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hypertension Flashcards

1
Q

Blood Pressure Definitions:
SBP: < 120
DBP: < 80

A

Normal

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2
Q

Blood Pressure Definitions:
SBP: 120-129
DBP: < 80

A

Elevated

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3
Q

Blood Pressure Definitions:
SBP: 130-139
DBP: 80-89

A

Stage 1

Hypertension

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4
Q

Blood Pressure Definitions:
SBP: ≥140
DBP: ≥ 90

A

Stage 2

Hypertension

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5
Q

smoking, obesity, and/or excessive alcohol intake can do what to hypertension?

A

Exacerbate

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6
Q

_______ is the term applied to 95% of hypertensive patients when no
single cause can be identified.

A

Essential hypertension

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7
Q

__________ has an identifiable cause and should be suspected in patients with HTN at an early age, when first symptoms appear after 50 years old, or when there is difficulty-controlling HTN with multiple medications

A

Secondary Hypertension

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8
Q

Essential or Secondary Hypertension

usually asymptomatic

A

Essential hypertension

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9
Q

Onset of essential hypertension is usually between what ages?

A

25-55 y/o

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10
Q

Onset of Secondary hypertension is usually around or after what age?

A

50 y/o

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11
Q

To evaluate new diagnosis of HTN you’re using labs/imaging to look for?

A

Evidence of end organ damage or comorbidities

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12
Q

What are labs/testing you would order for Hypertension???

A 
Fasting glucose
CBC
Chemistry
TSH
Lipid Panel
EKG
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13
Q

Patients must have a elevated BP recordings on how many separate visits?

A

3-5

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14
Q

With Hypertension what non pharmacological results

A

Lifestyle modifications

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15
Q

What are the lifestyle modifications for HTN

A

(a) Diets rich in fruits and vegetables and low in saturated fats
(b) Weight reduction (10 kg can lower SBP 5-20 mm Hg)
(c) Reduced alcohol consumption (no more than two drinks per day)
(d) Increase in physical activity

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16
Q

What is the goal BP when treating HTN pts and HTN pts with DM or kidney disease?

A

140/90

< 130/80 in patients with diabetes or kidney disease.

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17
Q

What are the first line classes of meds for HTN?

A

Diuretics
-Hydrochlorothiazide (HCTZ): 12.5-25 mg daily maximum of 50 mg
Angiotensin Converting Enzyme Inhibitors (ACEi)
-Lisinopril 5-10 mg daily and can titrate to a maximum of 40 mg

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18
Q

MOA of what HTN Med?
Lower BP initially by decreasing plasma volume, but during long-term therapy, their major hemodynamic effect is reduction of peripheral vascular resistance.

A

Diuretics

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19
Q

When starting a pt on HCTZ you should get an initial chem panel then a follow up after how long? What are you evaluating for?

A

3 months

electrolyte abnormalities

20
Q

MOA of what BP med?
inhibition of the renin angiotensin-aldosterone system, but they can also inhibit bradykinin degradation, stimulate the synthesis of vasodilating prostaglandins, and can reduce
sympathetic nervous system activity.

A

Angiotensin Converting Enzyme Inhibitors (ACEi)

21
Q

What drug classes are commonly prescribed for HTN?

A
  • Diuretics (First line)
  • Angiotensin Converting Enzyme Inhibitors (ACEi) (First Line)
  • Angiotensin Receptor Blockers (ARBs)
  • Calcium Channel Blockers (CCB)
  • Alpha Blockers
22
Q

MOA of what HTN Med
these agents act by causing peripheral vasodilation (it inhibits calcium from getting into the muscle cells to cause contraction).

A

Calcium Channel Blockers (CCB)

23
Q

Your HTN patient is taking Diltiazem 180 mg Daily. What class is the med?

A

CCB

24
Q

What are some examples of a CCB that a patient could be taking?

A
  • Diltiazem 180 mg daily and titrate to max dose of 360 mg daily
  • Amlodipine Initial dose 2.5 mg daily, titrate up to max dose of 10 mg daily.
25
Q

Referral to ______ to work up accompanying cardiovascular disease or secondary hypertension if just discovering it and have had ___ readings that qualifies as HTN.

A

MO

3-5 readings

26
Q

If your pt is well controlled on their meds, can you renew their RX?

A

Yes

27
Q

Hypertensive Urgency is what BP?

A

SBP > 220 mm Hg or DBP > 125 mm Hg

28
Q

Hypertensive Emergency is what BP?

A

DBP > 130 mm Hg,

but correlation between pressure and end organ damage is poor.

29
Q

Hypertensive Urgency vs Hypertensive Emergency

A

There is signs of end organ damage in HTN emergency

30
Q

These are signs of what?

1) Hypertensive encephalopathy (mental status changes, confusion, headache).
2) Intracranial hemorrhage
3) Ischemic stroke
4) Hypertensive nephropathy (proteinuria, hematuria, and progressive kidney dysfunction).
5) Unstable angina, AMI, CHF, or Aortic dissection

A

END ORGAN DAMAGE

HTN Emergency

31
Q

HTN Emergency

Substantial reduction in blood pressure within how many hours to prevent serious morbidity or death

A

1-2

32
Q

HTN EMERGENCY

Need to reduce blood pressure by what percentage within 1-2 hours? Then slowly decrease to less than ____ in 24 hours?

A

25%

< 160/110

33
Q

HTN Urgency/Emergency

The main goal of your physical examination is to evaluate for signs of

A

End organ damage

34
Q

With Hypertensive (Urgency or Emergency) physical examination is usually normal

A

Urgency

35
Q

Can you use PO meds for a pt with HTN urgency?

A

YES

36
Q

Can you use PO meds for a pt with HTN emergency?

A

NO use IV meds

37
Q

What is the Primacy treatment for HTN urgency?

A

Clonidine (Alpha Blocker)
0.1 - 0.2 mg orally initially, then 0.1 mg QH
to 0.8 mg orally.

38
Q

What are the first things to do for your pt with HTN emergency?

A
  • Need to establish IV

- Give O2 if less than 94%

39
Q

What is the initial med for HTN emergency?

A

Labetalol 20 mg IV (over 10 minutes) then 40-80 mg IV q10 min PRN, max 300 mg

40
Q

Once your HTN emergency pt is stable what med do you give them?

A

Metoprolol 25-50 mg PO twice daily

41
Q

What are the contraindications for labetalol

A

Asthma/COPD, bradycardia

42
Q

After the first 25% you want to go slowly as excessive reductions in BP may do what and why?

A

may cause renal, cerebral or coronary ischemia,

because those vessels could used to seeing high perfusion pressures.

43
Q

Initial Care:

Initially look for signs of what to determine Hypertensive Urgency vs Hypertensive Emergency?

A

END ORGAN DAMAGE

44
Q

Initial Care:

If Hypertensive Urgency then start ______ medication

A

PO

45
Q

Initial Care

If Hypertensive Emergency then start___ medication

A

IV

46
Q

Should you Medevac a HTN emergency?

A

YES!

47
Q

Should you MEDADVICE a Pri HTN?

A

yes

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