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Cardiology (Fall 2023) > HTN part 2 > Flashcards

HTN part 2 Flashcards

1
Q

fill in dots where the appropriate diuretic coincides with the condition/risk factor

A
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2
Q

If you studied the first HTN brainscape then you should pretty much know everything on this chart

A
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3
Q

how often do you follow up with HTN patients

A

6-12 months

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4
Q

How often do you obtain an EKG on a HTN pt

A

every 2-4 years

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5
Q

what is hypertensive urgency

A

severe HTN with NO symptoms

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6
Q

what is the criteria for hypertensive urgency

A

BP > 220/125 mmHg¹ (180/120)
No evidence of acute target-organ damage
No symptoms!

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7
Q

what should you obtain from a patient with hypertensive urgency

A
  • a thorough H&P to evaluate for s/s of organ damage
  • BMP
  • UA
  • EKG
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8
Q

fill in the pink spots for what is important to check for in each portion of the PE!

A
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9
Q

fill in the pink spots for what each PE finding can indicate!

A
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10
Q

How do you treat hypertensive urgency

A

ORAL therapy OUTpatient

GOAL - reduce BP within hours

give in office agent if available such as:
* Clonidine (Catapres)
* Captopril (Capoten)
* Metoprolol Tartrate (Lopressor)
* Hydralazine

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11
Q

what is the MOA, onset and DOA of clonidine

A

Central sympatholytic
30-60 min onset
6-8hrs DOA

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12
Q

what are the adverse effects and additional comments for clonidine

A

sedation

comment: may cause rebound HTN

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13
Q

what is the MOA, Onset and DOA of captopril

A

ACE
15-30min onset
4-6 hrs DOA

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14
Q

what is the adverse effects of captropril

A

excessive hypotension

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15
Q

what is the MOA, onset and duration of action for metoprolol tartrae

A

Beta blocker
20-60 min
5-6 hours

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16
Q

what are the adverse effects of metoprolol tartrate

A

excessive hypotension
bradycardia

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17
Q

what is the MOA, onset and duration of action of hydralazine

A

vasodilator
10-80 minutes
up to 12 hours

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18
Q

what are the adverse effects of hydralazine

A

tachycardia
headache
GI effects

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19
Q

what are the MOA, onset and DOA of nifedipine

A

CCB
15 minutes
2-6 hours

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20
Q

what are the adverse effects and comments for nifedipine

A

excessive hypotension
tachycardia
HA
angina
MI
stroke

comment: response is unpredictable!

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21
Q

what is hypertensive emergency

A

severe HTN with s/s of end-organ damage.

TRUE MEDICAL EMERGENCY
BP must be lowered ASAP to preserve organ function and life

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22
Q

what is blood pressure limit for hypertensive emergency

A

> 220/130

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23
Q

what should the initial evaluation of a patient with hypertensive emergency look like

A
  • problem focused H&P
  • CBC
  • CMP
  • EKG
  • CXR
  • CT head w/o contrast
  • UA
  • UDS
    (individualized based on suspected complication)
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24
Q

what is the goal of treatment in hypertensive emergency

A

Lower BP by no more than 25% in the first 2 hours.
then goal BP of 160/100 over the next 2-6 hours

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25
Q

what type of therapy is used for hypertensive emergency

A

parenteral therapy

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26
Q

What do goals for managing BP in hypertensive emergencies vary depend on

A

depedning on the organ involved!

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27
Q

what are the specific goals for the following:
Ischemic CVA
Hemorrhagic CVA
Aortic Dissection
MI

A
  • Ischemic CVA - SBP between 180-200 mmHg with slow reduction
  • Hemorrhagic CVA - target SBP is <140 mmHg
  • Aortic Dissection - goal SBP <120 mmHg
  • MI - will need anticoagulation and oxygen; typically use NTG for BP reduction, but no set goal
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28
Q

what are typically the first two agents used in hypertensive emergencies

A

Beta blockers and CCB

could also use: ACEi, Direct vasodilators, Nitrates

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29
Q

What are the calcium channel blockers used in hypertensive emergency

A

nicardipine
clevidipine

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30
Q

what is the onset and duration of action of nicardipine

A

1-5 minutes
3-6 hours

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31
Q

what are the adverse effects and additional comments for nicardipine

A
  • hypotension
  • tachycardia
  • headache
  • comment - may precipitate myocardial ischemia
32
Q

what is the onset and duration of action for clevidipine

A

2-4 minutes Onset
5-15 minutes duration

33
Q

what are the adverse effects and additional comments of clevidipine

A
  • headache
  • nausea
  • vomiting
  • comments - lipid emulsion: CI in pts with allergy to soy or egg
34
Q

what is the beta/alpha blocker used in hypertensive emergency

A

labetalol

35
Q

what is the onset and duration of action of labetalol

A

onset of 5-10 minutes
duration 3-6 hours

36
Q

what are the adverse effects and comments for labetalol

A
  • GI
  • hypotension
  • bronchospasm
  • bradycardia
  • heart block
  • comments - avoid in acute LV systolic dysfunction and asthma. may be continued orally
37
Q

what is the beta blocker used in hypertensive emergency

A

esmolol

38
Q

what is the onset and duration of action of esmolol

A

1-2 minutes onset
10-30 minutes duration

39
Q

what are the adverse effects and comments for esmolol

A
  • bradycardia
  • nausea
  • comments - avoid in LV systolic dysfunction and asthma. weak antihypertensive
40
Q

what is the dopamine receptor agnoist used in hypertensive emergency

A

fenoldapam

41
Q

what is the duration and onset of action for fenoldopam

A

4-5 minutes onset
<10 minutes duration

42
Q

what are the adverse effects and comments for fenoldopam

A
  • reflex tachycardia
  • hypotension
  • increased intraocular pressure
  • may protect kidney function
43
Q

what is the ACE inhibitor used during hypertensive emergency

A

enalaprilat (vasotec)

44
Q

what is the duration and onset of action of enalaprilat

A

15 min onset
6+ hours duration

45
Q

what are the adverse effects and comments for enalaprilat

A
  • excessive hypotension
  • comment - additive with diuretics, may be continued orally
46
Q

what is the diuretic used in hypertensive emergency

A

furosemide (lasix)

47
Q

what is the duration and onset of furosemide

A

onset - 15 min
duration 4 hours

48
Q

what is the adverse effects and comments for furosemide

A
  • hypokalemia
  • hypotension
  • comment - adjunct to vasodilator!
49
Q

what are the vasodilators used in hypertensive emergencies

A

nitroglycerin
nitroprusside

50
Q

what is the duration and onset time for nitroglycerin

A

2-5 minutes onset
3-5 minutes duration

51
Q

what are the adverse effects and comments for nitroglycerin

A
  • headache
  • nausea
  • hypotension
  • bradycardia
  • comments tolerance may develop, useful with myocardial ischemia
52
Q

what is the duration and onset of nitroprusside

A

seconds for onset
3-5 minutes duration

53
Q

what are the adverse effects of nitroprusside

A

literally so many. NO LONGER FIRST LINE!!!!!

54
Q

How does cardiac output change during pregnancy

A

increases by 40% d/t increased SV

55
Q

how does HR change in pregnancy

A

HR increased by 10 bpm during 3rd trimester

56
Q

how does BP change during pregnancy

A

decreases during 2nd trimester d/t decrease in systemic vascular resistance

57
Q

what is considered abnormal BP in pregnancy

A

BP ≥ 140/90 is ABNORMAL and associated with increased risk in perinatal morbidity and mortality

58
Q

What is the diagnostic criteria for hypertension during pregnancy

A

TWO elevated readings at least four hours apart!

59
Q

what is preeclampsia

A

new onset HTN (BP ≥ 140/90) and proteinuria (24h urinary protein >300 mg/24h or creatinine ratio ≥0.3) after 20 weeks gestation

60
Q

what is gesetational HTN

A

HTN (BP ≥ 140/90) after 20 weeks gestation w/o pre-existing HTN or proteinuria

61
Q

what is chronic HTN in pregnancy

A

HTN (BP ≥ 140/90) before 20 weeks gestation or longer than 12 weeks postpartum

62
Q

what is superimposed on chronic HTN

A

preeclampsia

63
Q

what is contraindicated in managing HTN in pregnancy

A

ACEi and ARBs

64
Q

what is the acute BP treatment for pregnant patients with chronic/gestational HTN

A

IV labetalol, IV hydralazine, oral immediate-release nifedipine

65
Q

what is the chronic BP treatment for pregnant patients with chronic/gestational HTN

A

labetalol, ER nifedipine, or methyldopa

66
Q

what is the target BP for pregnant patients with chronic/gestational HTN

A

target BP = 130-150/80-100

NOT recommended to reduce BP by more than 25% over 2 hours

67
Q

what is resistant HTN

A

Defined as the failure to reach BP control in patients who are adherent to full doses of an appropriate 3-drug regimen, including a diuretic

68
Q

what is a major issue with resistance HTN

A

medication noncompliance

69
Q

What should we do for patients with resistant hypertension?

A
  • Rule out secondary causes
  • Check for white-coat HTN
  • Consider switching diuretic to aldosterone receptor blocker (spironolactone)
  • Refer to a HTN specialist (Nephrology or Cardiology)
70
Q

what are possible causes of resistant hypertension

A
  • improper blood pressure management
  • volume overload and psuedotolerance
  • associated conditions
  • identifiable secondary causes
  • drug-induced/other
71
Q

what are some drug induced/other causes of resistant HTN

A
  • Nonadherence
  • Inadequate doses; Inappropriate combinations
  • NSAIDs
  • Cocaine, amphetamines, other illicit drugs;
    Sympathomimetics (decongestants, anorectics)
  • Oral contraceptives
  • Adrenal steroids
  • Erythropoietin
  • Licorice (including some chewing tobacco)
  • Selected OTC supplements and medicines (ephedra, ma huang, bitter orange)
72
Q

John is a 49-year-old white male returning to your clinic for follow up on his Type II DM. His glucose has been well controlled, as his last A1C was 6.2%. His BP at his last visit was 146/90. Today his BP is 148/84.

How would you evaluate this patient?
How would you manage this patient?

A

if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!

73
Q

Gracie is a 25-year-old white female returning to your clinic for follow-up. At her initial visit her BP was 152/90. Today her BP is 154/92. She has been following the lifestyle modifications you suggested last visit, including reducing her caffeine, sodium, and alcohol intake, but has seen no changes in her BP readings. Her BMI is 30.5%. She is working to lose weight and notes a 5 lb weight loss over the past month for her upcoming wedding.

How would you evaluate this patient?
How would you manage this patient?

A

if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!

74
Q

Caleb is a healthy appearing 75-year-old black male returning to your clinic for follow up on his BP. He has been checking his BP at home like you recommended and it averages 168/88 most days. He reports overall good health and is not currently on any medications. His BP is 170/92 at today’s visit. He has no HA, states no weakness and recalls that he was on a BP medication years ago but stopped taking it because he lost his insurance.

How would you evaluate this patient?
How would you manage this patient?

A

if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!

75
Q

Karen is a 78-year-old female returning to the clinic today. She is s/p Coronary Artery Bypass and has HTN. She also has DM, hx of mild systolic CHF and renal insufficiency. Vitals today are BP 152/92, HR 76, RR 12, O2 Sat 98% on room air. Medications include: Lantus insulin, Lasix (Furosemide), ASA, Plavix (Clopidogrel), and Lisinopril.

How would you evaluate this patient?
How would you manage this patient?

A

if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!

76
Q

Chole is a 35-year-old black female returning to your clinic for follow up on her BP. Her BP is 138/80 at today’s visit and was 132/86 at her last visit when she established care with you. She has no known h/o HTN, but admits that her father is treated for HTN. She does not currently take any medications.

How would you evaluate this patient?
How would you manage this patient?

A

if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!

77
Q

oh wow okay that was short

A

BYYYYYEeeeee!:)

Cardiology (Fall 2023) (45 decks)

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