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SU18: Internal med final > Hypertension > Flashcards

Hypertension Flashcards

1
Q

incidence

A

65 million adults, 50% of those >65 yo

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2
Q

pathophysiology

A
  • chronic elevation in arterial blood pressure

- asymptomatic damage to delicate lining

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3
Q

primary vs secondary etiology

A

primary - unknown cause

secondary - environment/genes

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4
Q

which type of etiology is the majority of htn cases?

A

primary (90%)

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5
Q

what happens if fat and calcium builds up in your arteries?

A

plaque stiffens and narrows the artery

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6
Q

normal BP

A

<120 AND <80

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7
Q

treatment for normal BP

A

follow-up in 2 years

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8
Q

elevated BP

A

120-129 AND <80

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9
Q

treatment for elevated BP

A

lifestyle mod

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10
Q

stage 1 htn

A

130-139 OR 80-89

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11
Q

treatment for stage 1 htn

A

drugs and lifestyle

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12
Q

stage 2 htn

A

≥140 OR ≥90

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13
Q

treatment for stage 2 htn

A

drugs and lifestyle

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14
Q

what are some lifestyle modifications?

A
  • weight loss in overweight/obese pts
  • smoking cessation
  • control blood glucose and lipids
  • heart healthy foods, decreased sodium, potassium supplementation
  • moderate alcohol
  • structured physical activity program
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15
Q

BP goal

A

≤130/80

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16
Q

stage 1 htn drug therapy

A
  • single drug therapy

- titrate and/or addition of another drug when necessary

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17
Q

stage 2 htn drug therapy

A
  • combo drug therapy of different classes
  • ACE inhibitors
  • angiotensin receptor blockers
  • thiazide diuretics
  • Ca channel blockers
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18
Q

which class of htn drug is generally prescribed first in stage 2 drug therapy?

A

diuretics

19
Q

htn targets which organs?

A
  • kidneys
  • heart
  • brain
20
Q

aggressive therapy decreases the risk of stroke by what percent in hypertensive pts?

A

30-40

21
Q

aggressive therapy decreases the risk of MI by what percent in hypertensive pts?

A

20-25%

22
Q

aggressive therapy decreases the risk of heart failure by by what percent in hypertensive pts?

A

> 50%

23
Q

hypertensive emergency

A

sudden, acute elevation of BP (≥180 and/or ≥120) with possibility of serious CV outcome

24
Q

endogenous catecholamines

A

stress/anxiety

25
Q

exogenous catecholamines

A
  • local with vasoconstrictor

- gingival retraction cord with vasoconstrictor

26
Q

MAJOR risk factors imposed by presence of CV disease

A
  • unstable coronary syndromes
  • decompensated heart failure
  • significant arrhythmias
  • severe valvular disease
27
Q

INTERMEDIATE risk factors imposed by presence of CV disease

A
  • history of ischemic disease
  • history of compensated heart failure
  • history of cerebrovascular disease
  • diabetes mellitus
  • renal insufficiency
28
Q

MINOR risk factors imposed by presence of CV disease

A
  • advanced age (>70 yo)
  • abnormal ECG
  • rhythm other than sinus
  • uncontrolled systemic htn (>180/110)
29
Q

HIGH risk procedures (>5%)

A
  • aortic/major vascular surgery

- peripheral vascular surgery

30
Q

INTERMEDIATE risk procedures (<5%)

A
  • intraperitoneal/intrathoracic surgery
  • carotid endarterectomy
  • head and neck surgery
  • orthopedic surgery
  • prostate surgery
31
Q

LOW risk procedures (<1%)

A
  • endoscopic procedures
  • superficial procedures
  • cataract surgery
  • breast surgery
  • ambulatory surgery
32
Q

dental procedures impose what type of risk?

A

considered superficial procedure so low risk (<1%)

33
Q

functional capacity

A

ability to engage in normal physical activity without syms

34
Q

METs

A

metabolic equivalents of tasks

*are you able to climb a flight of stairs without having chest discomfort or shortness of breath?

35
Q

should you treat METs > 4?

A

yes

36
Q

should you treat METs <4?

A

no

37
Q

should you proceed with dental care if pt’s BP is <160/100?

A

yes

*no referral necessary

38
Q

should you proceed with dental care if pt’s BP is ≥160/100 but <180/110?

A

yes but with caution; consider BP monitoring

39
Q

what would be your recommendation if pt’s BP is ≥160/100 but <180/110?

A

see PCP within 1 mo

40
Q

should you proceed with dental care if pt’s BP is ≥180/110?

A

defer elective treatment

41
Q

what would be your recommendation if pt’s BP is ≥180/110 and asymptomatic?

A

to PCP within 1 wk

42
Q

what would be your recommendation if pt’s BP is ≥180/110 and symptomatic and/or diastolic >120?

A

immediate evaluation (send to ER)

43
Q

mods to dental txt

A
  • good pain and anxiety control
  • short apts
  • give nitrous oxide
  • give local with modest doses of epi
  • avoid retraction cord with epi
  • slow chair repositioning
  • check ePocrates for potential drug interactions
44
Q

what is considered modest dose of epi?

A

1-2 carts 2% lido w/ 1:100k epi

SU18: Internal med final (25 decks)

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