hypertension Flashcards
HTN findings on physical exam?
fundoscopy: hemorrhage, papilledema, cotton wool spots
rhonchi, rales
renal masses, bruits
clinical presentation of secondary hypertension (symptoms)
muscle weakness, tachycardia, sweating, tremor, thinning of the skin, flank pain, confusion
rx management of HTN? (8)
diuretics, Ca2+ channel blockers, ACE inhibitors/ARB, B-blockers, direct renin inhibitor, central a-agonists, a-blockers
thiazide diuretic electrolyte effects
decrease K+, Mg2+, Na+
increase Ca2+
thiazide diuretic contraindication
sensitivity to sulfonamide-derived drugs
loop diuretic?
and the risk?
furosemide
hypokalemia- supplement K+
K+ sparing diuretic?
tx guidelines?
contraindications?
Triamterene
Weak anti-HTN, used w/ thiazide
Contraindicated in hepatic disease, renal failure, hyperkalemia
aldosterone antagonist?
side effects?
spironolactone
gynecomastia & hyperkalemia
aldosterone antagonist contraindications? (3)
renal impairment
DM w/ proteinuria
hyperkalemia
Ca2+ channel blocker? MOA?
-dipine
inhibition of Ca2+ influx into myocardial & vascular smooth muscle cells, decreasing resistance, causing vasodilation
Ca2+ channel blocker contraindication?
acute MI
acute HTN- nifedipine
heart conditions: AV block, cardiogenic shock, heart failure, ventricular tachycardia, etc
ACE inhibitors? MOA?
-pril
inhibit the RAAS & stimulate bradykinin –> vasodilator effect
ACE inhibitor indication? (4)
chronic kidney disease
DM
heart failure
post-MI
ACE inhibitor side effects? (4)
cough
hyperkalemia
angioedema
acute renal failure
ACE inhibitor contraindications? (3)
pregnancy
angioedema
renal a. stenosis
ARBs? MOA?
-sartan
inhibit the RAAS system
ARB side effects? (3)
hyperkalemia
angioedema
acute renal failure
ARB contraindications? (2)
pregnancy
renal aa. stenosis
direct renin inhibitor?
Aliskiren (Tekturna)
direct renin inhibitor side effects? (3)
hyperkalemia
renal impairment
hypersensitivity reactions
direct renin inhibitor contraindications (2)
use w/ ACE-I or ARB in diabetics
pregnancy
central alpha agonists (2)
clonidine
methyldopa
central alpha agonist side effects? (3)
anticholinergic side effects: dry mouth, hot red skin, urinary retention
bradycardia
orthostatic hypotension
methyldopa contraindication & ok?
ok for pregnancy
not for liver disease
alpha blockers? and usage guidelines?
-zosin
use in mild to moderate HTN & not for monotherapy
B-blockers?
effects?
-lol
decreased CO, PVR, renin activity
B-blockers cautions (3) & contraindications (4)?
caution: asthma/COPD, DM, depression
contraindications: AV block, cardiogenic shock, CHF, hypotension
hypertensive urgency?
180/120
asymptomatic- usually due to treatment non-adherence
hypertensive emergency?
180/120
associated w/ acute end-organ damage
ocular damage, encephalopathy, brain infarct, hemorrhage, aortic dissection, LV failure, MI, acute glomerulonephritis
are signs of?
end-stage organ damage secondary to HTN
failure to achieve a BP goal in a patient adhering to a full dose tx of a 3 drug regimen, incl HCTZ?
resistant HTN
resistant HTN causes? (5)
improper BP measurement volume overload/retention medication/drug induced obesity excess EtOH
requirements for resistant HTN? (3)
3 dose regimen
full doses
including HCTZ
hypertensive urgency tx (3)
gradual reduction to < 160/100
Rest, increase doses of meds, Sodium reduction
SL nifedipine is contraindicated
HTN emergency tx? (3)
hospitalized in ICU
BP goal of 160/100 over 2-6h.
IV Nitro
when end organ damage hits the eye
malignant HTN
marked HTN w/ retinal hemorrhages, exudates, or papilledema
malignant HTN
HCTZ is a?
thiazide diuretic
furosemide is a?
loop diuretic
Triamterene is?
K+ sparing diuretic
Spironolactone?
aldosterone antagonist
-dipine
Ca2+ channel blockers
-pril
ACE inhibitor
-sartan
ARBs
Aliskiren (Tekturna)
direct renin inhibitor
clonidine, methyldopa
Central Alpha Agonists
-zosin
Alpha blockers
-lol
B-blockers
