HTN/ Hyperlipidemia Flashcards by Tara Kinney

Hypertension, definition

When your blood pressure, the force of blood flowing through your blood vessels is consistently too high.
Most prevalent cardiovascular disorder in the US
Age 65 and older have a 50% chance of having hypertension
Major independent risk factor for MI and stroke
PERSISTENT ELEVATION OF SYSTOLIC BLOOD PRESSURE AND OR DIASTOLIC BLOOD PRESSURE AT OR ABOVE THE NORMAL PARAMETERS GREATER THAN 140/90

How well did you know this?

Not at all

Perfectly

How to measure your blood pressure when evaluating hypertension? 6

Obtain at least one to two weeks apart
Patient should rest for at least five minutes
Arm supported at heart level
Cuff in circles, 80% of the arm circumference
Older adults tested in all three positions
If repeated blood pressure needed on the same arm wait two minutes

How well did you know this?

Not at all

Perfectly

Ideal BP

120/80

How well did you know this?

Not at all

Perfectly

JNC

Evidence based Guidelines used for hypertension

How well did you know this?

Not at all

Perfectly

Prehypertensive

120 to 139 and or diastolic blood pressure 80 to 89

How well did you know this?

Not at all

Perfectly

Blood pressure goals

Goal for stage, one hypertension, Less than 140/90 and
Goal for stage two hypertension less than 130/80

How well did you know this?

Not at all

Perfectly

If they have micro albumin in the urine that could be an indication of hypertension? True or false

True

How well did you know this?

Not at all

Perfectly

Risk factor for hypertension

African-American ancestry

How well did you know this?

Not at all

Perfectly

Essential hypertension mean

No cause

How well did you know this?

Not at all

Perfectly

Secondary hypertension

Caused by another disease process-renovascular or kidney disease; glomerulonephritis; renal artery stenosis; endocrine disease

How well did you know this?

Not at all

Perfectly

Malignant, hypertension

Rapidly rising, diastolic blood pressure of 130 or more, intracranial pressure, papiledema

How well did you know this?

Not at all

Perfectly

Isolated systolic, hypertension or ISH

Elevated systolic pressure because the pipes are much stiffer as we get older

How well did you know this?

Not at all

Perfectly

Assessment of hypertension (9)

Past medical history
Identify other cardiovascular risk factors
Drug history
Throbbing occipital headache
Dizziness
Blurred vision
Dyspnea
Chest pain
Nose bleeds

How well did you know this?

Not at all

Perfectly

How to do a physical on phone with hypertension? What do you look for? (9)

Blood pressure down and bilateral upper extremities
Height and weight
Optic fundus
Check the thyroid
Check the heart PMI
Lungs
Abdomen check for bruits
Peripheral vasculature
Neurological exam

How well did you know this?

Not at all

Perfectly

What test do you check when person comes in with hypertension?

Urinalysis
CBC, fasting, blood sugar, electrolytes, BUN, and creatinine, calcium, uric acid, cholesterol, PO four, TG
EKG
Chest x-ray

How well did you know this?

Not at all

Perfectly

What lifestyle modifications can you recommend for someone with hypertension?

Weight loss
Sodium restriction
Dash diet
Exercise
Stress reduction
Smoke/alcohol cessation

How well did you know this?

Not at all

Perfectly

Hypertension in elders

Higher risk for symptomatic hypotension
Monotherapy
The protocol is start low and go slow
If there’s an inadequate response to the first dose, increase it
Substitute drug from another class
Add a prescription from another class
Stable with two drugs, attempt withdrawing from first drug

How well did you know this?

Not at all

Perfectly

Diuretics

African-Americans usually more responsive
Very effective for isolated systolic hypertension
1st line- THIAZIDE
2nd line- loop

How well did you know this?

Not at all

Perfectly

Beta blockers

B1 & B2 non specific class
Slow the heart rate
Decreases mortality after an MI

How well did you know this?

Not at all

Perfectly

With diuretics and loop diuretic, what lab level are you checking?

Which diuretics do not affect the potassium level?

Potassium sparing, diuretics
Spiranolactone
Eplerenone(inspra)
Triamterene (Dyrenium)

Alpha 1 Adrenergic Blockers

Prazosin, Doxazosin, Terazosin
Dilate arteries/relax, smooth muscles in the bladder
Side effects

Ace inhibitors

Lisinopril, Catapril, enalapril,
Inhibits conversion of angiotensin, one to angiotensin II
Decreases mortality in heart failure

Avoid which blood pressure medication in bilateral renal stenosis

Ace, inhibitors, Catapril, enalapril, lisinopril,

Side effects of ace inhibitors

Hyper kalemia Angioedema dry cough

What drug to avoid in heart failure?

Calcium channel blockers -pines

Calcium channel blockers

Pines greater vascular selectivity (amlodipine, Niphedipine) Non-pines- greater myocardial selectivity (cardizem, verapamil) vasodilation, slow, the heart rate, reduce force of contractions

Side effects of calcium channel blockers

Can cause, peripheral edema, asymptomatic, swelling of the legs

ARBs

Losartan, valsartan, irbesartan, candesartan Selectively block, a T1 receptors Check the K level

Stage 2 hypertension

Consider MD consult Begin pharmacological therapy Short interval for prescription therapy evaluation

First line therapy in stage one hypertension

Thiazide Calcium channel blockers Ace inhibitor ARB

First line therapy in stage two hypertension

2 first line meds of different classes

Caveats to meds for hypertension

CAD CKD CVA DM CHF

Intensification of medication

1. Optimize diuretic 2. Add Sparano lactone. 3. Add one of the following. Alpha blocker Clonidine or hydralazine 4. Add fourth agent. -can consider two different calcium channel blocker groups

What are the treatment goals for most patients especially those with cardiovascular disease or ASCVD risk scores of greater than 10%?

A blood pressure of less than 130/80

What are the treatment goals for a patient with no cardiovascular disease and ASCVD risk or is less than 10% and patients greater than 65 years old unable to tolerate aggressive therapy?

A blood pressure less than 140/90

Hyper lipidemia

Greater than 50% of adults, 20 years or older, have a triglyceride greater than 200

Only one and three treated patients achieve LDL goal, true or false

TRUE

Less than 1/2 highest risk persons with symptomatic CHD are receiving, lipid, lowering treatment, true false?

True

Less than half of the people prescribed lipid lowering treatment still take it after six months, true or false?

True

Less than half of the people who qualify for lipid modifying treatment for CHD risk reduction receive at? True or false

True

Fatty content= lipoprotein particles in blood Screening every??

5 years

Medications for hyperlipidemia BILE ACID RESINS

Bind with bile acids in intestines Questran Cholestyramine

Niacin

Decreases rate of the LDL and LDL synthesis in liver by increasing the HDL

Statins

Widely used common few side effects Decreased LDL’s and triglycerides

Fibric acid derivatives

Inhibits Lipolysis of fat in adipose tissue Increases HDL’s and decreases triglycerides

Points ATP IV GUIDLINES

Focus on ASCVD risk reduction using the ASCVD calculators New perspective on LDL and non-HDL – C treatments Global risk assessment for primary prevention

If labs that show the LDL are not 50% better. What should you do?

Up the dose of the statin or add zetia

Which medication would you use if the triglycerides are above 300?

Gemfibrozil