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Cardiovascular > Hypertension 2 > Flashcards

Hypertension 2 Flashcards

1
Q

How often should follow-up visits be scheduled until BP is at goal?

A

Every 4-6 weeks

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2
Q

How much of a BP reduction should you see per added agent?

A

10 mmHg

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3
Q

What are the 2 categories of hypertensive crises?

A

Hypertensive urgency, hypertensive emergency

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4
Q

What constitutes hypertensive urgency?

A

BP >180 and/or 120 without evidence of acute target-organ damage typically due to poorly controlled chronic HTN

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5
Q

How is hypertensive urgency assessed?

A

Rarely emergent therapy/monitoring
Thorough H&P to evaluate for signs/symptoms of organ damage
BMP, UA, EKG

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6
Q

What is the goal of hypertensive urgency treatment?

A

Reduce BP within hours
Give in office agent if available

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7
Q

What in office agents can be given for hypertensive urgency?

A

Clonidine, captopril, metoprolol tartrate, hydralazine, nifedipine

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8
Q

What is the action of clonidine?

A

Central sympatholytic

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9
Q

How fast is the onset of clonidine?

A

30-60 minutes

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10
Q

How long does clonidine last?

A

6-8 hours

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11
Q

What are adverse effects of clonidine?

A

Sedation

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12
Q

What is the mechanism of action of captopril?

A

ACEI

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13
Q

What is the onset of captopril?

A

15-30 minutes

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14
Q

How long is the duration of captopril?

A

4-6 hours

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15
Q

What are adverse effects of captopril?

A

Excessive hypotension

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16
Q

What is the action of metoprolol tartrate?

A

Beta blocker

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17
Q

What is the onset of metoprolol tartrate?

A

20-60 minutes

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18
Q

What is the duration of metoprolol tartrate?

A

5-6 hours

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19
Q

What are adverse effects of metoprolol tartrate?

A

Excessive hypotension, bradycardia

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20
Q

What is the action of hydralazine?

A

Vasodilator

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21
Q

What is the onset of hydralazine?

A

10-80 minutes

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22
Q

What is the duration of hydralazine?

A

Up to 12 hours

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23
Q

What are adverse effects of hydralazine?

A

Tachycardia, headache, GI
Often given with beta blocker due to risk of heart attack

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24
Q

What is the action of nifedipine?

A

CCB

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25
Q

What is the onset of nifedipine?

A

15 minutes

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26
Q

what is the duration of nifedipine?

A

2-6 hours

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27
Q

What are adverse effects of nifedipine?

A

Excessive hypotension, tachycardia, headache, angina, myocardial infarction, stroke

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28
Q

Severe HTN with signs and/or symptoms of end-organ damage. True medical emergency and must start lowering BP ASAP to preserve function

A

Hypertensive emergency

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29
Q

What is the typical BP with hypertensive emergency?

A

220/130

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30
Q

What is the initial evaluation of hypertensive emergency?

A

Problem-focused H&P (kidneys, heart, stroke, eyes, pulmonary)
CBC, CMP, EKG, CXR, CT head, UA, UDS

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31
Q

What is the goal of treatment for hypertensive emergency?

A

Use parenteral therapy to lower BP no more than 25% per first 2 hours then goal BP of 160/100 over next 2-6 hours

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32
Q

How do you determine specific goals for managing BP in hypertensive emergency?

A

Organ involved

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33
Q

What is the BP goal of ischemic CVA in hypertensive emergency? Hemorrhagic?

A

SBP between 180-200 mmHg with slow reduction
Hemorrhagic- target SBP is <140 mmHg

34
Q

What is the goal BP for aortic dissection?

A

SBP <120 mmHg

35
Q

What is the goal BP for MI?

A

Need anticoagulation and oxygen; typically use NTG for BP reduction, but no set goal

36
Q

What calcium channel blockers can be used for hypertensive emergency?

A

Nicardipine, clevidipine

37
Q

How fast is the onset of calcium channel blockers used in hypertensive emergency?

A

Within minutes

38
Q

What are adverse effects of nicardipine?

A

Hypotension, tachycardia, headache

39
Q

What medications are 1st line for african americans?

A

CCB or thiazide

40
Q

What medications are first line for non-african americans?

A

ACEI/ARB, CCB, or thiazide

41
Q

If a patient has elevated BP, how should they be managed?

A

Lifestyle changes

Trick question :)

42
Q

If a patient has stage 2 hypertension, how would you manage them?

A

nonpharmacologic therapy and BP lowering medication
Follow up in 1 month

43
Q

What is the only time that you would give a beta blocker or a aldosterone antagonist first line?

A

Heart failure or post-MI/CAD

44
Q

How often should an EKG be obtained on a patient with hypertension?

A

every 2-4 years

44
Q

What are adverse effects of clevidipine?

A

headache, nausea, vomiting

44
Q

what are clevidipine contraindications?

A

allergy to soy or egg

45
Q

what are adverse effects of labetalol?

A

GI, hypotension, bronchospasm, bradycardia, heart block

46
Q

which patients should you avoid using labetolol in?

A

Avoid in acute LV systolic dysfunction, asthma

47
Q

what are the adverse effects of esmolol?

A

bradycardia, nausea

48
Q

you should not give esmolol to patients with what?

A

LV systolic dysfunction, asthma

49
Q

what are adverse effects of fenoldopam?

A

reflex tachycardia, hypotension, increased intraocular pressure

50
Q

what is the mechanism of action of enalprilat?

A

ACE inhibitor

51
Q

what are adverse effects of enalaprilat?

A

excessive hypotension

52
Q

how is enalaprilat used?

A

additive with diuretics

53
Q

What is the mechanism of action of furosemide?

A

diuretic

54
Q

what are adverse effects of furosemide?

A

hypokalemia, hypotension

55
Q

How is furosemide used?

A

adjunct to vasodilator

56
Q

what is nitroglycerin?

A

vasodilator

57
Q

what are adverse effects of nitroglycerin?

A

headache, nausea, hypotension, bradycardia

58
Q

what do you need to keep in mind with nitroglycerin?

A

Can develop tolerance
most useful with myocardial ischemia

59
Q

what is the mechanism of action of nitroprusside?

A

vasodilator

60
Q

what are adverse effects of nitroprusside?

A

GI, CNS, thiocyanate and cyanide toxicity, especially iwth renal and hepatic insufficiency; decreased cerebral blood flow, increased intracranial blood pressure

61
Q

what are treatment options for hypertensive emergency?

A
  • nicardipine
  • clevidipine
  • labetolol
  • esmolol
  • fenoldopam
  • enalaprilat (additive with diuretics)
  • furosemide (adjunct to vasodilator)
  • nitroglycerin
  • nitroprusside (no longer first-line agent)
62
Q

How much is HR expected to change during pregnancy?

A

increase by 10 bpm during 3rd trimester

63
Q

How does pregnancy impact BP?

A

Tends to decrease during 2nd trimester due to decrease in systemic vascular resistance

64
Q

when is a BP considered abnormal during pregnancy? Why?

A

> 140/90
associated with increased risk in perinatal morbidity and mortality

65
Q

what does diagnosis of hypertension during pregnancy require?

A

2 elevated readings at least 4 hours apart

66
Q

What are classifications of hypertension during pregnancy?

A
  • Preeclampsia
  • Gestational
  • Chronic
  • Preeclampsia superimposed on chronic hypertension
67
Q

What is classified as preeclampsia?

A

New onset HTN (BP >140/90) and proteinuria (24 hr urinary protein >300 mg/24 h or creatinine ratio >.3) after 20 weeks gestation

68
Q

What is classified as gestational HTN?

A

HTN (BP 140/90) after 20 weeks gestation without pre-existing HTN or proteinuria

69
Q

What is considered chronic HTN in a pregnant patient?

A

HTN before 20 weeks gestation or longer than 12 weeks postpartum

70
Q

what HTN medications are contraindicated during pregnancy?

A

ACEI and ARBs

71
Q

How is acute chronic/gestational HTN treated?

A

IV labetolol, IV hydralazine, oral immediate-release nifedipine

72
Q

How is chronic HTN managed during pregnancy?

A

labetalol, ER nifedipine, or methyldopa

73
Q

what is the target BP during pregnancy?

A

130-150/80-100

not recommended to reduce BP by more than 25% over 2 hours

74
Q

failure to reach BP control in patients who are adherent to full doses of an appropriate 3-drug regimen, including a diuretic

A

Resistant HTN

75
Q

What could be an issue leading to resistant HTN?

A

medication noncompliance

76
Q

What would you do if a patient has resistant hypertension?

A

Refer to nephrology or cardiology
to rule out secondary causes
consider switching diuretic to aldosterone receptor blocker

77
Q

What are causes of resistant HTN?

A
  • Improper blood pressure measurement
  • volume overload and pseudotolerance: excess sodium intake, volume retention from kidney disease, inadequate diuretic therapy
  • Obesity
  • Excess alcohol intake
  • Secondary causes of hypertension
78
Q

What are drug-induced causes of resistant HTN?

A
  • Inadequate doses or inappropriate combinations
  • NSAIDs
  • Cocaine, amphetamines, other illicit drugs; sympathomimetics
  • oral contraceptives
  • adrenal steroids
  • erythropoietin
  • licorice
  • selected OTC supplements and medicines (ephedra, ma huang, bitter orange)
79
Q
A

Cardiovascular (17 decks)

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