HTN part 2 Flashcards
fill in dots where the appropriate diuretic coincides with the condition/risk factor
If you studied the first HTN brainscape then you should pretty much know everything on this chart
how often do you follow up with HTN patients
6-12 months
How often do you obtain an EKG on a HTN pt
every 2-4 years
what is hypertensive urgency
severe HTN with NO symptoms
what is the criteria for hypertensive urgency
BP > 220/125 mmHg¹ (180/120)
No evidence of acute target-organ damage
No symptoms!
what should you obtain from a patient with hypertensive urgency
- a thorough H&P to evaluate for s/s of organ damage
- BMP
- UA
- EKG
fill in the pink spots for what is important to check for in each portion of the PE!
fill in the pink spots for what each PE finding can indicate!
How do you treat hypertensive urgency
ORAL therapy OUTpatient
GOAL - reduce BP within hours
give in office agent if available such as:
* Clonidine (Catapres)
* Captopril (Capoten)
* Metoprolol Tartrate (Lopressor)
* Hydralazine
what is the MOA, onset and DOA of clonidine
Central sympatholytic
30-60 min onset
6-8hrs DOA
what are the adverse effects and additional comments for clonidine
sedation
comment: may cause rebound HTN
what is the MOA, Onset and DOA of captopril
ACE
15-30min onset
4-6 hrs DOA
what is the adverse effects of captropril
excessive hypotension
what is the MOA, onset and duration of action for metoprolol tartrae
Beta blocker
20-60 min
5-6 hours
what are the adverse effects of metoprolol tartrate
excessive hypotension
bradycardia
what is the MOA, onset and duration of action of hydralazine
vasodilator
10-80 minutes
up to 12 hours
what are the adverse effects of hydralazine
tachycardia
headache
GI effects
what are the MOA, onset and DOA of nifedipine
CCB
15 minutes
2-6 hours
what are the adverse effects and comments for nifedipine
excessive hypotension
tachycardia
HA
angina
MI
stroke
comment: response is unpredictable!
what is hypertensive emergency
severe HTN with s/s of end-organ damage.
TRUE MEDICAL EMERGENCY
BP must be lowered ASAP to preserve organ function and life
what is blood pressure limit for hypertensive emergency
> 220/130
what should the initial evaluation of a patient with hypertensive emergency look like
- problem focused H&P
- CBC
- CMP
- EKG
- CXR
- CT head w/o contrast
- UA
- UDS
(individualized based on suspected complication)
what is the goal of treatment in hypertensive emergency
Lower BP by no more than 25% in the first 2 hours.
then goal BP of 160/100 over the next 2-6 hours
what type of therapy is used for hypertensive emergency
parenteral therapy
What do goals for managing BP in hypertensive emergencies vary depend on
depedning on the organ involved!
what are the specific goals for the following:
Ischemic CVA
Hemorrhagic CVA
Aortic Dissection
MI
- 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
what are typically the first two agents used in hypertensive emergencies
Beta blockers and CCB
could also use: ACEi, Direct vasodilators, Nitrates
What are the calcium channel blockers used in hypertensive emergency
nicardipine
clevidipine
what is the onset and duration of action of nicardipine
1-5 minutes
3-6 hours
what are the adverse effects and additional comments for nicardipine
- hypotension
- tachycardia
- headache
- comment - may precipitate myocardial ischemia
what is the onset and duration of action for clevidipine
2-4 minutes Onset
5-15 minutes duration
what are the adverse effects and additional comments of clevidipine
- headache
- nausea
- vomiting
- comments - lipid emulsion: CI in pts with allergy to soy or egg
what is the beta/alpha blocker used in hypertensive emergency
labetalol
what is the onset and duration of action of labetalol
onset of 5-10 minutes
duration 3-6 hours
what are the adverse effects and comments for labetalol
- GI
- hypotension
- bronchospasm
- bradycardia
- heart block
- comments - avoid in acute LV systolic dysfunction and asthma. may be continued orally
what is the beta blocker used in hypertensive emergency
esmolol
what is the onset and duration of action of esmolol
1-2 minutes onset
10-30 minutes duration
what are the adverse effects and comments for esmolol
- bradycardia
- nausea
- comments - avoid in LV systolic dysfunction and asthma. weak antihypertensive
what is the dopamine receptor agnoist used in hypertensive emergency
fenoldapam
what is the duration and onset of action for fenoldopam
4-5 minutes onset
<10 minutes duration
what are the adverse effects and comments for fenoldopam
- reflex tachycardia
- hypotension
- increased intraocular pressure
- may protect kidney function
what is the ACE inhibitor used during hypertensive emergency
enalaprilat (vasotec)
what is the duration and onset of action of enalaprilat
15 min onset
6+ hours duration
what are the adverse effects and comments for enalaprilat
- excessive hypotension
- comment - additive with diuretics, may be continued orally
what is the diuretic used in hypertensive emergency
furosemide (lasix)
what is the duration and onset of furosemide
onset - 15 min
duration 4 hours
what is the adverse effects and comments for furosemide
- hypokalemia
- hypotension
- comment - adjunct to vasodilator!
what are the vasodilators used in hypertensive emergencies
nitroglycerin
nitroprusside
what is the duration and onset time for nitroglycerin
2-5 minutes onset
3-5 minutes duration
what are the adverse effects and comments for nitroglycerin
- headache
- nausea
- hypotension
- bradycardia
- comments tolerance may develop, useful with myocardial ischemia
what is the duration and onset of nitroprusside
seconds for onset
3-5 minutes duration
what are the adverse effects of nitroprusside
literally so many. NO LONGER FIRST LINE!!!!!
How does cardiac output change during pregnancy
increases by 40% d/t increased SV
how does HR change in pregnancy
HR increased by 10 bpm during 3rd trimester
how does BP change during pregnancy
decreases during 2nd trimester d/t decrease in systemic vascular resistance
what is considered abnormal BP in pregnancy
BP ≥ 140/90 is ABNORMAL and associated with increased risk in perinatal morbidity and mortality
What is the diagnostic criteria for hypertension during pregnancy
TWO elevated readings at least four hours apart!
what is preeclampsia
new onset HTN (BP ≥ 140/90) and proteinuria (24h urinary protein >300 mg/24h or creatinine ratio ≥0.3) after 20 weeks gestation
what is gesetational HTN
HTN (BP ≥ 140/90) after 20 weeks gestation w/o pre-existing HTN or proteinuria
what is chronic HTN in pregnancy
HTN (BP ≥ 140/90) before 20 weeks gestation or longer than 12 weeks postpartum
what is superimposed on chronic HTN
preeclampsia
what is contraindicated in managing HTN in pregnancy
ACEi and ARBs
what is the acute BP treatment for pregnant patients with chronic/gestational HTN
IV labetalol, IV hydralazine, oral immediate-release nifedipine
what is the chronic BP treatment for pregnant patients with chronic/gestational HTN
labetalol, ER nifedipine, or methyldopa
what is the target BP for pregnant patients with chronic/gestational HTN
target BP = 130-150/80-100
NOT recommended to reduce BP by more than 25% over 2 hours
what is resistant HTN
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
what is a major issue with resistance HTN
medication noncompliance
What should we do for patients with resistant hypertension?
- 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)
what are possible causes of resistant hypertension
- improper blood pressure management
- volume overload and psuedotolerance
- associated conditions
- identifiable secondary causes
- drug-induced/other
what are some drug induced/other causes of resistant HTN
- 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)
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?
if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!
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?
if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!
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?
if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!
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?
if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!
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?
if someone wants to listen back and tell me the answer to this thatd be great, otherwise ill try to do it soon!
oh wow okay that was short
BYYYYYEeeeee!:)
