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Comps - Mod 3 > NP 614 Module 1&2 - Sheet1 > Flashcards

NP 614 Module 1&2 - Sheet1 Flashcards

1
Q

5 most common chronic illnesses

A

Pulmonary diseases, hypertension, stroke, diabetes, heart failure

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2
Q

The primary goal of the Chronic Care Model is:

A

Improve outcomes for patients

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3
Q

The single most critical component in any chronic treatment program is:

A

Interventions that target self-management

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4
Q

Chronic problems have unique care issues. Those issues are:

A

Emotional drain on patient, family, and provider

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5
Q

In the Health Belief Model examples of cues to action are:

A

Reminder letters, follow-up phone calls, and advertisements or pulic service announcements

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6
Q

The Transtheoretical Model has been used extensively for smoking cessation. A patient who tells you that they are thinking of a change in the next 2 months is in what stage of change:

A

Contemplation

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7
Q

If you are using Motivational Interviewing techniques with a COPD patient who states they are not interested in smoking cessation your best response is:

A

Tell them when they are ready to discuss smoking cessation you will be ready

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8
Q

The Body Mass Index reflects:

A

Total body weight in relation to heigth

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9
Q

When counseling patients about weight which statement is most accurate:

A

Belly fat is the most dangerous type of fat to your health because abdominal fat is metabolically active

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10
Q

An adult BMI of ___ is considered obese.

A

30

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11
Q

Medications used for weight loss have all of the following characteristics:

A

Used short time, are not used as monotherapy, and have significant adverse side effects.

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12
Q

When to recommend weight loss therapy in relation to BMI

A

Weight loss therapy is linked to BMI of 30 of higher, or BMI between 25-29.9 with either high-risk waist circumference and/or other risk factors as stated in the NHLBI guidelines

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13
Q

The purpose of the strict perioperative diet for bariatric surgery is considered contraversial. The documented evidence for its benefit is:

A

Reduces liver volume in patients with hepatomegaly

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14
Q

Dumping syndrome post-bariatric surgery is a result from:

A

Hyperosmolar contents into the jejunum causing diarrhea

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15
Q

Following bariatric surgery, which route of medication are appropriate

A

Rectal, transdermal, and liquid. Never delayed release!

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16
Q

Question to ask patients regarding decisions or lifestyle changes:

A

How does this diagnosis affect your family and how does the family affect the diagnosis?

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17
Q

Cord elements of the Chronic Care Model - based on self management

A

Partners, team, action-plan, organized, menaingful visits, electronic database, group visits, non-physician providers

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18
Q

Motivational interviewing is all about:

A

The relationship

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19
Q

A provider needs to avoid -

A

A “righting” reflex and trying to persuade patients to change

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20
Q

A confrontational style of advice giving generally creates:

A

Resistance. Every time a provider hears the word “but”, listen to the reason the patient cannot make the change

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21
Q

A patient-centered platform includes

A

Not just being nice; involves careful listening; provide structure to a discussion about change; explore feelings on readiness for change, importance of a change, and confidence to make a particular change

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22
Q

Motivational interviewing is:

A

Patient driven; empowers patients to make changes, and less frustrating for providers

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23
Q

Implementing a patient-driven approach includes:

A

Simple open questions; listening and encouraging with verbal and non-verbal prompts; clarifying and summarizing; reflective listening is higher-level counseling and involves making statements which aim at understanding the patient’s meaning.

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24
Q

The ultimate goal of a patient-driven approach:

A

The patient devises their own plan. You only give the information based upon their desire for it.

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25
Q

No assuming with patient-driven approach:

A

Don’t assume - the person ought to or wants to change, that the patient’s health is their motivation, or that the consultation has failed is change does not occur.

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26
Q

Two phases of motivational interviewing

A

1) Assess and strengthen the person’s desire to change and 2) then move toward actions

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27
Q

Pieces of phase 1 motivational interviewing

A

Opening strategies: Ask open questions. Listen reflectively. Summarize. Affirm. Elicit self-motivational statements - problem recognition, concern, intention to change, and optimism for change

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28
Q

Phase 2 of motivational interviewing

A

Looks forward - “What would you like to see your life like in 5 years”.

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29
Q

If and only if the patient wants to explore change (regarding motivational interviewing)

A

Can you move to the next phase. If they say no, you simply bull back and tell them that you will be ready if they want to address the issue.

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30
Q

Pieces of phase 2 motivational interviewing

A

Moving toward action requires: making the transition; develop the end game; and handling resistance

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31
Q

Easy steps regarding motivational interviewing

A

Establish rapport, elicit information, reflect on your findings, and elicit their feelings

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32
Q

Ranking of obesity

A

4th of the 10 leading causes of death are related

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33
Q

Diseases associated with obesity

A

HTN, hyperlipidemia, CAD, gallbladder disease, sleep apnea, certain cancers, stroke, Type II diabetes

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34
Q

Benefits of weight loss based on evidence (category A)

A

Improves blood pressure, improves glycemic control, improes lipid profiles (lowers total cholesterol, lowers LDL, lowers triglycerides, and raises HDLs)

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35
Q

The goal for health regarding weight loss is:

A

A reduction of 10% in body weight over 6 months.

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36
Q

BMI measurements do not take into account:

A

Muscle mass or fat distribution

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37
Q

BMI 18-24.9

A

Normal

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38
Q

BMI 25-29.9

A

Overweight

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39
Q

BMI >30

A

Obese

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40
Q

BMI >40.0

A

Morbidly obese

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41
Q

Abdominal fat

A

Very active and metabolic and should be thought of as an endocrine organ. It produces hormones, enzymes, cytokines, and compliment factors, which play a role in the regulation of appetite, insulin resistance, and immune functions.

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42
Q

Barriers to weight loss

A

Media, lack of exercise

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43
Q

Resting Metabolic Rate (RMR)

A

Variable between individuals due to: the percentage of free fat mass (muscle requires more energy than fat), age, and sex. Familial effect can account for 41% of the variance in RMR.

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44
Q

Guideline recommendation for dieting

A

500-1000 less calories a day. Reducing fat and carbohydrates. Portion sizes matter.

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45
Q

Use of Orlistat for weight reduction

A

Inhibits fat absorption in the gut. Now over the counter at a reduced dose, but not at reduced cost. Can reduce calories by 150-200 a day. Average loss 4-5% of baseline weight within 1 year.

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46
Q

Use of Wellbutrin for weight reduction

A

Used for depression and smoking cessation. At 300 mg/day average weight loss was 4.6% of base weight.

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47
Q

Use of Glucophage for weight reduction

A

Average weight loss of 5% of baseline weight, but is this related to improved glucose tolerance or to the drug iteslf.

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48
Q

Use of Prozac for weight reduction

A

One of many SSRIs. Weight loss in clinical trials has been variable. Some gain and some lose.

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49
Q

Surgical interventions for weight loss

A

Favorable for morbid ovesity or BMI >25 with 2 or more co-morbid conditions

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50
Q

Gastric by-pass and weight reduction

A

Has demonstrated loss in first 6 months to one year of 30-50 kgs

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51
Q

Complication of gastric bypass

A

40% of patients develop complications such as vitamin deficiencies, bacterial overgrowth, and hernias 14 years after procedure.

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52
Q

Recent study finding of positive of gastric by-pass

A

There was an associated reduction in the risk of death in the by-pass group of about 30% at 10 years when compared to control group.

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53
Q

Which diet works best for a patient?

A

The one the patient chooses and feels that they can stick with

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54
Q

Characteristics of patient and clinician partnerships

A

Good communication, shared purpose, and mutual trust and understanding

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55
Q

Population management activities

A

Integral to the implementation of the chronic care model and the patient’centered medical home, both paradigms for primary care transformation

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56
Q

The overall goal of primary care transformation

A

The creation of an environment that puts patients at the center of care while improving quality and efficiency

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57
Q

Why the chronic care model (CCM) was developed

A

In response to recognition that the traditional acute care model does not effectively meet the longitudinal health care needs of patients and populations with complicated chronic conditions

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58
Q

Aim of the chronic care model (CCM)

A

To change care from acute and reactive to proactive, planned, and population based

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59
Q

Four interventions that will lead to greatest improvements in health outcomes

A

Increased provider expertise and skill; educated and supported patients; planned, team-based care; and better use of registry-based information systems

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60
Q

6 components of the chronic care model (CCM)

A

Clinical information systems; delivery system design; decision support; self-management suppport; community resources; patient-centered medical home

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61
Q

Clinical information systems

A

Organize data to make efficient, safe, and effective care possible

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62
Q

Delivery system design

A

Refers to the role and tasks of each individual participating in patient care, the way these individuals work together, the structure of visits, and the management of ongoing follow-up

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63
Q

Self-management support

A

Crucial component of chronic care model and effectively implemented by use of the population approach. Goal is to engage patients in their own care and to empower them to reach their full potential.

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64
Q

7 Principles of the Patient-Centered Medical Home

A

personal physician: ongoing relationship, continuous, comprehensive care. Physician-directed medical practice. Whole person orientation. Care coordinated and integrated: prevention and chronic care. Quality and safety. Enhanced access. Payment reform.

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65
Q

Population health

A

Used to describe activities to promote healthyhabits and risk reduction in otherwise healthy, low-risk groups.

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66
Q

How to apply population management in primary care

A

risk stratifying the population on basis of criteria such as age, gender, habits, and personal and family history and by determining the most effective interventions to promote routine screenings and healthy habits

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67
Q

Population disease management

A

Describes activities targeted to patients with specific high-prevalence diseases, such as diabetes, HTN, asthma, and CHF

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68
Q

Key components of care management

A

Patient identification, risk and needs assessment, collaborative care planning, patient/family education, anticipatory coaching, tracking, and care plan revision

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69
Q

Pre-contemplation stage of transtheoretical model

A

No desire to change

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70
Q

Contemplation stage of transtheoretical model

A

Thinking about change

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71
Q

Preparation stage of transtheoretical model

A

Making plans

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72
Q

Action stage of transtheoretical model

A

Doing the change

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73
Q

Maintenance stage of transtheoreical model

A

Keeping the action going

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74
Q

Use of motivational interviewing in practice

A

Explores the patient’s health behaviors, and listens for verbal hints that they may wish to make changes. Clinician uses reflective listening, affirmation, summarizing, and asking questions to guide patients to generate solutions that are feasible and workable given their personal situation.

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75
Q

Major goals of Healthy People 2020

A

Identify health improvement priorities; increase public awareness and understanding of health, disease, and disability; engage multiple sectors to take actions to strengthen evidence-based practices; identify critical research and data collection needs

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76
Q

3 maor focus areas for healthy lifestyle goals

A

Nutrition and weight management; physical activity and fitness; and increasing access to health facilities by increasing the number of people with insurance for prevention and promotion

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77
Q

Imbalances of lifestyle influences can lead to…

A

Type II diabetes, sleep apnea, gallbladder, HTN, musculoskeletal injuries, and psychiatric illnesses

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78
Q

Unmanaged stress is linked to…

A

HTN, heart disease, some forms of cancer, GI problems, and some emotional health disorders

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79
Q

High risk waist circumferences of men and women

A

Men - more than or equal to 40 inches. Women more than or equal to 35 inches

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80
Q

Cholesterol is essential for…

A

Production of bile acids, steroids, cell membranes, and sex hormones

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81
Q

Criteria of metabolic syndrome

A

Elevated waste circumference; elevated triglycerides or treatment; reduced HDL or treatment for this disorder; elevated BP or treatment for this disorder; and elevated fasting glucose or treatment for elevated glucose

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82
Q

5 elements of smoking cessation intervention

A

A strong message to quit smoking, self-help motivational quitting and relapse materials, brief conseling that includes a quit date, use of pharmacologic interventions when indicated, and follow-up support

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83
Q

Obesity

A

A chornic condition in which the body’s homeostatic balance between energy intake and energy expenditure is dysfunctional, resulting in excess energy stored in adipose tissue

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84
Q

Adipose tissue

A

Composed of adipocytes (fat cells that store energy as triglycerides plus glycerol), preadipocytes, vascular structures, fibroblasts, endothelial cells, and macrophages

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85
Q

Functions of adipose tissue

A

Energy storage, body structure cushioning, and complex endocrine, exocrine, paracrine, and immune roles

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86
Q

Hedonic hunger

A

Occurs when there is no physiologic base for preceived energy needs

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87
Q

Common lab tests for obese individuals

A

Urinalysis; serum glucose, uric acid, BUN, creatining; CBC; thyroid levels; lipid profile; LFTs; alk phos; and 2-hr glucose tolerance test

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88
Q

Components of all weight loss and weight management efforts

A

An energy deficit from reduced kilocalories, physical activity, and behavioral change

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89
Q

Indications for bariatric surgery

A

BMI greater than 40 or greater than 35 if obesity-related comorbidity; fialure of previous weight loss attempts; commitment of post-op care, supplements, and testing; and exclusion of reversible endocrine or other causes of obesity

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90
Q

Contraindications for bariatric surgery

A

Current substance abuse; uncontrolled, severe psychiatric illness; lack of understanding regarding surgery adn expected outcomes and lifestyle changes required; and extremely high operative risk

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91
Q

Lifelong testing after bariatric surgery

A

Vitamin D, calcium, phosphorus, parathyroid hormone, and alk phos, and bone DEXA every 6 months until weight is stable. Annually - CBC, LFTs, glucose, creatinine, electrolytes, iron, vit B12, folate, calcium, vit A, xinc, and vit B1

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92
Q

Meds to avoid after bariatric surgery

A

NSAIDs, salicylates, corticosteroids, oral bisphosphonates, ethanol, and extended-release formulations

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93
Q

Elements of the Health Belief Model

A

There must be a preceived threat; preceived susceptibility; preceived severity; preceived benefits; preceived barriers; cues for action; self-efficacy

94
Q

Health belief model - Preceived susceptibility - cultural considerations

A

Will I get this disease? Must understand the community’s knowledge of the issue.. Assess literacy level of community. Assess English proficiency. Consider culturally based health beliefs and values.

95
Q

Health belief model - Preceived severity - cultural considerations

A

How serious is the condition or consequence for me and my family? Consider previous experiences with trauma. Consider acceptance based on religious or spiritual beliefs - God’s will.

96
Q

Health belief model - Preceived benefits - cultural considerations

A

Will the change in behavior work to prevent this problem? Consider health belief systems. Consider the trust in health care systems. Trust in informaiton from government/official sources.

97
Q

Health belief model - Preceived barriers - cultural considerations

A

How difficult will it be (psychologically or economically) for me & my family to make the behavior change? Consider economics of the change. Consider language barriers to understanding behavior change message. Consider going against traditions or advice of elders.

98
Q

Health belief model - Cues to action - cultural considerations

A

What strategies will activate readiness to change behaviors? Media campaigns, brochures, word of mouth. Consider credibility of sources. Consider preferred ways of getting info. Consider literacy. Consider preferred language. Consider materials and training approaches respectful and reflect values of community.

99
Q

Health belief model - Self-efficacy - cultural considerations

A

How confident am I that my family & I can make the behavior change? Consider racism & impace - distruct, learned helplessness, socioeconomic impact, bias, discrimination, stereotyping. Consider multiple competing demands/stresses.

100
Q

Transtheoretical Model

A

Describes how people modify a problem behavior or acquire a positive behavior. This is a model of intentional change and focuses on the decision making of the individual. Involves emotion, cognitions, and behavior.

101
Q

DASH diet

A

Dietary Approaches to Stop Hypertension

102
Q

DASH diet high in…

A

Fruits, vegs, low fat or fat-free, whole grains, fish, nuts.

103
Q

DASH diet rich - elements

A

Calcium, magnesium, potassium, protein, fiber and aims to decrease red meats, sweets, and added sugars

104
Q

DASH diet food groups

A

Grains, vegetables, fruits, dairy, meets, nuts & seeds, & legumes, fat & oil, and sweets

105
Q

What is the treatment for Stage 1 hypertension according to JNC7?

A

HCTZ 12.5 mg 1d and lifestyle changes

106
Q

What is the best second agent for a patient suffering from Stage 1 HTN?

A

Calcium channel blocker

107
Q

During the fundoscopic exam of a hypertensive patient you would check all….

A

Hemorrhages, pipilledema, and arteriolar narrowing

108
Q

What would you assess in a patient recently started on Accupril, Lipitor, and Avanda?

A

If the patient is suffering from a new dry cough

109
Q

A suggestion of renovascular hypertension

A

Renal arterial bruits in the abdomen, flanks, or back

110
Q

Which class of hypertensive med is known for fatigue, depression, and must be tapered before discontinuing?

A

Beta blockers

111
Q

What is a side effect of calcium channel blockers?

A

Lower extremity edema

112
Q

What would you include in patient education regarding restricting dietary sodium

A

75% of sodium intake is derived from processed food

113
Q

Disease

A

The explanation that the clinician brings to the symptoms. How the clinician organizes what he or she learns form the patient that leads to a clinical diagnosis

114
Q

Illness

A

How the patient experiences all aspects of the disease, including its effects on relationships, function, and sense of well-being.

115
Q

Excess dietary socium

A

Suppresses the renin-angiotensin-aldosterone system and promotes fibrosis in the heart, kidney, and arteries causing HTN and stroke

116
Q

BMI calculation

A

Weight in kg divided by height in meters squared

117
Q

Prehypertension readings

A

120-139 / 80-89

118
Q

Stage 1 HTN readings

A

140-159/90-99

119
Q

Stage 2 HTN readings

A

> or equal to 160 / > or equal to 100

120
Q

Ideal BP readings for diabetic or renal disease patient

A

<80

121
Q

Vesicular breath sounds

A

Soft and low pitched. Heard through inspiration, continue without pause through expiration, and fade away about 1/3 through expiration. Heard over both lungs.

122
Q

Bronchovesicular breath sounds

A

Inspiratory and expiratory sounds about equal in length and may be separated by a silent interval. Often heard in 1st and 2nd interspaces anteriorly and between the scapulae

123
Q

Bronchial breath sounds

A

Louder, harsher, and higher in pitch, with a short silence between inspiration and expiration. Expiratory sounds last longer and heard over the manubrium

124
Q

Where normal electrical impulses are initiated

A

The sinus node, is the cardiac pacemaker and the rate is 60-100

125
Q

Factors that influence arterial pressure

A

Left ventricular stroke volume, distensibility of the aorta and the large arteries, peripheral vascular resistance, and volume of blood in the arterial system

126
Q

Occurrance of sudden dyspnea

A

May indicate pulmonary embolism

127
Q

Illnesses of cardiovascular disease

A

HTN, CAD, heart failure, stroke, and congenital heart disease

128
Q

Health promotion to prevent cardiovascular disease

A

Screening for important risk factors and developing critical interviewing and counseling skills. Must understand demographics, identify cardiovascular risk factors, and form partnerships to help patients reduce risks.

129
Q

Screening age for HTN

A

All people over 18

130
Q

Screening age for diabetes

A

45 years and repeated every 3 years and for any patient with BMI greater than 25

131
Q

Metabolic syndrome

A

A cluster of risk factors that create an increased risk of CVD and diabetes. Includes elevated waist circumference, fasting plasma glucose, HDL cholesterol, triglycerides, and HTN

132
Q

Indication of elevated JVP

A

98% specific for an increased left ventricular end diastolic pressure and low left ventricular ejection fraction, and increases risk of death from heart failure

133
Q

Using the diaphragm of stethoscope

A

Better for high-pitched sounds of S1 and S2, murmurs of aortic and mitral regurgitation, and pericardial friction rubs.

134
Q

Using the bell of stephoscope

A

Sensitive to low-pitched sounds of S3 and S4 and murmur of mitral stenosis. Use at apex.

135
Q

Follow up after bariatric surgery

A

1 wk, 1 month, 3 months, 6 months, 1 year, then annually

136
Q

Why new guidelines regarding screening

A

Early testing gives the individual the opportunity to begin primary prevention. Identify early risk factors that are modifiable. Increase awareness of personal risks

137
Q

Conditions under umbrella term ASCVD

A

ACS, history of MI, stable or unstable angina, coronary and other arteial revascularization, stroke, TIA, peripheral arterial disease presumed to be of atherosclerotic origin, diabetes

138
Q

Prevention of ASCVD

A

Diet - DASH, physical activity, maintaining a healthy weight, and not smoking

139
Q

Daily salt intake for a person with hypertension

A

1500 mgm

140
Q

Daily salt intake for the general public

A

2300 mgm

141
Q

Interventions for prehypertension

A

First - nonpharmacologic interventions (weight loss, DASH diet, exercise)

142
Q

When to start treatment for HTN regardless of risks

A

130/80

143
Q

Prehypertension classification

A

120-139/80-89. Encourage lifestyle modification

144
Q

Stage 1 hypertension classification

A

140-159/90-99. Encourage lifestyle modification

145
Q

Stage 2 hypertension classification

A

>160/>100. Encourage lifestyle modifications.

146
Q

HTN white men versus black men

A

More prevalent in black men

147
Q

HTN white women versus black women

A

More prevalent in black women

148
Q

HTN white versus hispanics

A

Same

149
Q

Kidney disease and failure secondary to HTN

A

HTN second most common cause of kidney failure (after diabetes). 1. Heart diease; 2. MI; 3. left ventricular hypertrophy; 4. cerebral hemorrhage; 5. eye complications - retinal microaneurysms

150
Q

HTN and atherosclerosis

A

Well-established independent risk

151
Q

Predictors or coronary, renal, cerebral, and peripheral vascular disease, and heart failure

A

HTN

152
Q

Incidence of stroke

A

Rises in direct proportion to BP

153
Q

Causes of peripheral arterial diseaes

A

Cigarette smoking, diabetes, and HTN

154
Q

Systolic BP and prediction of arterial disease

A

For middle-aged and older adults, systolic BP may be even more predictive of arterial disease than diastolic BP

155
Q

Primary hypertension

A

There is no underlying or immedite cause that can correct the blood pressure and is the majority of cases.

156
Q

Secondary hypertensive types of patients

A

Small percentage of patients (5-10%) and is typically the young you should worry about OR someone who is on all three classes of meds and still cannot control BP.

157
Q

Medications to avoid in someone with secondary hypertension

A

ACE and ARBs because you increase their risk for kidney failure

158
Q

Individuals in which salt raises BP

A

Older, black, and diabetic hypertensive persons

159
Q

Things that have a lowering effect on BP

A

Dietary calcium, potassium, and magnesium

160
Q

Lifestyle choices that raise BP

A

Physical inactivity, stress, cigarette smoking

161
Q

Region of US with higher BPs

A

southeastern US

162
Q

Prevention of HTN

A

Prevention is best. Make visits motivating and stress follow-up

163
Q

Doses of ASA in prevention

A

High does not work better than low-dose. Stick with 81 mg. Do not start preventitative ASA until BP is lower than 150/90

164
Q

Target BP in diabetics

A

140/80

165
Q

Why JNC7

A

Publiation of many new studies; need for a new, clear, and concise guideline useful for clinicians; need to simplify the classification of BP

166
Q

Blood pressure and CVD risk

A

For people over 50, systolic is more important than diastolic

167
Q

CVD risks and BP elevation

A

Starting at 115/75, CVD risk doubles with each increment of 20/10 throughout the BP rnage

168
Q

Normotensive BP and lifetime risks of HTN

A

Persons who are normotensive at age 55 have a 90% lifetime risk for developing HTN

169
Q

Initial therapy for most types of HTN

A

Thiazide-type either alone or combined with other drug classes

170
Q

Drugs required by most patients to control BP

A

Most will require two or more to achieve goal BP

171
Q

When to initiate dual drug therapy for BP

A

If BP is >20/10 above goal, initiate two agents, one usually should be a thiazide-type diuretic

172
Q

Most effective HTN therapy

A

One prescribed by the careful clinician will control HTN only if patients are motivated

173
Q

How to improve motivation of BP patients

A

Improves when patients have a positive experience and trust their clinician

174
Q

What is a potent motivator

A

Empathy

175
Q

HTN prevalence

A

50 million people in the U.S.

176
Q

BP relationship to risk of CVD

A

The risk is continuous, consistent, and independent of other risk factors

177
Q

Signal of prehypertension

A

Signals the need for increased education to reduce BP in order to prevent HTN

178
Q

Benefits of lowering BP

A

Stroke - 35-40%; MI - 20-25%; heart failure - 50%

179
Q

In-office BP measurement techniques

A

Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm

180
Q

Ambulatory BP measurement techniques

A

Indicated for evaluation of “white coat” HTN. Absence of 10-20% BP decrease during sleep may indicate increased CVD risk

181
Q

Self-measurement BP technique

A

Provides information on response to therapy. May help improve adherence to therapy and evalaute “white-coat” HTN

182
Q

BP drop at night and its indications

A

Usually drops 10-20% during night; if not, signals possible increased risk for CV events

183
Q

What does self-measurement of BP provide

A

Response to antihypertensive therapy; improving adherence with therapy; and evaluating white-coat HTN

184
Q

BP home measurements that indicate HTN

A

>135/85

185
Q

Evaluation objectives of documented HTN

A
  1. Assess lifestyle and identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment. 2. Reveal identifiable causes of higher BP. 3. Assess the presence or absence of target organ damage and CVD
186
Q

CVD risk factors

A

HTN, cigarette smoking, obesity, physical inactivity, dyslipidemia, diabetes, GFR <60 ml/min, older than 55 for men, older than 65 for women, family history of premature CVD

187
Q

Identifiable causes of HTN

A

Sleep apnea, drug-induced or related causes, chronic kidney disease, primary aldosteronism, renovascular disease, chronic steroid therapy and Cushing’s syndrome, pheochromocytoma, coarctation of the aortia, and thyroid or parathyroid disease

188
Q

Target organ damage of HTN - heart

A

Left ventricular hypertrophy, angina or prior MI, prior coronary revascularization, and heart failure

189
Q

Target organ damage - other organs

A

Brain - stroke or TIA; chronic kidney disease; peripheral arterial disease; retinopathy

190
Q

Routine lab tests for HTN

A

ECG, UA, glucose, Hct, K+, creatining, calcium, lipid profile, HDL, LDL, triglycerices, and urinary albumin excretion

191
Q

Goals of HTN therapy

A

Reduce CVD and renal morbidity and mortality; treat to BP 50

192
Q

Systolic BP reduction with weight loss

A

5-20 mmHg per 10kg

193
Q

Systolic BP reduction with DASH

A

8-14 mmHg

194
Q

Systolic BP reduction with sodium reduction

A

2-8 mmHg

195
Q

Treatment of prehypertension

A

No drugs - lifestyle modification

196
Q

Treatment of Stage 1 HTN - without compelling indication

A

Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combinations.

197
Q

Treatment of Stage 2 HTN - without compelling indication

A

Two-drug combos for most (usually thiazide and ACEI or ARB or BB or CCB.

198
Q

Treatment of Stage 1 HTN - with compelling indication

A

Drugs for the compelling indications

199
Q

Treatment of Stage 1 HTN - with compelling indications

A

other HTN drugs (such as ACEI, ARB, BB, CCB) as needed

200
Q

Follow up and monitoring of HTN therapy

A

Pt should return until BP goal is reached. More frequent for stage 2 with complicating comorbid conditions. Serum potassium and creatinine monitored 1-2 times per year. When BP goal - visits 3-6 months. Co-morbidities influence frequency of visits

201
Q

Special consideration of population regarding HTN

A

Minority, obesity, metabolic syndrome, left ventricular hypertrophy, PAD, HTN in older people, postural hypotension, dementia, HTN in women, HTN in children and adolescents, HTN urgencies and emergencies

202
Q

BP treatment in patients with heart failure

A

Thiazide, BB, ACEI, ARB, aldostone antagonists

203
Q

BP treatment in patients post MI

A

BB, ACEI, aldosterone antagonists

204
Q

BP treatment in patients with high CAD risk

A

Thiazide, BB, ACE, CCB

205
Q

BP treatment in patients with diabetes

A

Thiazide, BB, ACE, ARB, CCB

206
Q

BP treatment in patients with chronic kidney disease

A

ACEI, ARB

207
Q

BP treatment in patients with recurrent stroke prevention

A

Thiazide, ACEI

208
Q

Important barriers to BP control

A

Socioeconomic factors and lifestyle

209
Q

African Americans reduced response to what BP drugs

A

Monotherapy with BBs, ACEIs, or ARBs

210
Q

African Americans respond better to what BP drugs

A

CCBs

211
Q

Left ventricular hypertrophy

A

An independent risk factor that increases the risk of CVD

212
Q

Regression of left ventricular hypertrophy

A

Occurs with aggressive BP management; weight loss, sodium restriction, and treatment with all classes except direct vasodilators hydralazine adn minoxidil

213
Q

Peripheral arterial disease and BP

A

Equilalent in risk to ischemic heart disease. Any class of drugs can be used in most PAD pts. Other risk factors should be managed aggressively. Aspirin should be used.

214
Q

HTN in older persons

A

More than 2/3 of people over 65 have HTN. This population has the lowest rates of BP control. Treatment should follow same principles outlined for general care of HTN. Lower initial drug doses may be indicated to avoid symptoms; standard doses and multiple drugs will be needed to reach BP targets.

215
Q

Postural hypotension

A

Decrease in standing SBP >20, when associated with dizziness/fainting, more frequent in older SBP patients with diabetes, taking diuretics, venodilators, and some psychotropic drugs. Drugs should be monitored in upright position. Avoid volume depletion and excessively rapid dose titration of drugs.

216
Q

Dementia and HTN

A

Dementia and cognitive impairment occur more commonly in people with HTN. Reduced progression of cognitive impairment occurs with effective antihypertensive therapy.

217
Q

HTN in women

A

Oral contraceptive may increase BP and it should be checked regularly. In contrast, HRT does not raise BP.

218
Q

Pregnancy and HTN treatment

A

Should be followed carefully. Methyldopa, BBs, and vasodilators, perferred for the safety of the fetus.

219
Q

Drugs contraindicated during pregnancy

A

ACEI and ARBs

220
Q

HTN in children and adolescents

A

Defined as 95th percentile or greater, adjusted for age, height, and gender. Use lifestyle interventions first, then drug therapy for higher BP levels. Drug choices similiar to adults, but smaller doses. Uncomplicated HTN not a reason to restrict physical activity

221
Q

Plus regarding thiazide-type diuretics

A

Slow demineralization in osteoporosis

222
Q

BBs additional use

A

Atrial tachyarrhythmias/fibrillation, migraine, thyrotoxicosis (short-term), essential tremor, or perioperative HTN

223
Q

Adjunct therapy of CCBs

A

Useful in Raynaud’s syndrome and certain arrhythmias

224
Q

Adjunct therapy of alpha-blockers

A

Useful in prostatism

225
Q

Contraindications of thiazides

A

Used in caution with gout or history of significant hyponatremia

226
Q

Contraindications of BBs

A

Generally avoided in patients with asthma, reactive airway disease, or second- or third-degree heart block

227
Q

Contraindications of ACEIs adn ARBs

A

Contraindicated in pregnancy and those likely to become pregnant

228
Q

Contraindications for ACEIs

A

Not used in individuals with history of angioedema

229
Q

Adverse effects of aldosterone antagonists and postassium-sparing diuretics

A

Hyperkalemia

230
Q

Ways to improve hypertension control

A

Adherence to regimens and resistant hypertension

231
Q

Strategies for improving adherence to regimens

A

Clinician empathy increases patient trust, motivation, and adherence to therapy. Physicians should consider their patients’ cultural beliefs and individual attitudes in formulating therapy

232
Q

Causes of resistant HTN

A

Improper BP measurement; excess sodium intake; inadequate diuretic therapy, medication - inadequate doses or drug interactions; excess ETOH

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