic and its dose?
Hydrochlorothiazide HCTZ 12.5-25 mg PO daily
26
What are potential side effects of Thiazide diuretics?
- Hyponatremia | - Hyperuricemia (gout)
27
What are ACEI mechanism of action?
Inhibition of Angiotensin II formation
28
What is an example of an initial ACEI and dose that Sean da Paulson wants us to know??
Lisinopril 10 mg PO daily
29
What are potential side effects of ACEI?
Hyperkalemia (BNP) Angioedema Chronic Dry Cough ARF
30
What are ARBs mechanism of action?
Impair binding of Angiotensin II to the AT-1 receptor on cell membrane --> action of angiotensin II is inhibited.
31
When would you use a ARB over an ACEI
Used for pt's with cough on ACEI
32
What are two ARB medications and example of initial dosing that Sean da Paulson wants us to know?
Losartan 50 mg PO daily Valsartan 40-80 mg PO daily
33
What are potential Side effects of ARBs?
Hyperkalemia
34
What two hypertensive drugs should you never combine??
ARBs and ACEI
35
What is (CCB) Dihydropyridine's mechanism of action?
Vasodilation
36
What is an example of a CCB Dihydropyridine and dosing that Sean da Paulson wants us to know?
Amlodipine 2.5 mg PO daily
37
What is (CCB) Nondihydropyridine's mechanism of action?
Decreases Cardiac conduction and Contractility
38
What is an example of a CCB NonDihydropyridine and dosing that Sean da Paulson wants us to know?
Diltiazem ER 120-180 mg
39
What are side effects of CCB vasodilators?
Headache Edema
40
What are side effects of CCB nondihydros?
Constipation Bradycardia HA
41
What are beta blockers mechanism of action?
Blockage of beta-adrenergic activity (block receptor sites for Epi and Norepi) - Nonselective; Blocks B1 and B2 - Cardioselective; Blocks B1
42
What receptors do Nonselective Beta-blockers block?
B1 and B2 receptors
43
What receptors do Cardioselective Beta-blockers block?
B1 receptors das it mang
44
In which patients would you use Beta blockers for HTN control?
Pt's w/ Hx of - Post MI - Heart Failure - Afib Dont use it to treat HTN from cocaine!
45
What is an example of a Beta-blocker and dosing that Sean da Paulson wants us to know?
- Metoprolol tartrate 50mg PO BID | - Metoprolol succinate 25 mg PO daily (long acting)
46
What are some potential side-effects from Beta blocker use?
- Increased airway resistance | - Exacerbation of PAD
47
When are Alpha blockers often used?
In older men w/ BPH and HTN Not recommended for initial mono therapy
48
What are some side effects of alpha blockers?
Dizziness Orthostatic Hypotension
49
What are alpha blockers mechanism of action?
Block A1 receptors
50
What is clonidine's mechanism of action?
A2 adrenergic agonist
51
What is a side effect from clonidine?
Dizziness
52
What is hydralazine's mechanism of action?
Direct vasodilation of arterioles
53
What is the initial dosing of Hydralazine in HTN pt's?
10 mg PO QID
54
What are potential side effects of Hydralazine?
Dizziness
55
What is the mechanism of action for Aldosterone Antagonists?
Competes w/ Aldosterone for receptor sites in DISTAL RENAL TUBULE Increases Na+ and Water excretion
56
When would you use Aldosterone Antagonists in patients w/ HTN?
PT's with; - Resistant HTN - Heart failure w/ reduced EF - Cirrhosis
57
What is an example of aldosterone antagonists and dosing that Sean da Paulson wants us to know?
- Spironolactone 25-50 mg PO daily | - Eplerenon 50mg PO daily
58
What is a side effect of aldosterone antagonists?
Hyperkalemia
59
What is the mechanism of action for Furosemide (Lasix)?
Inhibits reabsorption of sodium and chloride in kidneys Increased excretion of water, sodium, chloride, magnesium, and calcium
60
What patients do you use furosemide (lasix) for HTN?
Pt's w/ - Heart failure - edema - cirrhosis w/ Ascites - Pulmonary edema
61
What is a potential side effect of Furosemide (lasix)
Hypokalemia
62
What is a Hypertensive urgency?
Severe HTN in asymptomatic patients Systolic > 180 Diastolic > 110 NO END ORGAN DAMAGE
63
Does Hypertensive urgency present with End organ damage?
NOOO
64
Is there proven benefit to lower BP in a hypertensive urgency rapidly?
NO, its okay to lower within 24-48 hours using oral meds
65
What is Hypertensive Emergency?
Severe HTN with end-organ damage Something is damaged as a result of HTN
66
Do you lower BP rapidly in a Hypertensive emergency?
No, too fast can cause ischemic complications

RRCCPA Clin Med Exam 4 (20 decks)

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