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Hypertension & PUD Flashcards

1
Q

Silent Killer

A

Hypertension

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2
Q

Hypertension

A

High blood pressure; when the force of blood pushing against your artery walls is consistently too high

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3
Q

What can HTN damage?

A

Your arteries over time and can lead to serious complications like heart attack, stroke, and kidney failure.

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4
Q

What two organizations guide treatment of hypertension

A

American Heart Association
American College of Cardiology

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5
Q

Primary hypertension
% of cases
Age group

A

Cause is unknown
(90-95% of cases)
High with those 60 and above

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6
Q

Secondary hypertension
% of cases
Age group

A

Cause is known (e.g., tumor)
(5-10% of cases)
Younger

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7
Q

Elevated BP (SBP & DBP)

A

120 - 129 mmHg SBP
80 mmHg DBP

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8
Q

What kind of visit is needed to determine hypertension

A

A wellness visit rather than an emergency visit.

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9
Q

Stage 1 HTN (SBP & DBP)

A

130 - 139 mmHg SBP
80 - 89 mmHg DBP

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10
Q

Stage 2 HTN (SBP & DBP)

A

> 140 mmHg SBP
90 mmHg DBP

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11
Q

White Coat HTN

A

Blood pressure elevated in a healthcare setting but normal at home.

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12
Q

Masked HTN

A

Blood pressure is normal in a healthcare setting but elevated at home.

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13
Q

Malignant HTN

A
  • Blood pressure is greater than 180/120 mmHg
  • Treatment varies on the cause of elevated BP
  • Gradual reduction to normal BP
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14
Q

Fixed RF for HTN

A

Family history
Increased Age
Gender

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15
Q

Modifiable RF for HTN

A

Obesity
Smoking
SES
Sedentary lifestyle
Diabetes
High Cholesterol
Stress
Diet in high sodium
Alcohol use

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16
Q

How do we dx patients with HTN?

A

We take their baseline BP during wellness visits (2x).
Rule out secondary causes
Evaluate end organ damage/disease
Determine cardiovascular risk
ECG
Blood & Urine test
Establish baseline levels (prior to therapy)

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17
Q

How do we manage HTN

A

DASH Diet
Exercise / Weight loss
Decrease stress
Smoking Cessation

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18
Q

End Organ Damage for HTN management

A

Neuro
Heart
Kidneys
Lungs
Peripheral
Vision

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19
Q

Medication Management: Prototypes for HTN

ACE inhibitors
ARBS
Beta Blockers
Calcium Channel Blockers
Thiazide Diuretics

A

ACE inhibitors – relax blood vessels and pressure (esp kidneys).

ARBS (Angiotensin II Receptor Blockers – paired with ACE. Help relax blood vessels and pressure.

Beta Blockers – reduce HR and cardiac workload

Calcium Channel Blockers – relax blood vessels and cardiac workload

Thiazide Diuretics – reduce fluid retention & BP. Increases reabsorption of calcium

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20
Q

Monitor End Organ Damage for HTN

A

Identification
Maintenance
Prevention

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21
Q

What medication relaxes blood vessels and lowers blood pressure (esp kidneys)?

A

ACE Inhibitors

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22
Q

What medication is paired with ACE and helps relax blood vessels and pressure?

A

ARBS (Angiotensin II Receptor Blockers

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23
Q

What medication reduces heart rate and the workload of the heart?

A

Beta Blockers

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24
Q

What medication relaxes blood vessels and cardiac workload?

A

Calcium Channel Blockers

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25
What medication reduces fluid retention and lowers blood pressure?
Thiazide Diuretics
26
Peptic Ulcer Diseases
Break in the lining of the mucosa with submucosa involvement. Ulcerations or erosions.
27
Where do Gastric Ulcers occur?
occurs in lesser curvature of the stoma near the pylorus
28
Where do Duodenal ulcers occur?
proximal part of the intestines; exacerbations occur, necessitating surgery in 5-10%
29
Protective part of the stomach
Prostaglandins Bicarbonate Blood Flow Mucous Production
30
Hostile factors of the stomach
H Pylori Gastric Acid NSAIDs
31
RF for PUD
H pylori (releases toxins) NSAIDS Excessive smoking Acid hyper secretion syndrome (Zollinger Ellison Syndrome) Genetics
32
What does H Pylori do to the stomach
Releases toxins that promote inflammation & ulcerations
33
What do NSAIDs do to the stomach
Inhibits the production of prostaglandin
34
How does H Pylori transmit
Fecal to Oral (water)
35
What predisposes patients to develop gastric cancer (NSAIDs or H Pylori)?
H Pylori
36
What ulcer type is aggravated by fasting?
Duodenal Ulcer
37
What ulcer type is NOT relieved by antacids?
Gastric Ulcer
38
What ulcer type IS relieved by antacids?
Duodenal Ulcer
39
What diagnostic testing is used for H Pylori?
Urease breath test Fasting serum gastrin
40
What do you see in the CBC of someone with gastric ulcers?
Decreased (slow drop) of Hematocrit
41
Labs for gastric ulcers?
CBC & fecal occult blood tests LFT/CPK, ekg, abdominal ultrasound, x-rays
42
Complications of gastric ulcers
GI hemorrhage - abdominal pain - decrease in HCT/HBG - vomiting blood Intestinal perforation - increased WBC - abdominal pain - VS changes
43
Medication for management of peptic ulcers
H2 receptor antagonist Proton Pump Inhibitor Sucralfate
44
What medication for peptic ulcers do patients take on an empty stomach?
Proton Pump Inhibitor
45
What are irritants of peptic ulcers?
Caffeine ETOH Spices Smoking
46
Peptic ulcer patient education
Avoid NSAIDs, spicy foods, ETOH, smoking Eat small meals Avoid eating within 2 hrs of bedtime (eating increases gastric acid secretion)
47
What is GERD?
A condition that occurs when stomach contents flow back up into the esophagus. Occurs when the muscle at the end of the esophagus does not close properly
48
Symptoms of GERD
Worsens after eating, worsens when bending over or lying down, worsens at night
49
Non-modifiable RF for GERD
Genetics Hiatal Hernia Obesity Zollinger-Ellison Syndrome (incr gastric secretions) NSAIDS leads to pyrosis Scleroderma Hypercalcemia
50
Pyrosis
heart burn
51
Esophageal symptoms for GERD
Dysphagia, Pyrosis, Regurgitation, Odynophagia, Nausea
52
Extra esophageal symptoms for GERD
Chronic cough, chest pain, laryngitis, Asthma/SOB/pneumonia/bronchitis, pharyngitis, sinusitis*, sleep apnea, erosion of dental enamel, otitis media*
53
Complications of GERD
Reflux esophagitis (erosions of esophagus) Esophageal strictures (narrowing bc of inflammation and scarring) Barrett's Esophagus (precancerous lesions in esophagus) Esophageal adenocarcinoma
54
Diagnostics of GERD
Esophageal pH monitoring Esophageal manometry or esophageal motility study (EMS) Barium Swallow Esophageal-gastroduodenoscopy (EGD)
55
Lifestyle modifications of GERD
Improve diet Avoid trigger food Eat small meals Lose weight Down lay flat (esp after meals) Avoid alcohol Stop smoking
56
Medication management of GERD
Proton Pump inhibitors H2 Receptor Antagonist Sucralfate
57
Surgery for GERD
Nissen Fundoplication (tighten up the sphincter) Linx procedure
58
Notify the provider if you have GERD and experience
food gets stuck continued symptoms
59
Sucralfate
Binds to ulcer tissue; acts as a barrier
60
Where on the body do people complain of gastric pain (GERD)
Epigastric region
61
What is the method of action for ACEIs (Captopril or Lisinopril)
Blocks the enzyme ACE, decreases production of angiotensin II and aldosterone release
62
What is the therapeutic use for ACEIs (Captopril or Lisinopril)
HTN, HF, MI, Nephropathy, Diabetic Retinopathy
63
MOA for Lorsartan
Directly blocks angiotensin II receptor
64
MOA for aldosterone antagonists (Eplerenone (Inspra®) or Spironolactone)
Antagonize effects of aldosterone at the collecting tubule – causing renal excretion of NA and H2O
65
MOA for beta blockers (propanolol)
Beta1 and Beta2 receptor antagonists – Decrease BP by decreasing CO and decreasing renin release from kidneys – Blocking beta2 receptor causes increased peripheral resistance
66
MOA for Adrenergic Antagonists Alpha Blockers (Prazosin)
Blocks alpha1 receptors, decreases peripheral resistance
67
MOA for Alpha 2 Agonists
Alpha-2 agonist (central effect), decreases sympathetic outflow (cardiac output and vasodilation)
68
MOA for Calcium Channel Blockers (Verapamil)
Blacks calcium channels in the blood vessels AND heart
69
MOA for Calcium Channel Blockers (Nifedipine)
Blocks calcium channels in the blood vessels
70
MOA for Thiazide diuretics (Hydrochlorothiazide)
Block sodium reabsorption in distal convoluted tubule
71
MOA for direct acting vasodilators (hydralazine)
Directly dilate arterioles – Reflex tachycardia is common – Stimulates aldosterone secretion
72
(SATA) Thiazide diuretics can: promote calcium excretion retain calcium promote urine excretion retain potassium
retain calcium promote urine excretion
73
Masked hypertension a person has _______ at home; and whitecoat syndrome the patient has ______ at the doctors office.
elevated BP; elevated BP
74
Direct renin inhibitor MOA
Acts on RAAS
75
What is ARB?
Angiotensin II Receptor Blockers
76
What are Loop diuretics?
a class of medications that help the kidneys remove excess fluid and salt from the body, primarily used to treat fluid retention, high blood pressure, and heart failure
77
What does the Proton Pump Inhibitor do?
Treats the heartburn from GERD and PUD
78
DASH Diet What do you increase? What do you decrease?
Increase potassium Decrease condiments, bread.

Common (13 decks)

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