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Clin Med Exam 1(Lauren) > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Normal blood pressure is defined as a systolic pressure of ________
AND a diastolic of _______.

A

Less than 120/80 (both numbers need to be lower)

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2
Q

Pre-hypertension is systolic ____to____

OR diastolic ____ to _____

A

Systolic: 120-139

Diastolic: 80-89

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3
Q

Stage 1 Hypertension is systolic ___to____

OR diastolic ___ to____

A

Systolic: 140-159

Diastolic: 90-99

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4
Q

Stage 2 hypertension is systolic _____

OR diastolic _____

A

Systolic: 160+

Diastolic: 100+

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5
Q

What is primary/essential HTN?

A

HTN that is due to multiple factors combining to raise BP

95% of all hypertension is essential HTN

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6
Q

What are the risk factors for Primary HTN?

There are 11 just look at the list

A

55yo + 👵🏿

Black 👩🏾‍🦱

Family history

Smoker 🚬

High salt diet🧂

Drinks a lot 🍸

Obese 🐽

Physical inactivity 🛋

Dyslipidemia 🥓

Personality traits (Type A, asshole, etc)

Vitamin D deficiency 🌞

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7
Q

What is secondary hypertension?

A

HTN resulting from an identifiable medication or medical condition

(You can have primary and secondary HTN going on at the same time. You should consider that your patient may have secondary HTN if they’re not responding to the tx you give them)

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8
Q

What are some of the possible causes of secondary HTN?

A

Renal disease

Renovascular disease

Medication (NSAIDS, estrogen, steroids)

Thyroid disease

Coarctation of the Aorta

Primary Hyperaldosteronism

Cushing‘s syndrome

Pheochromocytoma

Obstructive Sleep Apnea

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9
Q

What else is in the triad of primary hyperaldosteronism?

A

Hypokalemia

Metabolic acidosis

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10
Q

What is the triad of pheochromocytoma?

A

Headache

Sweating

Tachycardia

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11
Q

If your pts BP is elevated in the office, what should you do before you confirm their diagnosis of HTN?

A

Out of office blood pressure measurement

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12
Q

What is the gold standard for out-of-office BP measurement?

A

Ambulatory Blood Pressure Monitoring

(It’s the BP cuff you wear around for a few days. Good because it avoids white coat HTN, masked HTN, and lets you see nocturnal BP readings, which are better predictors anyways)

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13
Q

What are some of the general principles of obtaining a BP measurement?

A

Serial measurements are required

Measure on both arms

Comfortable setting

Avoid smoking, eating, exercising, and caffeine before taking your BP

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14
Q

What is better when checking BP in office: automated machine or manual BP?

A

Automated machine

Less likely to cause anxiety for the pt

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15
Q

What are some signs of end organ damage?

A

Heart failure

Renal failure

Stroke/CVA

Dementia

Aortic dissection

Retinopathy (vision changes)

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16
Q

What will you see on a fundoscopic exam of someone with MODERATE hypertensive retinopathy?

What else will you see if they have SEVERE hypertensive retinopathy?

A

Moderate: hard exudates, cotton wool spots, copper wiring, hemorrhaging, AV nicking

Severe: all of the above PLUS edema

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17
Q

What tests do you need to order when you’re thinking your pt has primary HTN?

A 
Lipid Profiile
Urinalysis 
Creatinine 
Blood Glucose
Electrolytes 
EKG

(LUCBEE)

(Creatanine, Glucose and electrolytes are all a basic metabolic panel)

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18
Q

What is the best available method to monitor BP?

A

ambulatory BP monitoring

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19
Q

Does diagnosing HTN require multiple BP readings over time?

A

Yes

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20
Q

What kinds of questions should you be asking about when you take your pt’s history?

A

Identifying risk factors

Identifying secondary etiologies

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21
Q

What kinds of things should you be looking for in your exam of the pt with HTN?

A

Signs of end-organ damage

Secondary etiologies

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22
Q

What is the FIRST line treatment for ALL patients with essential HTN?

A

Lifestyle modifications:
Diet

Exercise

Weight management

Stop smoking

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23
Q

How much sodium should people be eating?

A

Ideally less than 1.5 g/day

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24
Q

What is the maximum amount of alcohol pts should drink

A

1-2/day for men

1/day for women

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25
Q

What are the “Big 4” medications that you start with when treating HTN?

A

Diuretics

ACE inhibitors

Angiotensin Receptor Blockers (ARBs)

Calcium Channel Blockers (CCB)

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26
Q

At what BP should you start HTN meds for patients 60 or older who are otherwise healthy?

A

150/90

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27
Q

At what BP should you start HTN meds for pts who are younger than 60yo?

A

140/90

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28
Q

At what BP should you start HTN meds for anyone with CKD or diabetes?

A

140/90

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29
Q

If you have CKD, what BP meds should you start with?

A

ACE or ARB

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30
Q

If you are black, what BP med should you start with?

A

Thiazide diuretic

Or

Calcium channel blocker

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31
Q

What BP med should you start with if you are not black and do not have CKD?

A

Any of the big 4:

Thiazide diuretic

CCB

ACE inhibitor

ARB

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32
Q

Which 2 of the big 4 BP meds should not be used together?

A

ACE and ARB

Kidneys explode

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33
Q

If a patient is on 3/4 of the big 4 HTN meds, what should you do?

A

Consider other classes of meds

Refer to a specialist

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34
Q

If a single drug is not maintaining your pt’s BP, what should you do?

A

Add another one from the big 4

And if that doesn’t work, add another one from the big 4

(But don’t use an ACE and an ARB together)

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35
Q

What is resistant HTN and what should you do if your patient has it?

A

BP that is not controlled with 3 drugs or requires 4 drugs to control it

You should ensure the pt is actually adhering to lifestyle changes and medication regimen, and consider referral

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36
Q

What treatment would you recommend:

75 yo Hispanic female with BP 162/98 with DM and CKD?

A

Lifestyle modification

ACE or ARB (CKD trumps every else!)

Goal BP: 140/90

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37
Q

What treatment would you recommend:

65 yo black female with BP 162/98 and is diabetic

A

Lifestyle modifications

Thiazide or CCB (because of her race)

Goal BP is 140/90

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38
Q

What treatment would you recommend:

45 yo white male with BP 148/78

A

Lifestyle modifications

CCB, ARB, ACEI, or thiazide

Goal BP is 140/90

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39
Q

What is the MOA of diuretics?

A

Inhibits sodium reabsorption in nephron.

Reduces plasma volume AND peripheral vascular resistance

40
Q

What are the side effects of thiazide type diuretics?

A

HYPOkalemia

Hypomagnesia

Hypercalcemia

Hyperuricemia (gout…)

Hyperglycemia

Dyslipidemia

Erectile dysfucntion

41
Q

What is the main contraindication to thiazide and loop diuretics

A

Sulfa sensitivity

42
Q

What supplement should your pt be on if you have them on a loop diuretic?

A

Potassium

43
Q

Name one thiazide diuretic

A

Hydrochlorothiazide (HCTZ)

44
Q

Name one loop diuretic

A

Furosemide (Lasix)

45
Q

What are the side effects of loop diuretics?

A

Hypokalemia

Hypomagnesia

Hypokalemia

Sexual dysfunction

(Similar to thiazides)

46
Q

Name one potassium sparing diuretic

A

Triamterene (Dyrenium)

47
Q

What are the side effects of potassium sparing diuretics?

A

HYPERkalemia (especially with CKD or DM)

Kidney stones

48
Q

Name one aldosterone antagonist

A

Spironolactone (Aldactone)

49
Q

What are the side effects of aldosterone antagonists?

A

HYPERkalemia

Gynecomastia

50
Q

Which is a more potent antihypertensive: Potassium Sparing Diuretics or Aldosterone Antagonists

A

Aldosterone antagonists

Spironolactone

51
Q

What HTN meds can NOT be used in pregnancy?

A

ACE inhibitors

ARBs

Direct Renin inhibitors (Aliskiren)

52
Q

What is the most commonly used HTN drug in pregnancy?

A

Central alpha agonists (Methyldopa or Clonidine)

53
Q

What are the side effects of ACE inhibitors?

A

Cough****

Hyperkalemia

Angioedema

Dizziness

Renal failure

54
Q

What is the MOA of ACE inhibitors?

A

Inhibit the RAAS system AND stimulate bradykinin (which has a vasodilator effect….also the reason for the cough)

55
Q

What are the names of the ACE inhibitors?

A

The -prils

Lisinopril

Quinapril

Enalapril

56
Q

What are the contraindications to ACE inhibitoes?

A

Pregnancy

Angioedema

Renal artery stenosis

57
Q

What are some compelling indications for ACE inhibitors other than HTN

A

DM

CKD

Post-MI

Heart failure

58
Q

Name some ARBs

A

The -sartans

Losartan

Valsartan

Olmesartan

Etc

59
Q

What are the contraindications to ARBs?

A

Pregnancy

Renal artery stenosis

60
Q

Which type of calcium channel blocker has more of a cardiac depressant effect?

A

Non-dihydro

61
Q

Which type of calcium channel blocker is more selective as vasodilators and has less cardiac depressant effect?

A

Dihydropyridine

62
Q

Which two drugs are non-dehydropyridine calcium channel blockers?>

A

Verapamil

Diltiazem

63
Q

Which drugs are the dihydropyridine calcium channel blockers?

A

The ones that end in -dipine

Amlodipine

Felodipine

Isradipine etc

64
Q

Wat is the MOA of calcium channel blockers?

A

Inhibit calcium influx into arterial smooth muscle cells which reduces peripheral vascular resistance

65
Q

What are the contraindications to calcium channel blockers?

A

NON-dihydro: LV dysfunction, sick sinus syndrome, 2 or 3 degree AV block

Dihydropyridine: acute MI

BASICALLY HEART STUFF

66
Q

What are the side effects of calcium channel blockers?

A

Headache

Constipation

Peripheral edema

Bradycardia

Flushing

Dizziness

Nausea

67
Q

What are the 2 types of beta blockers?

A

Cardioselective (B1 receptors only)

Noncardioselective (B1 and B2 receptors)

68
Q

What is the MOA of beta blockers?

A

Blocks activity of catecholamines at B receptors which leads to decreased cardiac output, decreased peripheral vascular resistance, and decreased renin activity (propranolol)

69
Q

Is it ok to use beta blockers in pregnancy?

A

Yes they are used often

70
Q

What can happen if you abruptly stop your beta blocker?

A

Acute coronary events and severe increase in BP (hypertensive crisis)

71
Q

What are some compelling indications for beta blockers other than for HTN control/

A

Stable heart failure

Post-MI

High CAD risk pts

72
Q

Which drugs are beta blockers?

A

The ones that end in -olol

Propranolol

Nadolol

Atenolol

Metoprolol

Nabivolol

73
Q

What are the contraindications to beta blockers ?

A

Asthma***

Conduction abnormalities

74
Q

What are the side effects of beta blockers

A

Bronchospasm

Bradycardia

Sleep disturbance

Depression

Erectile dysfunction

75
Q

Which two drugs are Central alpha agonists?

A

Clonidine

Methyldopa

76
Q

Which central alpha agonist is OK in pregnancy?

A

Methyldopa

77
Q

What is the MOA of central alpha agonists?

A

Stimulate a2 adrenergic receptors in the brain which reduces CNS sympathetic outflow

78
Q

What are the side effects of Methyldopa?

A

Hepatitis**

Hemolytic anemia*****

Fever

79
Q

What are the side effects of alpha blockers?

A

Orthostatic hypotension

Reflex tachycardia

Dizziness

80
Q

Which drugs are the alpha blockers?

A

The ones that end in -zosin

Doxazosin

Terazosin

Prazosin

81
Q

What is the MOA of alpha blockers?

A

Target a1 receptors on vascular smooth muscles, causing a decrease in peripheral resistance

82
Q

What is a compelling indication for the drugs that end in -zosin?

A

-zosin drugs = alpha blockers

Compelling indication is for BPH to relax the bladder sphincter

83
Q

Which type of blood pressure medication can be used to help men with BPH urinate more easily?

A

Alpha blockers

Doxazosin

Terazosin

Prazosin

84
Q

Can we use alpha blockers all by themselves for HTN? Can we use them for severe HTN?

A

No

No, mild-moderate only

85
Q

Which drug is a direct renin inhibitor?

A

Aliskiren

86
Q

What are the contraindications of direct renin inhibitors aka Aliskiren?

A

Diabetics who are on an ACE or ARB

Pregnancy

87
Q

Which two of the big 4 can cause angioedema?

A

ACE and ARBs

88
Q

Which two of the big 4 are great for DM, CKD, and heart failure?

A

ACE and ARBs

89
Q

Which two of the big 4 is contraindicated in renal artery stenosis?

A

ACE and ARBs

90
Q

Which two of the big 4 are contraindicated in pregnancy?

A

ACE and ARBs

91
Q

What are the 2 kinds of hypertensive crises?

A

Hypertensive urgency

Hypertensive emergency

92
Q

What is hypertensive urgency?

A

asymptomatic* severe HTN (diastolic over 120)

No evidence of end-organ damage

93
Q

What is a hypertensive emergency?

A

Severe HTN (diastolic over 120) AND evidence of end organ damage

94
Q

What usually causes a hypertensive urgency?

A

Nonadherence/abrupt stop to BP meds (rebound)

Eating a ton of salt

other:
Stroke, trauma, MI, aortic dissection, pre-eclampsia, pheo, renal emergency

95
Q

What is the goal of treating hypertensive urgency?

A

To reduce BP to less than 160/120 over a period of hours to days

96
Q

What do you do to treat hypertensive urgency?

A

Rest in quiet room

Increase dose of current meds

Add additional med (diuretic)

Adhere to sodium restriction

Follow up

**basically go home and rest and take your meds*

97
Q

What do you do to treat hypertensive emergency?

A

Hospitalize in ICU

Address underlying cause

don’t drop BP too fast-can cause brain ischemia

Sublingual nefidipine is CONTRAINDICATED

Clin Med Exam 1(Lauren) (8 decks)

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