Hypertension & PUD Flashcards
Silent Killer
Hypertension
Hypertension
High blood pressure; when the force of blood pushing against your artery walls is consistently too high
What can HTN damage?
Your arteries over time and can lead to serious complications like heart attack, stroke, and kidney failure.
What two organizations guide treatment of hypertension
American Heart Association
American College of Cardiology
Primary hypertension
Cause is unknown
(90-95% of cases)
Secondary hypertension
Cause is known (e.g., tumor)
(5-10% of cases)
What are the Clinical manifestations of primary HTN
No symptoms for most
Severe HTN: Painful headaches, confusions, hallucination, vision problems, nose bleeds, N/V (ICP)
Vascular damage
Elevated creatinine, BUN, proteinuria
Target organ diseases (Heard disease, PD, CV disease, nephrosclerosis, Retinal damage)
Elevated BP (SBP & DBP)
120 - 129 mmHg SBP
80 mmHg DBP
Complications of HTN
Heart attack
Stroke
Kidney disease
Heart failure
Retinopathy
What kind of visit is needed to determine hypertension
A wellness visit rather than an emergency visit.
Stage 1 HTN (SBP & DBP)
130 - 139 mmHg SBP
80 - 89 mmHg DBP
Stage 2 HTN (SBP & DBP)
> 140 mmHg SBP
90 mmHg DBP
White Coat HTN
Blood pressure elevated in a healthcare setting but normal at home.
Masked HTN
Blood pressure is normal in a healthcare setting but elevated at home.
Malignant HTN
- Blood pressure is greater than 180/120 mmHg
- Treatment varies on the cause of elevated BP
- Gradual reduction to normal BP
Fixed RF for HTN
Family history
Increased Age
Gender
Modifiable RF for HTN
Obesity
Smoking
SES
Sedentary lifestyle
Diabetes
High Cholesterol
Stress
Diet in high sodium
Alcohol use
How do we dx patients with HTN?
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)
How do we manage HTN
DASH Diet
Exercise / Weight loss
Decrease stress
Smoking Cessation
End Organ Damage for HTN management
Neuro
Heart
Kidneys
Lungs
Peripheral
Vision
Medication Management: Prototypes for HTN
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.
Monitor End Organ Damage for HTN
Identification
Maintenance
Prevention
What medication relaxes blood vessels and lowers blood pressure (esp kidneys)?
ACE Inhibitors
What medication is paired with ACE and helps relax blood vessels and pressure?
ARBS (Angiotensin II Receptor Blockers
What medication reduces heart rate and the workload of the heart?
Beta Blockers
What medication relaxes blood vessels and cardiac workload?
Calcium Channel Blockers
What medication reduces fluid retention and lowers blood pressure?
Thiazide Diuretics
Peptic Ulcer Diseases
Break in the lining of the mucosa with submucosa involvement. Ulcerations or erosions.
Where do Gastric Ulcers occur?
occurs in lesser curvature of the stoma near the pylorus
Where do Duodenal ulcers occur?
proximal part of the intestines; exacerbations occur, necessitating surgery in 5-10%
Protective part of the stomach
Prostaglandins
Bicarbonate
Blood Flow
Mucous Production
Hostile factors of the stomach
H Pylori
Gastric Acid
NSAIDs
RF for PUD
H pylori (releases toxins)
NSAIDS
Excessive smoking
Acid hyper secretion syndrome (Zollinger Ellison Syndrome)
Genetics
What does H Pylori do to the stomach
Releases toxins that promote inflammation & ulcerations
What do NSAIDs do to the stomach
Inhibits the production of prostaglandin
How doe H Pylori transmit
Fecal to Oral (water)
What predisposes patients to develop gastric cancer (NSAIDs or H Pylori)?
H Pylori
What ulcer type is aggravated by fasting?
Duodenal Ulcer
What ulcer type is NOT relieved by antacids?
Gastric Ulcer
What ulcer type IS relieved by antacids?
Duodenal Ulcer
What diagnostic testing is used for H Pylori?
Urease breath test
Fasting serum gastrin
What do you see in the CBC of someone with gastric ulcers?
Decreased (slow drop) of Hematocrit
Labs for gastric ulcers?
CBC & fecal occult blood tests
LFT/CPK, ekg, abdominal ultrasound, x-rays
Complications of gastric ulcers
GI hemorrhage
- abdominal pain
- decrease in HCT/HBG
- vomiting blood
Intestinal perforation
- increased WBC
- abdominal pain
- VS changes
Medication for management of peptic ulcers
H2 receptor antagonist
Proton Pump Inhibitor
Sucralfate
What medication for peptic ulcers do patients take on an empty stomach?
Proton Pump Inhibitor
What are irritants of peptic ulcers?
Caffeine
ETOH
Spices
Smoking
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)
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
Symptoms of GERD
Worsens after eating, worsens when bending over or lying down, worsens at night
Non-modifiable RF for GERD
Genetics
Hiatal Hernia
Obesity
Zollinger-Ellison Syndrome (incr gastric secretions)
NSAIDS leads to pyrosis
Scleroderma
Hypercalcemia
Pyrosis
heart burn
Esophageal symptoms for GERD
Dysphagia, Pyrosis, Regurgitation, Odynophagia, Nausea
Extra esophageal symptoms for GERD
Chronic cough, chest pain, laryngitis, Asthma/SOB/pneumonia/bronchitis, pharyngitis, sinusitis, sleep apnea, erosion of dental enamel, otitis media
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
Diagnostics of GERD
Esophageal pH monitoring
Esophageal manometry or esophageal motility study (EMS)
Barium Swallow
Esophageal-gastroduodenoscopy (EGD)
Lifestyle modifications of GERD
Improve diet
Avoid trigger food
Eat small meals
Lose weight
Down lay flat (esp after meals)
Avoid alcohol
Stop smoking
Medication management of GERD
Proton Pump inhibitors
H2 Receptor Antagonist
Sucralfate
Surgery for GERD
Nissen Fundoplication (tighten up the sphincter)
Linx procedure
Notify the provider if you have GERd and esxperience
food gets stuck
continued symptoms
Sucralfate
Binds to ulcer tissue; acts as a barrier
Where on the body do people complain of gastric pain (GERD)
Epigastric region
What is the method of action for ACEIs (Captopril or Lisinopril)
Blocks the enzyme ACE, decreases production of angiotensin II and aldosterone release
What is the therapeutic use for ACEIs (Captopril or Lisinopril)
HTN, HF, MI, Nephropathy, Diabetic Retinopathy
MOA for Lorsartan
Directly blocks angiotensin II receptor
MOA for aldosterone antagonists (Eplerenone (Inspra®) or Spironolactone)
Antagonize effects of aldosterone at the collecting tubule – causing renal excretion of NA and H2O
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
MOA for Adrenergic Antagonists Alpha Blockers (Prazosin)
Blocks alpha1 receptors, decreases peripheral resistance
MOA for Alpha 2 Agonists
Alpha-2 agonist (central effect), decreases sympathetic outflow (cardiac output and vasodilation)
MOA for Calcium Channel Blockers (Verapamil)
Blacks calcium channels in the blood vessels AND heart
MOA for Calcium Channel Blockers (Nifedipine)
Blocks calcium channels in the blood vessels
MOA for Thiazide diuretics (Hydrochlorothiazide)
Block sodium reabsorption in distal convoluted tubule
(SATA) What are some factors that will decrease BP?
increase in job related hours
increase in K+ intake
decrease in sodium containing foods
weight loss
increase in exercise
increase in K+ intake
decrease in sodium containing foods
weight loss
increase in exercise
(SATA) Thiazide diuretics can:
promote calcium excretion
retain calcium
promote urine excretion
retain potassium
retain calcium
promote urine excretion
Masked hypertension a person has _______ at home; and whitecoat syndrome the patient has ______ at the doctors office.
elevated BP; elevated BP
