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UF COM ClinDx Unit 4 > L2 - HTN > Flashcards

L2 - HTN Flashcards

1
Q

Describe the correlation in occurence between HTN & Cardiovascular disease:

A

Continuous & consistent directly proportional relationship that is independent of other risk factors

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2
Q

HTN can lead to what serious medical conditions?

A

Heart failure (over strained)

HTN –> vessel injury –> atherosclerosis –> MI, Stroke & Kidney Failure

Aneurysm

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3
Q

What is the #1 primary diagnosis in US?

A

HTN

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4
Q

What % of patients with HTN are unaware they have it?

A

About 1/3

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5
Q

Correlation of age & HTN risk?

A

Directly proportional in both sexes

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6
Q

Joint National Commission (JNC) VII guidelines?

A

Treat until below 140/90

If chronic kidney disease or diabetes, treat until <130/80

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7
Q

How is BP measured for classification purposes?

A

Average of at least 2 readings per visit at at least 2 visits

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8
Q

HTN stages?

A

< 120/80 = nl

120/80 < Pre-hypertensive < 140/90

140/90 < Stage 1 HTN < 160/100

Stage 2 HTN >160/110

Urgency/emergency >180/120

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9
Q

For staging or classification purposes, how do you proceed if diastolic & systolic are in different ranges?

A

Classify based on whichever one is worse

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10
Q

Follow up recommendations based on HTN stages?

A

nl = recheck in 2 years

Pre-HTN = recheck in 1 year & give info about lifestyle changes

Stage 1 = confirm within 2 months & give info about lifestyle changes

Stage 2 = evaluate or refer within 1 month
>180/110 = treat immediately

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11
Q

American Heart Association (AHA) recommendations?

A

Treat until below 140/90

If chronic kidney disease, CAD, CAD equivalent (diabetes) or Framingham risk >10% = treat until <130/80

If have heart failure, treat until lower than 120/80

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12
Q

National Kidney Foundation (NKF) guidelines?

A

If have chronic kidney disease treat until under 130/80

If have proteinuria greater than 1g, treat until <125/75

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13
Q

First thought when see really high BP reading?

A

Probably was done incorrectly

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14
Q

Common mistakes that can give incorrectly high BP

A 
Not waiting 5 min
Cuff too small
Checking over clothes or rolling up sleeve
Not at level of heart
Checking same arm too soon
Auscaltory gap
Not rechecking
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15
Q

What are the 3 main goals during evaluation of documented HTN?

A

Find cause

Identify risk factors which may alter treatment or prognosis

Assess for end organ damage & CVD

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16
Q

Meds which can cause HTN?

A 
NSAIDs
Oral contraceptives
Hormone therapy
Steroids
Sympathomemetics
Ephedra
Diet pills
Herbal supplements
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17
Q

What food can oddly cause HTN? (Not salt, obesity …)

A

Licorice

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18
Q

What social habits can cause HTN?

A 
Alcohol
Tobacco
Stress
High salt diet
Caffeine 
Cocaine
Methamphedamines
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19
Q

How does caffeine effect BP?

A

If always have 1-2 cups of coffee, no effect

If suddenly spike in caffeine or take a massive amount can cause HTN

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20
Q

Effect of weight on BP?

A

Obese people are more likley to have HTN, but just because you are fat doesnt mean you automatically have HTN

More important than absolute weight is change in weight. Sudden increase –> HTN

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21
Q

Poorly controlled chronic HTN can cause what fundoscopic findings?

A

Permanent Arterial narrowing
AV nicking
Copper Wiring
Silver Wiring

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22
Q

What is AV Nicking?

A

Abnormal fundoscopic finding in patients with chronic poorly controlled HTN

Represents artery & vein crossing paths –> compression of the vein

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23
Q

What is Copper Wiring?

A

Chronic HTN –> Arteriosclerosis with moderate vascular changes –> changes light reflex

Diffuse red-brown light reflex

Progresses to silver wiring

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24
Q

What is silver wiring?

A

Chronic HTN –> Arteriosclerosis with severe vascular changes (vascular wall thickening & hyperplasia) –> changes light reflex

White light reflex

Progressed from copper

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25
Q

Severe acute HTN can cause what fundoscopic finding?

A

Flame shaped hemorrhage

Ischemia –> white superficial focus = cotton wool spot

Yellow hard exudate

Optic disk edema or papiladema (swelling)

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26
Q

HTN labs?

A 
CMP
Lipids
Glucose
CBC
Urinalysis
ECG
Echocardiogram
  • similar to PAD workup
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27
Q

What things in general should make you suspicious that HTN may be SECONDARY to another cause?

A 
< 25 yo
Drug resistant (3 drugs at max dose dont work)
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28
Q

HTN with hypokalemia points towards what? Test?

A

High aldosterone/Conn’s Disease (secondary HTN)

Plasma aldosterone-renin ratio

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29
Q

Intermittent HTN with palpatations, sweating & headaches points towards what? Tests?

A

Pheochromocytoma (secondary HTN) = adrenal tumor

Serum catecholamines or metanepherines, Ab CT/MRI

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30
Q

HTN with a epigastric bruits points towards what? Test?

A

Coarctation (secondary HTN). Aorta narrowed –> blood has to pump harder –> entire body effected

Chest Film

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31
Q

HTN with renal artery bruits points towards what? Best test?

A

Renal artery stenosis (secondary HTN) = renovascular disease

Angiography

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32
Q

Suggested lifestyle changes to lower BP?

A 
Lose weight
DASH diet
Na reduction
Physical Activity
Alcohol in moderation
33
Q

Who generally needs a 2 drug combination for HTN? Which drugs are these usually?

A

Stage 2 (think 2 for 2)

Diuretic + CCB/BB/ARB/ACEI

34
Q

Difference between HTN urgency & emergency?

A

Emergency has some sort of end organ damage

35
Q

What HTN meds should not be given to pregnant patient?

A

ACEI

ARB (ang rec block)

36
Q

If have edema & HTN, what is the best treatment?

A

Diuretic

37
Q

If have BPH & HTN, what is the preferred treatment?

A

Alpha blocker (relax muscle in prostate & bladder)

38
Q

If you have Raynaud’s & HTN, what is the preferred treatment?

A

CCB (relax peripheral vessels cuz have less Ca for smooth muscle contraction)

39
Q

Who should not receive diuretics?

A

Gout
Hyponatremia
Hypokalemia

40
Q

Who should not receive beta blockers?

A

Asthma
Reactive airway disease
2nd or 3rd degree heart block

41
Q

Who should not receive ACEI?

A

Patients with history of angioedema

Pregnant patient

42
Q

Best treatment for HTN patient with diabetes?

A

ACEI or ARB (both processes that take place in kidney) can have renal protective effects & prevent proteinuria

Same as kidney disease

43
Q

CVD stands for?

A

Cardiovascular disease

44
Q

If have proteinuria greater than 1g, you should treat HTN until BP is <125/75 according to who?

A

National Kidney Foundation

45
Q

A patient with prior angioedema should not receive what drug?

A

ACEI

46
Q

Somebody with gout should not receive what mediation?

A

Diuretic

47
Q

Somebody with hyponatremia should not receive what drug?

A

Diuretic

48
Q

Somebody with Asthma or reactive ariway disease should not receive what drug?

A

Beta blocker

49
Q

Somebody with gout should not receive what drug?

A

Diuretic

50
Q

What is suspected with HTN & high or low TSH?

A

Hypo or hyper thyroid can be related to HTN (secondary HTN)

51
Q

What is suspected with HTN & fatigue?

A

Sleep apnea
Hypothyroidism

Both = secondary HTN

52
Q

What is suspected with HTN, high Ca & low P? Test?

A

Hyperparathyroidism (secondary HTN)

Serum PTH

53
Q

What is suspected with HTN & high aldosterone?

A

Aldosteronism/Conn’s (secondary HTN) where adrenal tumor causes the release of aldosterone with causes salt & water retention –> more blood volume

54
Q

What is suspected with HTN & high urinary cortisol? Test?

A

Cushings (secondary HTN) = pituitary hormone

Dexamethasone suppression test

55
Q

How are kidney diseases and HTN related?

A

Limit the kidney ability to excrete fluid –> increased blood volume –> secondary HTN

56
Q

What is suspected with HTN & adrenomegaly on CT?

A

Pheocromocytoma

Primary aldosteronism/Conns

Secondary hypertension

57
Q

Treatment regimen for stage 1 HTN?

A

Diuretic usually enough on its own

May need additional though

58
Q

Why is pharm therapy for HTN difficult?

A

Everyone is different, need to individualize

59
Q

How to treat HTN emergency?

A

Oral & IV drugs

60
Q

If have atrial fibrilization & HTN, best treatment?

A

beta blocker

61
Q

If have perioperative HTN, best treatment?

A

Beta blocker

62
Q

If have essential tremor & HTN, best treatment?

A

Beta Blocker

63
Q

If have migraine & HTN, best treatment?

A

Beta Blocker

64
Q

If have thyrotoxicosis & HTN, best treatment?

A

Beta Blocker

65
Q

What drugs can cause hyperkalemia & therefore should not be used on a patient with preexisitng hyperkalemia?

A

ARB & ACEI

66
Q

How to treat HTN in elderly?

A

More sensitive (metab slower)

Don’t want BP to drop too much. Start with smaller initial doses

67
Q

Who probably shouldn’t receive any anti-hypertensive drugs?

A

Some one with a BP that is already too low

68
Q

If have HTN + one of the following, beta blocker is the best treatment:

A

Migraines

Essential Tremor

Perioperative HTN

Atrial Fib

thyrotoxicosis

69
Q

Which kidney diseases are related to HTN?

A

Polycystic kidney disease
Renovascular HTN
Glomerular disease (renal parenchymal disease)

70
Q

Somebody with Conn’sDisease & HTN should not receive what drug?

A

Diuretic

71
Q

Best treatment for HTN patient with Kidney Disease?

A

ACEI or ARB (both processes that take place in kidney) can have renal protective effects & prevent proteinuria

Same for diabetes

72
Q

What tests for renal parenchymal disease if suspect secondary HTN?

A

24 hour creatine
GFR
Creatinine
Renal ultrasound (small kidney)

73
Q

Losing weight will lower your systolic about how many mm Hg?

A

5-20

74
Q

DASH diet will lower your systolic about how many mm Hg?

A

8-14

75
Q

Lowering Na intake will lower your systolic about how many mm Hg?

A

2-8

76
Q

Increasing physical activity will lower your systolic about how many mm Hg?

A

4-9

77
Q

Decreasing alcohol intake will lower your systolic about how many mm Hg?

A

2-4

78
Q

Main treatment option for somebody with metabolic syndrome & HTN?

A

Lifestyle changes –> weight loss

UF COM ClinDx Unit 4 (10 decks)

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