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Cardiology > Hypertension part II > Flashcards

Hypertension part II Flashcards

1
Q

First-line medications for HTN

A

ACE
ARBs
CCB
Thiazides

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2
Q

After getting dx with HTN stage 1, what should you do?

A

Order a lipid panel in order to see if they have an ASCVD > 10% to treat

After 2 readings (for textbook medicine)

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3
Q

How long does it take BP meds to take affect?

A

4-6 week intervals
Can counsel about at-home cuff (reliable, cross-checked

Want to see if the reading is less than 130/80 to make sure that the treatment is working, and if it is less than 100/60

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4
Q

If a patient has CKD, what should you be mindful of when treating HTN? What do you do for this?

A

Potassium status

BMP to check kidney function that there is not a jump

Can get renal artery stenosis and order an ultrasound to dx

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5
Q

What patients should specifically be on an ACE or an ARB?

A

DM
CKD

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6
Q

What meds should you start with for HTN?

A

Any of them
ACE/ARB should not be taken at the same time though!
CCB
Thiazide

Pick one med, max it out, then pick another, max it out, then pick it out

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7
Q

When do we use BB?

A

After you max meds out, or if there is a heart issue

Aldosterone antagonist should not be started as well

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8
Q

What should you keep in mind with comorbid treatment and treating HTN?

A

Could kill two birds with one stone and may be able to treat multiple conditions

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9
Q

After a patient is stable (130/80), how often should you see a patient?

A

every 6-12 months

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10
Q

How often should you do an EKG for HTN patients?

A

2-4 years, unless there is additional concerns.

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11
Q

What additional labs can you order for HTN patients?

A

Lipids
TSH
UA (make sure kidney is ok)

Don’t have to

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12
Q

What are the two different types of hypertensive crises?

A

Hypertensive urgency
Hypertensive emergency

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13
Q

How is Hypertensive urgency and
Hypertensive emergency treated?

A

Urgency = outpatient
Emergency = inpatient

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14
Q

What is hypertensive urgency? What is the BP?

A

Severe HTN w/out ACUTE symptoms
BP > 220/125 mmHg¹

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15
Q

What is the etiology of HTN urgency?

A

Exacerbation of poorly controlled chronic HTN

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16
Q

What are red flags of a HTN urgency that would merit a referral to inpatient treatment?

A

HA
No urine
Neurologic issues

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17
Q

What labs should you obtain for HTN urgency?

A

BMP, UA, and EKG

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18
Q

What is a short-acting HTN treatment that is used for ACUTE treatment only?

A

Clonidine (very small pill)
Great for fast-acting HTN Urgency

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19
Q

What is the first thing that you should ask a patient in a HTN urgency?

A

Taken meds? Can call pharmacy to see if they have been picking up meds.

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20
Q

What is the overall goal of HTN urgency treatment?

A

Reduce BP w/in hours!
Should still start low and go slow

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21
Q

What are the four in-office agents for HTN urgency?

A

Clonidine
Captopril (ACE-I)
Metoprolol tartrate (short-acting)
Hydralazine (Dosed 3 times a day)

Most (metoprolol)
Common (clonidine)
Cure (captopril)
Hypertension (Hydralazine)

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22
Q

What is a concern of clonodine?

A

Sedation (clon = clause = santa = sleep)

Worry about driving

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23
Q

What is a concern of captopril?

A

Excessive hypotension
Worried about

24
Q

What is a concern of metoprolol tartrate?

A

bradycardia

25
Q

Why do you see tachycardia in hydralazine?

A

Vasodilation, which reduces BP, but requires the heart to pump faster

26
Q

What is nifedipine and why is it no longer used?

A

CCB
Response is unpredictable

27
Q

What differs HTN Emergency from Urgency?

A

NOT the number, just that there is organ failure

28
Q

What should you do for HTN Emergency first?

A

EMS referral with nitroglycerine or clonidine

29
Q

What PE should you check for HTN emergency?

A

Head to toe, but need to treat right away

30
Q

Why do you keep BP elevated for ischemic stroke?

A

Reducing blood flow can further organ damage

31
Q

What BP should you do for someone who is actively bleeding?

A

Lower BP to reduce bleeding

32
Q

What do you do for the initial evaluation of HTN emergency?

A

Same as HTN

33
Q

Why do you do a CXR for HTN emergency?

A

CXR allows you to check for HF, aortic dissection,

34
Q

Why do you order a urinary drug screening for HTN emergency?

A

Cocaine can elevate BP

35
Q

What labs do you order for HTN emergency?

A

CBC, CMP, EKG CXR, CT head (w/o 1st), UA, UDS, and so on

36
Q

Why no contrast for HTN emergency?

A

Worsens hemmoragic stroke

37
Q

What type of therapy do you do for a HTN emergency and how quickly do you lower BP and why?

A

Parenteral therapy should be used
Lower BP by no more than 25% in first 2 hours¹ (not more than this so that you maintain O2 delivery to other tissues)

38
Q

What is the end BP goal of a HTN emergency?

A

Then goal BP of 160/100 over next 2-6 hours

39
Q

What are the specific goals of BP for HTN Emergency for Ischemic CVA, Hemorrhagic CVA, Aortic dissection, and MI?

A

Ischemic CVA - SBP between 180-200 mmHg with slow reduction
Hemorrhagic CVA - target SBP is <140 mmHg
Aortic Dissection - goal SBP <120 mmHg
MI - will need anticoagulation and oxygen; typically use NTG for BP reduction, but no set goal

40
Q

What 2 med classes do you use for HTN emergency?

A

Beta blockers
Calcium channel blockers

41
Q

What are the 4 preferred HTN emergency meds in order of preference?

A

Nicardipine (CCB)
Clevidipine (CCB)
Labetalol (BB)
Esmolol (BB)
Fenoldopam (dopamine receptor agonist, rarely used)

42
Q

If BP is still not managed with the 4 preferred HTN emergency meds, what other meds do you use?

A

Enalaprilat
Furosemide
Nitroglycerine
Nitroprusside (should not be used!)

43
Q

What happens to your CO and HR during pregnancy? What is an abnormal BP>

A

Both increase
CO increases by 40%
HR increases 10 bpm

Abnormal BP is >140/90

44
Q

How does dx of HTN different in preggos?

A

Diagnosis requires two elevated readings at least 4 hours apart

45
Q

What is preeclampsia?

A

new onset HTN (BP ≥ 140/90) and proteinuria (24h urinary protein >300 mg/24h or creatinine ratio ≥0.3) after 20 weeks gestation

46
Q

What is the difference between preeclampsia and eclampsia?

A

eclampsia includes seizures as well as the other characteristics of preeclampsia.

47
Q

What is gestational HTN?

A

HTN (BP ≥ 140/90) after 20 weeks gestation w/o pre-existing HTN or proteinuria

48
Q

What med classes are CI in gestational or chronic HTN in pregnancy?

A

ACE and ARBs!

49
Q

What medications do you use for Acute BP treatment?

A

IV labetalol
IV hydralazine
oral immediate-release nifedipine

50
Q

What medications do you use for chronic BP treatment?

A

labetalol
ER nifedipine
methyldopa

51
Q

What is the target BP for preggos w/ HTN?

A

Target BP = 130-150/80-100
NOT recommended to reduce BP by more than 25% over 2 hours

52
Q

Define resistant HTN?

A

Defined as the failure to reach BP control in patients who are adherent to full doses of an appropriate 3-drug regimen, including a diuretic

53
Q

MC of resistant HTN?

A

Noncompliance with meds (because you are maxing out 3 meds)

54
Q

How do you manage resistant HTN?

A

Refer to nephro (preferred) or cardio to make adjustments

55
Q

What can you switch a patient on for resistant HTN?

A

Consider switching diuretic to aldosterone receptor blocker (spironolactone)

56
Q

Other than non-compliance, what can cause Resistant HTN?

A

Improper BP measurements
Volume overload and pseudotolerance
Poor lifestyle
Obesity
Alcohol
Drug-induced

57
Q
A

Cardiology (22 decks)

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