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Hypertension Flashcards

1
Q

how to ensure accurate BP measurement

5 things

A
  1. accurate cuff size
  2. cuff on bare arm
  3. arm supported at level of heart
  4. legs uncrossed
  5. back and feet uncrossed
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2
Q

what are ACC/AHA/ADA guidelines BP goal?

A

less than 130/80

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3
Q

what is BP goal in with associated kidney disorders?

A

less than 120/80

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4
Q

when is typical onset for primary HTN? secondary?

A
  • primary: 30-50 y/o
  • secondary: under 30 y/o
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5
Q

when to suspect secondary HTN?

3

A
  • abrupt onset HTN
  • exacerbation of previously controlled HTN
  • drug resistant HTN
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6
Q

environmental/lifestyle factors of primary HTN?

6

A
  1. obesity
  2. OSA
  3. diet (high salt intake, low potassium intake)
  4. physical inactivity
  5. excessive alcohol activity
  6. smoking
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7
Q

sx of HTN?

8

A
  • headache
  • blurred vision
  • dizziness
  • nausea
  • fatigue
  • chest pain
  • SOB
  • confusion
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8
Q

PE findings for HTN

5

A
  1. abnormal eye exam
  2. LV heave
  3. abd bruit
  4. radial-femoral delay
  5. pulsatile abd mass
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9
Q

findings on ecg/echo & UA

1 on each

A
  1. LVH
  2. proteinuria
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10
Q

complications of HTN

A
  • coronary heart disease
  • heart failure
  • LVH
  • ischemic/hemorrhagic stroke
  • CKD/other renal disease
  • HTN emergencies
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11
Q

work up for HTN

8 components

A
  1. BMP
  2. Serium creatinine & GFR
  3. Fasting glucose/A1C
  4. Urinalysis
  5. CBC
  6. Lipid profile
  7. TSH
  8. calculate 10 year ASCVD risk
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12
Q

common causes of secondary HTN

5

A
  1. obstructive sleep apena
  2. renovascular disease
  3. primary aldosteronism
  4. renal parenchymal disease
  5. drug or alcohol induced
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13
Q

what is characteristic of renal artery stenosis as secondary cause of HTN

A

acute decline in GFR/kidney function with start of ACE/ARB
* meaning: test results for kidney function will increase

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14
Q

what is associated with primary aldosteronism?

A
  • HTN + hypokalemia
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15
Q

which drugs/meds can induce HTN?

7

A
  • caffeine
  • nicotine
  • EtOH
  • NSAIDs
  • OCPs
  • decongestants
  • amphetamines
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16
Q

Secondary HTN

define O CRAP H3

A
  • O: obstructive sleep apnea
  • C: cushing’s
  • R: renal artery stenosis
  • A: aortic coarctation
  • P: pheochromocytoma
  • H3: thyroid aldosterone calcemia / parathyroid
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17
Q

Secondary HTN

describe obstructive sleep apnea as it relates to secondary HTN

presentation, PE, labs

A
  1. daytime somnolence, snoring
  2. short, thick neck, obesity
  3. sleep study
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18
Q

Secondary HTN

describe Cushing’s as it relates to secondary HTN

presentation, PE, labs

A
  1. easily bruises, malaise, depression
  2. abd obestiy, dorsal hump, moon face, purple striae
  3. elevated ACTH, elevated cortisol
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19
Q

Secondary HTN

describe renal artery stenosis/FMD as it relates to secondary HTN

presentation, PE, labs

A
  1. HTN refractory to rx
  2. renal artery bruit
  3. elevated creatinine post ACE/ARB, consider US
20
Q

Secondary HTN

describe aortic coarctation as it relates to secondary HTN

presentation, PE, labs

A
  1. HTN, HA, narrowing aorta
  2. BP/pulses UE > LE, machinery M (??)
  3. imaging
21
Q

Secondary HTN

describe pheochromocytoma as it relates to secondary HTN

presentation, labs

A
  1. HA, hidrosis, palpitations, episodic
  2. elevated plasma metanphrines
22
Q

Secondary HTN

describe thyroid aldosterone calcemia/parathyroid as it pertains to secondary HTN

presentation, PE, labs

A
  1. HTN, palpitations
  2. goiter/nodules on thyroid
  3. elevated TSH, low K+, elevated PTH/Ca
23
Q

34 y/o presents for follow up from ED. No PMHx. Has been having “panic attacks”. Acute onset of sweating, heart is fast/stron, HA, pressure behind eyes. BP at home: 189/110. Lasts approx 1 hr then resolves. ED dx was panic attack. Vital signs today are normal.
* what is the work up?
* differential?

A
  1. ECG, TSH, BMP, Urine Drug Test, HCG, FLP, UA, CBC
  2. Pheochromocytoma
24
Q

which scenarios to use:
* ACE/ARB
* Beta Blockers
* Calcium Channel Blockers
* Spironolactone
* Thiazide Diuretics/Clonidine

A
  1. DM, CKD, proteinuria, cardiomyopathy
  2. post-ACS, cardiomyopathy, ESRD
  3. prefered in african americans, Raynaud’s, vasospastic angina
  4. cardiomyopathy or adjunct therapy
  5. CKD/ESRD
25
what is first line therapy for most patients?
ACE or ARB
26
what is first line therapy in Black/AA patients?
calcium channel blockers
27
what are lifestyle modifications that could be recommended? | 7
* wt loss * healthy diet (DASH) * reduce sodium intake * moderation in alcohol consumption * reduce sat fats & cholesterol consumption * regular exercise * smoking cessation
28
Thiazide Diuretics- meds & dosing | 2
1. Hydrochlorothiazide (12.5 to 25 mg PO QD) 2. Chlorthalidone (12.5-25 mg PO QD)
29
Thiazide Diuretics MOA/Adverse Effects
1. inhibits sodium reabsorption in DCT, which increases excretion of H2O + electrolytes 2. Hypokalemia, hyponatremia, hypocalciuria, hypomagnesemia, hyperglycermia, hyperuricemia, hypercalcemia
30
ACE Inhibitor Meds/Doses | 4
1. Lisinopril (5-20mg PO BID) 2. Captopril (25-100mg PO BID) 3. Ramipril (2.5-20mg PO BID) 4. Enalapril (2.5-20mg PO BID)
31
ACE Inhibitors MOA, Adverse Effects, Contraindication
1. prevents conversion of angiotensin I to angiotensin II 2. dry cough, hyperkalemia, skin rash, headache, renal impairment, angioedema 3. contraindicated in preg
32
ARB meds & doses | 4
1. Valsartan (80-320mg PO QD) 2. Candesartan (8-32mg PO QD) 3. Losartan (25-200mg PO QD) 4. Irbesartan (150-300mg PO QD)
33
ARBs MOA, Adverse Effects, Contraindication
1. blocks effects of angiotensin II 2. hyperkalemia, renal impairment, HA 3. pregnancy
34
Calcium Channel Blocker meds & dose
1. Amlodipine (5-10mg PO QD) 2. Nicardipine (15-180mg PO QD)
35
Calcium Channel Blockers MOA, Adverse Effects, Contraindication
1. inhibits influx of calcium to stop cardiac and ventricular SM contraction 2. constipation, peipheral edema, HA, beart block, gingival overgrowth 3. CHF
36
Selective Beta Blocker Meds & doses
1. Atenolol (25-50mg PO BID) 2. Metoprolol (12.5-100mg PO BID) 3. Bisoprolol (2.5-10mg PO BID) 4. Nebivolol (5-20mg PO QD)
37
non-selective Beta Blocker meds & doses
1. Propranolol (40-180mg PO BID) 2. Cravedilol (3.125-25mg PO BID) 3. Labetalol (5-150mg PO BID)
38
1. most commonly prescribed beta blocker? 2. strongest BB for HTN? 3. BB with most side effects?
1. Metoprolol, Cavedilol 2. Labetalol 3. Atenolol
39
BBs MOA, Adverse Effects, Contraindication
1. blocks beta-adrenergic stimulation to reduce CO & decrease release of renin from kidney 2. Fatigue, can mask hypoglycemia s/sx, depression, sexual dysfunction, insomnia, decreases HR 3. do not use cocaine MI or pheochromocytoma until alpha blockage established
40
drug of choice for pregnancy?
labetalol, nifedipine, HCTZ, methlydopa
41
common causes of resistant HTN | 7
1. improper BP measurement 2. drug non-adherence 3. excess sodium intake 4. excess alcohol intake 5. licorice 6. obesity 7. OCPs
42
differentiate HTN urgency vs emergency
* urgency: no evidence of end organ damage, can be managed closely outpaitent * emergency: evidence of end organ damage, manage inpatient w/ IV meds
43
CNS signs of end organ damage | 6
1. ischemic stroke/hemorrhage 2. HA 3. focal neuro deficits 4. seizures 5. altered mental status 6. visual disturbances
44
CVS signs of end organ damage | 6
1. angina 2. MI 3. dissection 4. HF 5. Pulm edema 6. chest/back pain
45
Renal signs of end organ damage | 4
1. ARF 2. hematuria 3. oliguria 4. proteinuria
46
Ocular signs of end organ damage | 3
1. HTN encephalopathy 2. papilledema 3. retinal hemorrhage

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