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Clinical Medicine Lecture - Professor Kramer > HTN Exam 5 > Flashcards

HTN Exam 5 Flashcards

1
Q

Angiotensin causes adrenal glands to secrete ?

A

aldosterone - increases sodium reabsorption

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2
Q

kidneys secrete ______ if the blood pressure falls below normal.

A

renin

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3
Q

Hypotheses for idiopathic HTN?

A

reduced renal sodium excretion

genetic variations of the renin-angiotensin system

Environmental factors like obesity and smoking

Chronic vasoconstriction

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4
Q

secondary HTN caused?

A

Renal - CKD, RAS ( renal artery stenosis)

Endocrine - adrenal , thyroid dysfunction

Cardiovascular - MI and aortic dissection

Neurologic - stroke and dementia

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5
Q

Normal systolic and diastolic ?

A

<120 , <80

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6
Q

Prehypertension systolic and diastolic ?

A

120-139 / 80-89

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7
Q

Stage 1 Hypertension systolic and diastolic ?

A

140-159 / 90-99

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8
Q

Stage 2 Hypertension systolic and diastolic ?

A

> 160 / >100

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9
Q

Essential HTN

A

90% of cases
usually asymptomatic

sx - non specific HA

any other symptoms then may indicate secondary HTN or complications

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10
Q

Secondary HTN

A

another primary medical condition created the HTN

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11
Q

Malignant HTN syndrome

A

retinopathy and encephalopathy or nephropathy and a very high high of complications

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12
Q

Urgency HTN

A

acutely elevated BP W/O evidence of end organ damage

S: >220
D: >125

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13
Q

Emergency HTN

A

acutely elevated BP WITH evidence of end-organ damage

such as: Heart attack, Stroke, Renal failure

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14
Q

Metabolic syndrome findings that increase the risk of CVD and DM?

A 
Central obesity 
Hypertriglyceridemia
Low HDL
Hyperglycemia
Hypertension
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15
Q

what can you see on PE or eye if HTN is considered?

A

Rentiopathy - retinal exudates or hemorrhages

Papilledema

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16
Q

usually you run no tests if BP is significantly elevated or if patient is symptomatic ? T to F

A

T

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17
Q

For a new diagnosis what basic labs do we want to run?

A

EKG
BUN/creatinine

Optional: CXR

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18
Q

If HTN the on a EKG we will see?

A

Left ventricular Hypertrophy

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19
Q

If HTN the on a CXR we will see?

A

ventricular hypertrophy (cardiomyopathy)

severe: aortic tortuosity

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20
Q

IF HTN then what blood tests will be increased

A 
BUN
creatinine
Potassium
Calcium
Uric acid
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21
Q

What is evidence of metabolic syndrome?

A

elevated serum and urine glucose

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22
Q

if end organ brian damage what will we see on the CT?

A

Hemorrhage

increased ICP

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23
Q

End organ cardiac disease what will we test ?

A

EKG and troponin

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24
Q

Essential HTN diagnosis?

A

at least 2 visits with elevated BP over a period of weeks to months

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25
Q

Secondary HTN diagnosis?

A

at least 2 visits with elevated BP over a period of weeks to months with underlying cause.

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26
Q

IF you suspect White coat syndrome HTN then what do you do?

A

home BP monitoring

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27
Q

IF malignant HTN what is diagnostic and what will we see?

A

retinopathy, HTN, encephalopathy

neuropathy

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28
Q

IF urgency HTN what is diagnostic and what will we see?

A

S: >220 or
D: >125

w/ no end organ damage

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29
Q

IF emergent HTN what is diagnostic and what will we see?

A

acutely elevated BP w/ end organ damage

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30
Q

Typical management of 1 high reading?

A

Lifestyle modifications education - DASH (dietary approaches to stop hypertension)

  • low total fat
  • low sodium
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31
Q

Typical management of 2 high reading?

A

CHOOSE ONE OR TEO:

ace inhibitor
calcium channel blocker
diuretic

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32
Q

what are the treatment/management goals for HTN?

A

BP less than 140/90

if over 60 y.o. : BP less than 150/90

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33
Q

social life style modifications?

A

smoking cessation

decrease alcohol

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34
Q

Physical life style modifications?

A

weight loss

aerobic exercise

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35
Q

If patient fails life style modifications then what are the primary choices for tx?

A

Diuretic
ACE inhibitor
CCB

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36
Q

If Stage 1 start with a ______ medication

A

single

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37
Q

IF stage 2 or above start with ___ medications

A

two

38
Q

Examples of Diuretics?

A

Thiazide diuretics (Chlorthalidone)

Loop Diuretics (Furosemide) Lasics

Potassium-sparing diuretics (Triamterene)

Aldosterone Receptor Blockers (Spironolactone)

39
Q

Thiazide diuretics ?

A

(Chlorthalidone)

40
Q

Loop Diuretics?

A

Furosemide) Lasics

41
Q

Potassium-sparing diuretics

A

Triamterene

42
Q

Aldosterone Receptor Blockers

A

Spironolactone

43
Q

Examples of Renin- Angiotension system

A

Angiotensin Converting Enzyme Inhibitors (ACEI) (Lisinopril)

Angiotensin Receptor Blockers (ARB) (Losartan)

44
Q

Examples of Vasodilators?

A

Calcium Channel Blockers* (Amlodipine)

Alpha 1 Blockers (Doxazosin) - prostate

Alpha 2 Agonists (Clonidine) - knock it down fast but pos the time we do want to drop the BP to fast

Direct Vasodilators (Hydralazine) - vasodilator

45
Q

Rate control? heart rate

A

Beta-blockers (Metoprolol) - rate control is not great; v so the rate down o the stroke volume is more effective - not pushing out as much blood - used mostly with people with true heart disease ( CHF) - decreases demand of the heart

46
Q

Thiazide diuretics MOA

A

Blocks sodium resorption at the distal tubule of kidney nephrons

Causes increase salt concentration in urine

Water follow salt for increased diuresis

SE: gout, hypokalemia

47
Q

Angiotensin Converting Enzyme Inhibitors (ACEI) MOA?

A

Inhibits conversion of angiotensin I to angiotensin II

Inhibits vasoconstriction by angiotensin II

Increases kidney blood flow
increasing diuresis

SE: cough

48
Q

Beta-blockers MOA?

A

Blocks sympathetic beta receptors

Decrease heart rate which decreases cardiac output

this also messes with the kidney beta cells

best for pregnancy

49
Q

Calcium Channel Blockers (CCB) MOA?

A

Inhibit calcium influx

smooth muscle relaxation and arterial dilation

best for AA and elderly and if renal failure

50
Q

CHF

A

loop diuretic, ACEI, BB

51
Q

Post- MI

A

ACEI, BB

52
Q

Renal disease

A

ACEI

53
Q

Diabetes

A

ACI

54
Q

Pregnancy

A

beta blocker ( labaetalol?)

55
Q

BPH

A

alpha 1 antagonist

56
Q

Liver Disease, ascites

A

aldosterone antagonist

57
Q

African americans

A

diuretic, CCB

58
Q

Elderly

A

diuretic, CCB

59
Q

If acute HTN that is asymptomatic consider giving?

A

meds only

60
Q

If acute HTN that is symptomatic consider giving?

A

meds to lower BP by 25-33%
or
treat underlying casue

61
Q

One thing we have to be careful of when prescribing BP meds?

A

Do NOT decrease the BP to rapidly cause we can cause a stroke

62
Q

Emergency HTN medical management Step 1 ?

A

Initiate antihypertensive by end organ damage

63
Q

Emergency HTN medical management Step 1 goal?

A

Goal typically 20-30% reduction

64
Q

Emergency HTN medical management Step 2?

A

Treat underlying condition

Hypertensive urgency

65
Q

Emergency HTN medical management Step 3, if symptomatic?

A

Initiate treatment - antihypertensive by end organ damage

66
Q

Emergency HTN medical management Step 4 ?

A

consider discharge

Initiate antihypertensive by comorbidities

67
Q

Hypertensive emergency First Line options IV CCB?

A

Nicardipine

68
Q

Hypertensive emergency First Line options IV Beta Blocker?

A

Labetalol

69
Q

Hypertensive emergency First Line options IV, especially if MI?

A

Nitroglycerin

70
Q

Hypertensive emergency First Line options IV additional choices?

A

Sodium nitroprusside

ACEI (Enalaprilat)

Anticholinergic (Trimethaphan)

Loop diuretics (Furosemide)

71
Q

Hypertensive urgencies/emergencies - Aortic dissection?

A

beta blocker - labetalol, esmolol

72
Q

Hypertensive urgencies/emergencies - Acute renal failure?

A

dopamine 1 receptor agonist

73
Q

Hypertensive urgencies/emergencies - Pregnancy?

A

direct vasodilator

74
Q

Hypertensive urgencies/emergencies - Oral options for less severe emergencies

A

CCN

Clonidine
Captopril
Nifedipine

75
Q

Hypertensive Emergency - Aortic dissection tx?

A

B-Blocker ( labetalol, esmolol)
then,
Nicardipine, nitroprusside

76
Q

Hypertensive Emergency - Pulmonary edema tx?

A

Nitroglycerine

Enalaprilat or Nicardipine

77
Q

Hypertensive Emergency - MI tx?

A

Nitroglycerine

78
Q

Hypertensive Emergency - Sympathetic crisis (cocaine OD) tx?

A

Benzodiazepine (decrease stimulation)
Nitroglycerine

No BB cause it causes severe HTN

79
Q

Hypertensive Emergency - Renal failure tx?

A

Labetalol

Nicardipine

80
Q

Hypertensive Emergency - Severe preeclampsia, HELLP syndrome, eclampsia tx?

A

Labetalol

Nicardipine

81
Q

Hypertensive Emergency - Hypertensive encephalopathy tx?

A

Nicardipine

Labetalol

82
Q

Hypertensive Emergency - Subarachnoid hemorrhage tx?

A

Labetalol

Nicardipine

83
Q

Hypertensive Emergency - Intracranial Hemorrhage tx?

A

Labetalol

Nicardipine

84
Q

Hypertensive Emergency - Ischemic stroke tx?

A

Labetalol

Nicardipine

85
Q

Hypertensive Emergency - Postoperative tx?

A

Nicardipine

Labetalol

86
Q

Outpatient treatment initiation for 120-140/80-90 ?

A

Advise follow-up

87
Q

Outpatient treatment initiation for 140-160/90-100 ?

A

advise follow-up within 2 mo.

88
Q

Outpatient treatment initiation for >160/ >100 ?

A

advise follow-up within 1 mo.

89
Q

Outpatient treatment initiation for >180/ >110 ?

A

Consider initiating therapy at discharge, follow-up in 1 week.

90
Q

Outpatient treatment initiation for >220/ >120 ?

A

begin antihypertensive therapy at discharge, follow-up in 1 week

Clinical Medicine Lecture - Professor Kramer (28 decks)

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