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Cardiology Part I > Hypertension Lecture Powerpoint > Flashcards

Hypertension Lecture Powerpoint Flashcards

fuck me

1
Q

Hypertension prevalence in the US

A

50 million individuals

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2
Q

hypertension is most prevalent in (men v women) and (white v blacks)

A

males, blacks

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3
Q

A patient with blood pressure over 160/90 more than twice requires…

A

….medication to bring it down

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4
Q

only ___% of adults with hypertension are receiving treatment

A

58

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5
Q

BP classifications (current guidelines)

A 
normal <120 and <80
elevated 120-129 and <80
Stage 1 130-139 or 80-89
Stage 2 >140 or >90
Hypertensive crisis >180 or >120
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6
Q

The ACC/AHA hypertension guidelines became the standard following…

A

…JNC 8 conditions which are too lax on target SBP and DBP goals

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7
Q

systolic BP that is lowest risk for stroke

A

<120 mmHg

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8
Q

Untreated high blood pressure can cause these condition (5)

A
  • left ventricular hypertrophy
  • angina
  • CHF
  • CVA
  • Retinopathy
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9
Q

Symptoms of hypertension (6)

A
  • typically asymptomatic
  • headache behind eyes particularly in morning
  • dizziness
  • visual disturbances
  • confusion
  • fatigue
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10
Q

Constant tobacco use throughout the day can result in…

A

….consistent vasospasm that results in peripheral vascular disease or coronary artery disease

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11
Q

Metabolic syndrome puts a patient ___x higher risk for heart disease

A

2-4

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12
Q

Major drugs that can increase BP (8)

A
  • OCP’s
  • alcohol
  • recreational drugs
  • NSAIDS
  • corticosteroids
  • TCA’s
  • MAO inhibitors
  • ephedrine sulfate
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13
Q

White coat hypertension

A

Patient’s tendency to have higher blood pressure in presence of doctor’s office due to nerves, still needs to be treated as hypertension but can be mitigated by having patient rest 5 min prior to taking BP

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14
Q

BP should ____ by 10-20% during sleep, failure to do so indicates…

A

decrease, indicates increased CVD risk

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15
Q

Physical exam for hypertension

A
  • 2 or more bp measurements separated by 2 min sitting, with arm supported at heart level
  • verification in contralateral arm
  • ocular fundus exam
  • exam neck for carotid bruits, jvd, enlarged thyroid
  • cardiac murmur, s3, s4, PMI, lifts or heaves
  • abdominal bruits
  • do CNS exam checking orientation, mental status, cranial nerve, motor and sensory
  • do skin exam looking for hydration, pallor, hair loss, edema
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16
Q

Imaging studies for hypertension

A

-Echocardiography can pick up late disease

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17
Q

Types of hypertension and notes about each (3)

A
  • essential or primary (without identifiable cause, 90% of them, treated with 2 medications)
  • 2ndary hypertension (often in those older than 60)
  • isolated systolic hypertension (elevated systolic pressure with normal or mildly elevated with diastolic, most common in older population)
18
Q

Kinogen-kallikrein system

A

Stimulates nitric oxide release, bradykinin is an active vasodilator and a natriuretic substance, bradykinin broken down by angiotensin II causing further increase in vasoconstriction in the RA system

19
Q

Sleep apnea is an often undiagnosed and untreated condition that is a risk factor for…

A

…cardiovascular disease

20
Q

5 drug classes for treatment of hypertension and one to avoid

A
  • diuretics
  • B blockers
  • ace inhibitors
  • ARB’s
  • Ca2+ channel blockers
  • alpha blockers should be avoided except in therapy with prostatic
21
Q

Thiazide diuretics mechanism of action, relative contraindications (3)

A
  • Works on distal convoluted tubule to prevent reabsorption of Na+, allowing water to follow and increase urine production
  • relatively contraindicated in patients with cardiac arrhythmias, gout, hypokalemia
22
Q

Loop diuretics mech of action, indication, and ADRs (4)

A
  • Works on ascending loop of henle
  • Only indicated to use for Htn associated with renal insufficiency
  • can result in weakness, hypokalemia, hyperlipidemia, hyperglycemia
23
Q

B blockers mech of action, ADR’s (5)

A
  • Reduces cardiac output and treats tachycardia

- bronchospasm, fatigue, exercise intolerance, decreases HDL, increases triglycerides,

24
Q

atenolol is associated with…

A

Increased risk of diabetes and stroke (so probably don’t use this medication)

25
Q

Nebivolol (bystolic) - New B blocker

A

-highest specificity for B1 receptor resulting in no metabolic or sexual side effects unlike current B blockers

26
Q

Ca2+ channel blockers side effects of 2 common bois

A

really awesome, can cause edema as most common side effect of amoldipine, and constipation is most common side effect of felodipine

27
Q

ACEI, what patient group is it used for and why?

A

inhibits angiotensin I from converting to angiotensin II, slows progression of renal disease so used if a patient has proteinuria or diabetes

28
Q

If a patient has proteinuria or diabetes you treat with a ___ or ___ rather than a ___

A

ACEI ARB, Ca2+ channel blocker

29
Q

2 drugs that are always used in hypertensive patients

A
  • ACEI

- B blocker

30
Q

a receptor antagonist for hypertension and most common ADR

A

only use on patient with underlying BPH prostate problems, problems include syncope most common

31
Q

ARB ADR’s (2)

A

-hyperkalemia or angioedema

32
Q

2ndary hypertension causes (7)

A
  • atherosclerosis
  • PKD
  • Cushing’s disease
  • hyperaldosteronism
  • AV fisula
  • coarctation of aorta
  • sleep apnea
33
Q

Hyperensive urgency

A

Desirable to reduce BP within 24-48 hrs

34
Q

Hypertensive emergencies

A

Severe Htn that requires immediate reduction over minutes to hrs

35
Q

Accelerated hypertension

A

markedly elevated BP associated associated with acute, target organ damage

36
Q

Malignant hypertension

A

A hypertensive emergency with papilledema due to increased intracranial pressure requiring imediate but controlled decrease of BP

37
Q

Hypertension must be controlled in order to prevent…

A

…end organ damage

38
Q

Pharmacologic therapy for hypertension begins at a BP of ____ for most patients or ____ for patients with diabetes, CKD, age >65, or 10 year risk of atherosclerotic disease >10%

A

140/90, 130/80

39
Q

Nonblack patient first line of hypertension treatment (5)

A
  • thiazide diuretic
  • Ca2+ channel blocker
  • B blocker
  • ACE inhibitor
  • ARB
40
Q

Black patient first line of hypertension treatment

A
  • thiazide diuretic

- Ca2+ channel blocker

41
Q

In patients with kidney disease, initial hypertension treatment should be these 2 regardless of race

A

ACEI and ARB’s

Cardiology Part I (28 decks)

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