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Family Medicine Cases > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Screening (USPSTF)

A

Start at 18 years of age

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2
Q

Hypertension in a 60 year old

A

> 150 or > 90

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3
Q

Organ systems impacted by hight blood pressure

A 
Heart
Brain
Kidney
Blood vessels
Eyes
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4
Q

How quickly can end organ damage begin

A

Within 10 years

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5
Q

Family Hx: Death from CAD

A

Men

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6
Q

Moderate EtOH

A
  1. 0 oz men (2 drinks)

0. 5 oz women ( 1 drink)

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7
Q

Kidney markers that indicate higher risk of hypertnesion

A

Micoalbuminuria

GFR 60 or lower

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8
Q

Secondary HTN

A 
Sleep apnea
CKD
Endocrine: Aldosterone, Thyroid, Cortisol, Epi/Norepi, Parathyroid
Coarctation of the aorta
Medications/Supplements/Drugs
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9
Q

Percent of HTN that is essential

A

95 to 98

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10
Q

How many times should BP be taken at a single visit if elevated

A

Twice

  • 5 minutes apart
  • Once in each arm
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11
Q

How many visits does it take to dx HTN

A

At least two

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12
Q

Length requirements for BP cuff

A

80% of arm circumference

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13
Q

Width requirement for BP cuff

A

40% of arm circumference

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14
Q

What should you conduct a neurological exam with new onset HTN

A

Get a baseline

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15
Q

Explanatory model of illness

A

How a patient explains the cause of their illness, how they think they can manage it, and how they can stay healthy

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16
Q

Labs for new dx of HTN

A 
ECG: Baseline
UA: End organ damage
Blood glucose: Risk factor
Hematocrit: Anemia
K+: Medication
Cr or GFR: End organ damage
Ca+: May indicate HTN 2/2 renal dysfunction
Lipids: Risk factor
Albumin or Albumin/Cr ratio: End organ damage
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17
Q

When should an ACEI be used for HTN in the general black population?

A 
Age 60+
Chronic Kidney Disease
- Required 
Diabetes
- This is no longer a required medication
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18
Q

Which treatment population can have a goal of

A

Age 60+

- Unless they are diabetic or have CKD

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19
Q

Most cost effective medication for HTN

A

HCTZ

20
Q

Side effects of HCTZ

A

Low Na+
Precipitate gout flare
Incontinent

21
Q

Recommended dosages of HCTZ

A

25 mg is the optimal dose and be started in health adults

Pts 60+ should be started at lower doses and titrated up

22
Q

Effect of weight reduction

A

5 to 20 per 10 kgs lost

23
Q

Effect of DASH on HTN

A

8 to 14

24
Q

Effect of Na restriction on HTN

- 100 mmol/day (2.4 g Na or 6 g NaCl

A

2 to 8

25
Q

Effect of physical activity on HTN

A

4 to 9

26
Q

Effect of moderate EtOH on HTN

A

2 to 4

27
Q

ASA use in HTN

A

Men: 45 to 79 for MI reduction
Women: 55 to 79 for stroke reduction

28
Q

Options for adjusting medication if not meeting goal

- All of the following are options

A
  1. Maximize doses
  2. Add second agent without changing the first
  3. Do a fixed combo drug
29
Q

If BP is resistant to two medications

A

Add a third

30
Q

Should alpha-blockers ever be used as first line management?

A

No

  • No reduction in morbidity and mortality
  • Not even if patient has BPH
31
Q

Ethnic groups with worst BP control

A

Mexican and Native Americans

32
Q

Which medications are renal protective, regardless of BP control?

A

BB
ACEI
ARB

33
Q

One not so well known benefit of thiazides

A

Slows demineralization in osteoporosis

34
Q

Good for tachyarrhythmias/fibrillation, migraines, essential tremors, and perioperative HTN

A

Beta blockers

35
Q

Can BB mask hypoglycemia?

A

In theory

36
Q

What patients should avoid BB

A

Asthma patients

37
Q

Acceptable rise Cr after starting ACEI

A

35%

38
Q

Preg C category drugs

A

ACEI

ARBS

39
Q

Benefit of ARBS of ACEI

A

Less bradykinin production

40
Q

Useful in raynaud’s and some arrhythmias

A

CCB

41
Q

Contraindicated for use in essential HTN and HTN urgencies or emergencies

A

Short acting CCB

42
Q

Cut off for starting a K sparing diuretic

A

K of 5+

43
Q

Risk of using high dose aldosterone in CHF

A

increase risk of sudden death

44
Q

When to refer to specialsit

A

Full adherence to appropriate 3 drug regimen
- One drug must be a diuretic
Maximize TLC

45
Q

Often overlooked medication that worsens HTN

A

NSAIDs

Family Medicine Cases (13 decks)

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