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CMT > Hypertension > Flashcards

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
Q

what is first line therapy for most patients?

A

ACE or ARB

26
Q

what is first line therapy in Black/AA patients?

A

calcium channel blockers

27
Q

what are lifestyle modifications that could be recommended?

7

A
  • wt loss
  • healthy diet (DASH)
  • reduce sodium intake
  • moderation in alcohol consumption
  • reduce sat fats & cholesterol consumption
  • regular exercise
  • smoking cessation
28
Q

Thiazide Diuretics- meds & dosing

2

A
  1. Hydrochlorothiazide (12.5 to 25 mg PO QD)
  2. Chlorthalidone (12.5-25 mg PO QD)
29
Q

Thiazide Diuretics MOA/Adverse Effects

A
  1. inhibits sodium reabsorption in DCT, which increases excretion of H2O + electrolytes
  2. Hypokalemia, hyponatremia, hypocalciuria, hypomagnesemia, hyperglycermia, hyperuricemia, hypercalcemia
30
Q

ACE Inhibitor Meds/Doses

4

A
  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
Q

ACE Inhibitors MOA, Adverse Effects, Contraindication

A
  1. prevents conversion of angiotensin I to angiotensin II
  2. dry cough, hyperkalemia, skin rash, headache, renal impairment, angioedema
  3. contraindicated in preg
32
Q

ARB meds & doses

4

A
  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
Q

ARBs MOA, Adverse Effects, Contraindication

A
  1. blocks effects of angiotensin II
  2. hyperkalemia, renal impairment, HA
  3. pregnancy
34
Q

Calcium Channel Blocker meds & dose

A
  1. Amlodipine (5-10mg PO QD)
  2. Nicardipine (15-180mg PO QD)
35
Q

Calcium Channel Blockers MOA, Adverse Effects, Contraindication

A
  1. inhibits influx of calcium to stop cardiac and ventricular SM contraction
  2. constipation, peipheral edema, HA, beart block, gingival overgrowth
  3. CHF
36
Q

Selective Beta Blocker Meds & doses

A
  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
Q

non-selective Beta Blocker meds & doses

A
  1. Propranolol (40-180mg PO BID)
  2. Cravedilol (3.125-25mg PO BID)
  3. Labetalol (5-150mg PO BID)
38
Q
  1. most commonly prescribed beta blocker?
  2. strongest BB for HTN?
  3. BB with most side effects?
A
  1. Metoprolol, Cavedilol
  2. Labetalol
  3. Atenolol
39
Q

BBs MOA, Adverse Effects, Contraindication

A
  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
Q

drug of choice for pregnancy?

A

labetalol, nifedipine, HCTZ, methlydopa

41
Q

common causes of resistant HTN

7

A
  1. improper BP measurement
  2. drug non-adherence
  3. excess sodium intake
  4. excess alcohol intake
  5. licorice
  6. obesity
  7. OCPs
42
Q

differentiate HTN urgency vs emergency

A
  • urgency: no evidence of end organ damage, can be managed closely outpaitent
  • emergency: evidence of end organ damage, manage inpatient w/ IV meds
43
Q

CNS signs of end organ damage

6

A
  1. ischemic stroke/hemorrhage
  2. HA
  3. focal neuro deficits
  4. seizures
  5. altered mental status
  6. visual disturbances
44
Q

CVS signs of end organ damage

6

A
  1. angina
  2. MI
  3. dissection
  4. HF
  5. Pulm edema
  6. chest/back pain
45
Q

Renal signs of end organ damage

4

A
  1. ARF
  2. hematuria
  3. oliguria
  4. proteinuria
46
Q

Ocular signs of end organ damage

3

A
  1. HTN encephalopathy
  2. papilledema
  3. retinal hemorrhage

CMT (78 decks)

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