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Renal Exam III > Hypertension Pales CIS > Flashcards

Hypertension Pales CIS Flashcards

1
Q

Definition of Htn

A

Normal:

Systolic

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2
Q

What are the contributing (risk) factors for developing essential HTN?

A 
Genetic predisposition
Abdominal Obesity
Salt intake
Alcohol intake
Age
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3
Q

HTN is a risk factor for:

A 
Stroke
Myocardial Infarction
Heart Failure
ESRD
Atrial Fibrillation
Aortic Dissection
PVD
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4
Q

older patients with HTN?

A

lder patients have atherosclerosis in larger vessels, aorta

high systolic and lower diastolic

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5
Q

What is the likely mechanism of this patient’s blood pressure elevation?

A

vasoconstriction of capillaries, or vasospasm

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6
Q

physical activity

A

Modification: engage in regular aerobic physical activity such as brisk walking 30 min every day

Approximate systolic bp reduction range: 4 to 9 mmHg

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7
Q

Weight reduction

A

Modification: maintain normal body weight

Approximate systolic bp reduction range: 5-20 mmHg per 10kg of weight loss

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8
Q

adopt a dash eating plan

A

Modification: consume a diet rich in fruits beggies and low fat dairy products with a reduced content of saturated and total fat

Approximate systolic bp reduction range: 8 to 14 mmHg

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9
Q

dietary sodium reduction

A

Modification: Reuce dietary sodium intake to no more than 100meq/day (2.4 g sodium or 6 g sodium cholride

Approximate systolic bp reduction range:2 to 8 mmHg

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10
Q

Moderation of alcohol consumption

A

Modification: limit consumption to no more than 2 drinks per day in most men and no more than 1 drink per day in women and ligther weight persons

Approximate systolic bp reduction range: 2 to 4 mmHg

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11
Q

Initial Recommended HTN treatment for Non-Black population

A

ACE Inhibitors
ARB
CCB
Thiazide diuretics

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12
Q

Initial Recommended HTN treatment for Black population

A

CCB

Thiazide diuretics

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13
Q

When should we suspect secondary HTN?

A

Compelling finding on initial evaluation
Hard to control HTN (either new onset or well controlled HTN becoming hard to control)
Atypical age of diagnosis (less than 30)
Absence predisposing factors

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14
Q

Diagnosis of Renovascular Hypertension

A
  1. Captopril Test (reactive rise in renin and large fall in BP after administration)
  2. DSA
  3. MRI –angiography
  4. Arteriography
  5. Renal vein renin ratio (ratio of 1.5 or greater)
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15
Q

2 main cuases of renovascular hypertension

A

atherosclerosis

fibromuscular dysplasia

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16
Q

Atherosclerosis over view

A 
Age - >50
sex - male
bilaterality33% - 
progressive - +++
response to angioplasty - +
associated risks, tobacco, lipids, diabetes, etc - +++
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17
Q

fibromuscular dysplasia overview

A

Age -

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18
Q

3 types of renovasuclar htn

A

Unilateral
bilateral
one kidney

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19
Q

Unilateral renovascular htn

A

decreases intravascular volume

more renin mediated than the others

bp usually falls with ACEI

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20
Q

Bilateral renovasuclar htn

A

increase intrabascular volume

renin mediation is more varied

ace response unpredicatlbe and may worsen htn

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21
Q

One kidney renovascular htn

A

increased intravascular volume

renin mediation is more varied

ace response unpredicatable andy may worsen htn

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22
Q

graves disease tests

A

tsh should be low, t3 would be high and antibodies will be high

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23
Q

meds for graves (hyperthyroidism)

A

beta blockers for htn

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24
Q

hypertensive urgency

A

A systolic BP > 180 or a diastolic BP > 130 and NO evidence of end organ damage.

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25
Q

hypertensive emergency

A

May occur at any BP, but involves ACUTE DAMAGE to at least one organ system.

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26
Q

Signs of Target Organ Involvement Acute and Chronic

cardiovascular

A

MI (A), Angina (A), Aortic dissection (A), Aneurysmal dilatation of large vessels (C), LVH (C),
CHF (A)

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27
Q

Signs of Target Organ Involvement Acute and Chronic

CNS

A

Cerebral edema (A), Altered mental status (A), Bleed (A), Stroke (A) or TIA (A)

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28
Q

Signs of Target Organ Involvement Acute and Chronic

renal

A

Hematuria (C), Proteinuria (C), ARF (A)

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29
Q

Signs of Target Organ Involvement Acute and Chronic

ophthalmologic

A

Retinal hemorrhages or exudates (A or C), Papilledema (A)

A-V nicking (C)

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30
Q

primary hyperaldosteronism

cons disease

A
  1. Located in adrenal gland without exogenous stimulus.

2. Elevated aldosterone and low renin levels

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31
Q

Primary hyperaldosteronism types

A
  1. Aldosterone producing adenoma
  2. Idiopathic Hyperaldosteronism
  3. Bilateral adrenal hyperplasia
  4. Aldosterone producing Ca
  5. Aldosterone producing renin-responsive adenoma
  6. Ectopic aldosterone producing tumor
  7. Dexamathasone suppressible hyperaldosteronism
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32
Q

Secondary hyperaldosteronism

A 
Elevated aldosterone and elevated renin levels
Causes are:
1. Diuretics
2. CHF
3. Cirrhosis
4. Ascites
5.
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33
Q

why are pts with hyperaldosteronism weak

A

hypokalemia

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34
Q

how do you treat hyperaldosteronism?

A

aldosterone blockers

spironolactone

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35
Q

secondary hypertension causes

A
  1. Sleep apena
  2. Drug induced causes
  3. Chronic kidney disease
  4. Primary aldosteronism
  5. Renovascular disease
  6. Steroid therapy or Cushing’s syndrome
  7. Pheochromocytoma
  8. Coarctation of the aorta
  9. Thyroid disease
  10. Parathyroid disease
  11. Pain induced
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36
Q

coarctation of aorta

A

1) Narrowing of medial layer of aorta.
2) Commonly at ligamentum arteriosum.
3) 3 types:
A) Interrupted
B) Preductal
C) Postductal

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37
Q

Diagnosis of Coarctation

A
  1. Differences in upper and lower extremities
  2. Blood Pressure
  3. systolic hypertension in an infant
  4. 20mm hg between arms
  5. Heart Sounds –if isolated a systolic ejection murmur in the aortic outlet and between scapulae.
  6. Radiology –
  7. Cardiomegaly
  8. Rib notching
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38
Q

Suffices

acei

A

pril

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39
Q

suffixes

b blockers

40
Q

suffixes

dihydropyridines ccb

41
Q

suffixes

arbs

42
Q

suffixes alpha blockers

43
Q

suffixes

thiazides

A

hctz chlorthalidone

44
Q

suffixes direct vasodilators

A

hydralazine and minoxidil

45
Q

suffixes

central sympatholytics

A

clonidine

methyldopa

46
Q

DRI suffixes

47
Q

Nondihydropyridine ccb

A

verapamil

diltiazem

48
Q

Cough is the most annoying side effect of which BP med

A

lisinopril

49
Q

This BP medication may lead to severe symptomatic bradycardia including heart block when added to a Beta blocker

50
Q

Hyperkalemia is a possible life-threatening side effect of which blood pressure medication

A

valsartan

arbs block k secretion

51
Q

This medication is a drug of choice for treatment of blood pressure for patients with mild to moderate kidney disease (especially with proteinuria), but in patients with severe kidney disease it may tip patient into the ESRD

52
Q

How can ACE Inhibitors help/hurt the kidneys

A

they dialate efferent arteriole

high pressure will cause sclerosis but if gfr is too low it will hurt the kidney

53
Q

Patients with severe sulfa allergies should avoid this BP medication

54
Q

Alcoholic withdrawals symptoms are helped with this blood pressure medication

55
Q

Patients with history of severe asthma could get an asthma exacerbation with initiation of this blood pressure medication

56
Q

This medication precipitated condition shown on this picture.

A

chlorthalidone

thiazides increase uric acid

57
Q

This medication may help with symptoms of prostate enlargement, but may cause reflex tachycardia

58
Q 
All of these medications may cause lower extremities edema, except which one?
Amlodipine
Hydralazine
Metoprolol
Minoxidil
Terazosin
A

metoprolol

the other ones are all peripheral vasodilators so they cause edema

59
Q

Watch out for drug induced lupus when you use this Blood Pressure medication at high doses

A

hydralazine

diagnosed by antihistones

60
Q

This medication may worsen blood sugar control in diabetic patients

61
Q

Also used as a hair growth product for alopecia, this BP medication should be used with caution in women not desiring hursitism.

A

minoxidil

or rogaine

62
Q

This diuretic blood pressure medication should be used in patients with systolic heart failure and in patients with one specific cause of secondary HTN, though it may cause gynecomastia in men

A

spironolacton

63
Q

According to JNC-VIII guidelines, this medication class is recommended for initial treatment of HTN in non-black population, but not in African-American patients.

A

ace inhibtiors

64
Q

In patients with diabetes, the best initial choice of an antihypertensive medication is

A

acei or arbs

65
Q

Patient with recent heart attack, should be on this BP medication

A

metoprolol

66
Q

In patients with systolic congestive heart failure, all but one of these blood pressure medications should be the first ones to be prescribed

A

nifedipine

67
Q

These combination pill is frequently used in treatment of HTN. Each of the medication within the combination often cancel each other’s opposing effect on serum potassium level.

A

Lisinopril/hydrochlorothiazide (Zestoretic)

68
Q

In pregnant patients, this medication is preferred to treat HTN because it’s one of the oldest and the most studied in pregnancy

A

methyldopa

69
Q

Angioedema is a rare but scary and life threatening side effect of this medication, especially in patients with C1 esterase deficiency.

70
Q

Cocaine addict coming with severe HTN should not be treated with this medication alone

A

propranolol, cocain is alpha beta agonism so if you block beta 2 alpha 1 is unopposed and things may get worse

71
Q

Patients with hypertensive emergencies can be treated with all of the below medication except for this one.

A

losartan it doesnt come in iv

72
Q

Thiazide diuretics may decrease all of the following electrolytes in the blood except

73
Q

If you abruptly stop this medication, it may cause severe rebound hypertension

74
Q

meds that cause angioedema

75
Q

meds that causeankle edema

A

amlodipine

76
Q

After MI

A

Agent:Beta Blocker, ACE Inhibitor

Caution:Direct Vasodilators (may worsen coronary insufficiency)

77
Q

CHF

A

Agent: ACE Inhibitor, Diuretics; Beta blockers (no pulm edema)

Caution: Beta Blockers, CCB

78
Q

Hypertrophic cardiomyopathy

A

Agent:Beta Blockers, CCB

Caution: Diuretics, ACE Inhibitors, direct vasodilators

79
Q

Bradycardia, Heart Block

A

Agent:

Caution: Beta Blockers, CCB non dihydropyridines

80
Q

Tachyarrhythmias

A

Agent:Beta Blockers, verapamil

81
Q

Angina

A

Agent: Beta Blockers, CCB, Nitroglycerin,

Caution: Direct Vasodilators (

82
Q

COPD/ROAD

A

Agent: ccb

Caution: bet blockers

83
Q

Aortic Disecction

A

Agent: Nitroprusside, Beta Blocker

Caution: Drugs that > cardiac output
Increased shear stress

84
Q

bilateral renal artery stenosis

A

Agent:

Caution:: Ace Inhibitors, Angiotensin Blockers (May worsen renal function)

85
Q

chronic renal insufficiency

A

Agent: Ace Inhibitors (With serum creatinine

86
Q

Renal Transplants

A

Agent:

Caution: ACE Inhibitors (may worsen renal function)

87
Q

Migraine headaches

A

Agent:Beta Blockers, CCB (may relive migrai ne symptoms) non dihydropyridines

Caution:

88
Q

Stroke or TIA

A

Agent: ACE Inhibitors (may allow reestablishment of cns autoregulation)

Caution: Vasodilators may increase intracranial pressure

89
Q

Diabetes

A

Agent: ACE inhibitor (delay renal failure; decrease proteinuria)

Condition:

90
Q

Pregnancy (preeclampsia, eclampsia)

A

Agent: Methyldopa, Hydralazine; Beta blockers with caution

Caution: ACE Inhibitors, Angiotensin blockers, (may cause renal agenesis) Diuretics

91
Q

gout

A

Agent:

Caution: Diuretics (worsen joint pain or precipitate gout)

92
Q

Cocaine use

A

Agent: Labetalol, Clonidine

Caution: Selective B-blockers (unopposed cocaine induced Alpha agonism)

93
Q

GI BLeed

A

Agent: Non-selective Beta Blocker (lower portal blood pressure)

Caution: Beta Blockers (may mask signs of acute bleeding)

94
Q

Pheochromocytoma

A

Agent: Alpha Blocker –then –Beta blockade

Caution: Selective Beta Blocker (unopposed alpha agonism)

95
Q

Bening prostatic hypertrophy

A

Agent: Alpha-1 antagonist

Caution: Selective Beta Blocker (unopposed alpha agonism)

Renal Exam III (17 decks)

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