hypertension

Question 1

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

Answer 1

Normal

Question 2

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

Answer 2

Elevated

Question 3

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

Answer 3

Stage 1

Hypertension

Question 4

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

Answer 4

Stage 2

Hypertension

Question 5

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

Answer 5

Exacerbate

Question 6

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

Answer 6

Essential hypertension

Question 7

__________ 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

Answer 7

Secondary Hypertension

Question 8

Essential or Secondary Hypertension

usually asymptomatic

Answer 8

Essential hypertension

Question 9

Onset of essential hypertension is usually between what ages?

Answer 9

25-55 y/o

Question 10

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

Answer 10

50 y/o

Question 11

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

Answer 11

Evidence of end organ damage or comorbidities

Question 12

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

Answer 12

Fasting glucose
CBC
Chemistry
TSH
Lipid Panel
EKG

Question 13

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

Answer 13

3-5

Question 14

With Hypertension what non pharmacological results

Answer 14

Lifestyle modifications

Question 15

What are the lifestyle modifications for HTN

Answer 15

(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

Question 16

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

Answer 16

140/90

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

Question 17

What are the first line classes of meds for HTN?

Answer 17

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

Question 18

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.

Answer 18

Diuretics

Question 19

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?

Answer 19

3 months

electrolyte abnormalities

Question 20

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.

Answer 20

Angiotensin Converting Enzyme Inhibitors (ACEi)

Question 21

What drug classes are commonly prescribed for HTN?

Answer 21

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

Question 22

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

Answer 22

Calcium Channel Blockers (CCB)

Question 23

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

Answer 23

CCB

Question 24

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

Answer 24

• 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.

Question 25

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

Answer 25

MO | 3-5 readings

Question 26

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

Answer 26

Yes

Question 27

Hypertensive Urgency is what BP?

Answer 27

SBP > 220 mm Hg or DBP > 125 mm Hg

Question 28

Hypertensive Emergency is what BP?

Answer 28

DBP > 130 mm Hg, | but correlation between pressure and end organ damage is poor.

Question 29

Hypertensive Urgency vs Hypertensive Emergency

Answer 29

There is signs of end organ damage in HTN emergency

Question 30

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

Answer 30

END ORGAN DAMAGE | HTN Emergency

Question 31

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

Answer 31

1-2

Question 32

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

Answer 32

25% | < 160/110

Question 33

HTN Urgency/Emergency | The main goal of your physical examination is to evaluate for signs of

Answer 33

End organ damage

Question 34

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

Answer 34

Urgency

Question 35

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

Answer 35

YES

Question 36

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

Answer 36

NO use IV meds

Question 37

What is the Primacy treatment for HTN urgency?

Answer 37

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

Question 38

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

Answer 38

- Need to establish IV | - Give O2 if less than 94%

Question 39

What is the initial med for HTN emergency?

Answer 39

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

Question 40

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

Answer 40

Metoprolol 25-50 mg PO twice daily

Question 41

What are the contraindications for labetalol

Answer 41

Asthma/COPD, bradycardia

Question 42

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

Answer 42

may cause renal, cerebral or coronary ischemia, | because those vessels could used to seeing high perfusion pressures.

Question 43

Initial Care: | Initially look for signs of what to determine Hypertensive Urgency vs Hypertensive Emergency?

Answer 43

END ORGAN DAMAGE

Question 44

Initial Care: | If Hypertensive Urgency then start ______ medication

Answer 44

PO

Question 45

Initial Care | If Hypertensive Emergency then start___ medication

Answer 45

IV

Question 46

Should you Medevac a HTN emergency?

Answer 46

YES!

Question 47

Should you MEDADVICE a Pri HTN?

Answer 47

yes