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Clin Med 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

classification of normal blood pressure

A

<120 AND <80

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2
Q

classification of elevated blood pressure

A

120-129 AND <80

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3
Q

classification of stage 1 hypertension

A

130-139 or 80-89

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4
Q

classification of stage 2 hypertension

A

> or equal to 140 or > or equal to 90

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5
Q

risk factors for primary htn

A 
smoking
unhealthy diet
excess alcohol intake
obesity/weight gain
physical inactivity
dyslipidemia
and others
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6
Q

secondary htn etiology

A 
renal disease
renovascular disease
obstructive sleep apnea
coarctation of the aorta
primary hyperaldosteronism
cushing's syndrome
pheochromoctoma
medication induced
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7
Q

what is the gold standard for diagnosing elevated blood pressure

A

ambulatory blood pressure monitoring

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8
Q

what is white coat HTN

A

erroneously high BP in clinic due to anxiety

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9
Q

what is masked HTN

A

erroneously low BP in clinic due to being sneaky

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10
Q

what is nocturnal monitoring

A

useful in predicting cardiovascular events

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11
Q

Basic an optional tests for primary HTN *know well

A 
fasting blood glucose
complete blood count
lipid profile
serum creatine with eGFR
serum sodium, potassium, calcium
thyroid-stimulating hormone
urinalysis
electrocardiogram
urinary albumnin to creatine ratio in all patients with diabetes or chronic kidney disease
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12
Q

Management of htn first line for ALL patients

A

dietary modifications: low salt, DASH, EtOH reduction
exercise 3-4 days week
achieve and maintain a healthy weight
smoking cessation

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13
Q

management of htn medications

A

Diuretics
angiotensin converting enzyme inhibitors ACE-1
angiotensinogen receptor blockers ARB
calcium channel blockers CCB

beta blockers
alpha blockers
central alpha agonists
direct renin inhibitor

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14
Q

what do you use for initiation of antihypertensive drug therapy

A

first line include thiazide diuretics, CCBs, and ACE inhibitors or ARBs

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15
Q

what do you use for stage 1 initial medication

A

a single hypertensive drug is reasonable, titrating up or adding a second medication as need to achieve BP goal

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16
Q

what do you use for stae 2 initial medication

A

starting with 2 first line agents of different classes

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17
Q

how often do you follow up

A

monthly after starting/change dose of medication until control is achieved

18
Q

if chronic kidney disease what med should be first

A

if albuminuria greaterthan or equal to 300 or creatinine then should be an ACE inhibitor

19
Q

if diabetes mellitus what med first

A

if albuminurea present ACE or ARB should be considered if not use first line choices

20
Q

if heart failure what med first

A

avoid nondihydropyridine CCBs not recommended if ejection fraction is reduced
should receive ACE, ARB, or beta blocker if ejection fraction is preserved

21
Q

Diuretics MOA

A

decreases body’s sodium stores by inhibiting sodium reabsorption in the nephron

reduces plasma volume and peripheral vascular resistance

22
Q

Thiazide-type diuretics preferred what to monitor and contras

A

Chlorthalidone
monitor for hyponatremia, hypokalemia, uric acid and calcium levels (electrolyte imbalance)
contras: sulfa hypersensitivity

23
Q

Loop diuretics (secondary agents) diuretics preferred what to monitor and contras

A

furosemide (lasix)
preffered diuretic in symptomatic HF
monitor for hyponatremia, hypokalemia, and calcium levels
contras: sulfa sensitivity

24
Q

potassium sparing diuretics diuretics preferred what to monitor and contras

A

triamterene
weak antihypertensives
Ses: hyperkalemia nephrolithiasis, renal dysfunction
caution combining with ACE-1, ARB, DRI, K supplements

25
Q

Aldosterone antagonists diuretics preferred what to monitor and contras

A

spironolactone (aldactone)
preferred agent in primary aldosterone
common add-on in resistant HTN
contra: renal impairment

26
Q

Ace inhibitors diuretics preferred what to monitor and contras

A

lisinopril, quinapril, enalapril
inhibit the RAAS system and stimulate bradykinin which has a vasodilator effect
SEs: cough, hyperkalemia, angioedema, dizziness, acute renal failure

Contras: pregnancy, angioedema, renal artery stenosis
cannot combine with ARB

Compelling indications: DM, CKD, post-MI, heart failure

27
Q

alpha blockers diuretics preferred what to monitor and contras

A

doxazosin, terazosin, prazosin

MOA: targets a1 receptors on vascular smooth muscle causing peripheral vascular resistance to decrease thus decreasing blood pressure

SEs: orthostatic hypotension and reflex tachycardia dizziness
use mild-moderate HTN and not for monotherapy
compelling indication =BPH

28
Q

Direct renin inhibitors diuretics preferred what to monitor and contras

A

aliskiren

MOA: inhibit enzyme activity of renin, reducing the activity of angiotensin I and II and aldosterone

SEs: hyperkalemia, renal impairment, hypersensitivity reactions (anaphylaxis angioedema)

Contras: use with an ACE-I or ARB in diabetics; pregnancy

29
Q

central alpha agonists diuretics preferred what to monitor and contras

A

last line
safe for pregnancy
methyldopa is contraindicated in liver failure
avoid abrupt cessation

30
Q

what is hypersensitive crisis

A

ASYMPTOMATIC severe HTN (diastolic > 120) and NO evidence of end organ failure

usually nonadherence to chronic antihypertensive meds or low sodium diet

31
Q

what is hypertensive emergency

A

severe HTN diastolic > 120 and evidence of acute to end-organ damage

32
Q

causes of hypertensive crisis

A 
abrupt d/c of BP meds 
high salt load
neurological emergencies (stroke, trauma)
cardiac emergencies (HF, MI)
vascular emergencies (aortic dissection)
pregnancy (pre-eclampsia)
sympathetic overactivity (rebound HTN, pheo)
renal emergencies
33
Q

Hypertensive urgency goal and treatment strategy

A

goal is reduce BP to <160/120 in a few hours to days
treatment:
rest in quiet room
increase dose of current meds
add additional medication (diuretic)
adherence to sodium restriction
follow up to monitor for symptoms of HTN or hypoTN

34
Q

hypertensive emergency treatment and goal

A 
should be hospitalized to ICU
address underlying cause:
Neuro exam
CXR
EKG
UA
Electrolytes/creatinine
CT/MRI

Reduction of BP
no more than 25% within minutes to 1 hour
goal is 160/100-110 over 2-6 hours
if stable, then decrease to normal BP goal over 24-48 hours
IV nitrates; CCBs adrenergic blockers, hydralazine
sublingual nefidipine is contraindicated

35
Q

how to measure orthostatic hypotension

A

2-5 min of quiet standing after a five minute period of supine rest:
at least a 20 fall in systolic
at least a 10 fall in diastolic

36
Q

Etiology of hypotension

A

autonomic dysfunction
parkinson’s
neuropathies (diabetes)

Volume depletion:
diuretics, hemorrhage, or vomiting

Medication often contribute
anti-HTN meds in the elderly

37
Q

orthostatic hypotension symptoms and treatment

A

weakness
dizziness or lightheadedness
visual blurring or darkening of the visual fields
syncope

treat underlying cause but tx is symptomatic

38
Q

what is cardiogenic shock and how does it commonly occur

A

a state of cellular and tissue hypoxia

occurs when there is a circulatory failure manifest as hypotension

39
Q

Etiology of cardiogenic shock

A

MI
atrial/ventricular arrhythmias
valve/ventricle septal rupture

40
Q

hypotension range definition etc

A

absolute SBP <90 MAP <65
relative drop in systolic pressure >40
>20 sys >10 dias
profound (vasopressor-dependent)

41
Q

presentation of cardiogenic shock

A

hypotension
pulmonary edema (diffuse crackles, JVD)
Echocardiography (dilated ventricles, valvular or septal abnormalities)
tachypnea, oliguria, AMS, clammy skin, etc

42
Q

management of cardiogenic shock

A

ABCs, IV placement, fluids
stabilize pt
determine/treat underlying conditions

Clin Med 2 (6 decks)

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