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Clinica Médica > Sd Metabolica > Flashcards

Sd Metabolica Flashcards

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1
Q

Diag resistencia a insulina

A

3 dos seguintes:

Pressao arterial > 130/85
Triglicerides > 150
HDL : H <40 M<50
Glicemia: jejum > 100
Obesidade abd:  H>102  M> 88
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2
Q

Definiçao HAS

A

Niveis elevados e persistentes de PA cm aumento do risco cardiovascular

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3
Q

HAS adulto mais comum

A

Primaria

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4
Q

Quadro clinico HAS

A

Assintomatico

LOA

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5
Q

LOA HAS: orgaos

A 
Coraçao
Cerebro
Retina
Rim
Aorta
Arteriopatia
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6
Q

Classificaćao de retinopatia hipertensiva

A

Keith-wagener-barker (KWB)

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7
Q

Retinopatia hipertensiva grau 1

A

Estreitamento arteriolar

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8
Q

Retinopatia hipertensiva grau 2

A

Cruzamento arteriovenoso patologico

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9
Q

Retinopatia hipertensiva grau 3

A

Hemorragia/ exudato

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10
Q

Retinopatia hipertensiva grau 4

A

Papiledema

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11
Q

Nefroesclerose hipertensiva

A

Benigna e maligna

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12
Q

Nefroesclerose benigna

A

Arteriosclerose hialina

Hipertrofia da camada media

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13
Q

Nefroesclerose hipertensiva maligna

A

Arteriosclerose hiperplasica (bulbo de cebola)

Necrose fibrinoide

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14
Q

PA Normal

A

PAS: < 120
PAD: < 80

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15
Q

PAS: < 120
PAD: < 80

A

Normal

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16
Q

PA elevada

A

PAS: 120-129
PAD: <80

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17
Q

PAS: 120-129
PAD: <80

A

PA elevada

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18
Q

HAS estagio 1

A

PAS: 130-139
PAD: 80-89

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19
Q

PAS: 130-139
PAD: 80-89

A

HAS estagio 1

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20
Q

HAS estagio 2

A

PAS: > = 140

PAD>= 90

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21
Q

PAS>= 140

PAD>=90

A

HAS estagio 2

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22
Q

Diagnostico HAS

A

Media da PA em pelo menos 2 consultas

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23
Q

HAS jaleco branco

A

MAPA normal

Consultorio: elevada

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24
Q

HAS mascarada

A

MAPA alterada

Consultorio normal

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25
Q

Duvida diagnostica de HAS

A

MAPA

MRPA

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26
Q

Tto PA normal/elevada

A

Mudança estilo de vida (MEV)
Perder peso (maior impacto)
Atividade fisica
Cessar tabagismo

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27
Q

Tto HAS estagio I

A

Escore de framminghan: risco cardiovascular

Baixo: mudança estilo de vida 3-6m

Alto/ dç cardiovascular/ DM/ dç renal: 1 droga

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28
Q

Drogas 1 linha tto HAS

A

Tiazidicos
Bloqueadores canal de calcio
IECA
BRA

29
Q

Classe de drogas tto HAS que nao pode associar

A

IECA e BRA

30
Q

Tto HAS estagio II

A

Associar 2 drogas de 1 linha

31
Q

Tto HAS: PA alvo

A

< 130 x 80

32
Q

Indicaçoes especificas IECA/ BRA na HAS

A 
Jovens
Brancos
Nefropatia
IC
IAM previo
Hiperuricemia: usar losartan
33
Q

Medicaçoes classe IECA

A

Prils

34
Q

Medicaçoes classe BRA

A

Sartans

35
Q

Medicaçoes tiazidicos

A

Hidroclotiazida

Clortalidona

36
Q

Indicaçoes especificas usa de tiazidicos HAS

A

Negro
Idoso
Teoricamente osteoporose

37
Q

Bloqueadores canal de calcio medicaçoes

A

Vasosseletivas: dipinos
Cardiosseletivos: diltiazem, verapamil

38
Q

Indicaçoes especificas usa de bloqueadores canal de calcio

A

Negro
Idoso
Dipinas: arteriopatia periferica
Cardiosseletivos: Fibrilaçao atrial

39
Q

Efeitos adversos IECA/ BRA

A

IRA e hipercalemia

IECA: tosse e angioedema (^ bradicininas)

40
Q

Contra indicaçao uso de IECA/ BRA

A

Creatinina > 3,0 (relativo)
K> 5,5
Estenose bilateral de arteria renal

41
Q

Efeitos adversos tiazidicos

A

4 hipos: volemia, natremia, calemia (+ importante), magnesemia

3 hiper: glicemia, lipidemia, uricemia (nao pode na gota)

42
Q

Ef adversos bloqueadores canal de calcio

A

Dipinos: cefaleia; edema

Diltiazem/ vera: bradrritimias; IC

43
Q

Definiçao HAS resistente

A

PA nao controlada cm 3 drogas (1 sendo diuretico)

Ou

PA controlada com 4 medicaçoes

44
Q

CD HAS resistente

A

Pesquisar má aderencia/ jaleco branco

HAS secundária

45
Q

Dica de HAS secundaria

A

HAS resistente/ grave
Inicio < 30a ou >50
Dica de doença

46
Q

Sequencia sistema renina angiotensina

A 
Renina
Angiotensina I
ECA
Angiotensina II
Aldosterona
47
Q

Hipertensao renovascular

A

Estenose de arteria renal
Hiperaldosteronismo secundario
Aumenta renina
Tto IECA/ BRA

48
Q

Anenoma/ hipeplasia adrenal

A 
Hiperaldo primario
Aumenta aldosterona (renina baixa)

Tto: espironolactona

49
Q

Causas de HAS + K+ baixo

A

Diureticos

Hiperaldo primario e secundario

50
Q

Confirmar feocromocitoma

A

Urina de 24h: catecolaminas e metanefrinas

Apos confirmaçao: localizar tumor (TC/RM/PET)

51
Q

Abordagem terapeutica do feocromocitoma

A

Cirurgia
Fazer alfa bloqueio por 10 dias com prasozin
Depois b bloqueio

52
Q

Calcular pressao arterial media

A

(PAS+ 2PAD)/3

53
Q

Definiçao crise hipertensiva

A

Aumento subito da PA que desequilibra o fluxo sanguineo

54
Q

PA da crise hipertensiva

A

180x120 (PAM 140)

55
Q

Urgencia hipertensiva

A

Risco de lesao (IAM, AVE, IC previo)

56
Q

PA urgencia hipertensiva

A

160x100 em 24-48h

57
Q

Tto urgencia hipertensiva

A

Drogas VO
captopril
Clonidina

NAO fazer nifedipino sublingual

58
Q

Emergencia hipertensiva: diag

A

Lesao aguda de orgao alvo

59
Q

Emergencia hipertensiva: CD

A

Diminuir 20-25% da PAM em 1h

60
Q

Quais drogas fazer na emergencia hipertensiva

A

Nitroprussiato
Nitroglicerina (vasodilata coronaria)
B bloqueador
Hidralazina (gestantes)

61
Q

Crise hipertensiva por dissecçao de aorta e AVE hemorragico

A

Normalizar PA

AVE isquemico: HAS permissiva

62
Q

Intoxicaçao por nitroprussiato clinica

A

Nauseas
Confusao mental
Acidose metabolica

63
Q

Intoxicaçao nitroprussiato: fatores de risco

A 
Uso por > 48h
Dose alta
Disfunçao de orgaos
    Hepatica: metaboliza cianeto
    Renal: excreta o tiocianato
64
Q

Antidoto intoxicaçao nitroprussiato

A

Vit b12
Nitrito ou tiossulfato de sodio
Hemodialise

65
Q

Formula de friedewald

A

LDL= CT- HDL- TG/5

Se TG>400 nao usa

66
Q

Triglicerides: alvo e terapeutica

A

Alvo: < 150 ou < 175 sem jejum

150-499: dieta
>= 500: fibrato

67
Q

Terapia alta intensidade com estatinas

A

Dç aterosclerotica ou LDL>= 190
Alvo: reduzir 50% LDL
Atorvastatina: 40-80mg

68
Q

Terapia com estatinas de moderada intensidade

A

LDL 70-189 + diabetico ou alto risco
Alvo: reduzir LDL 30-50%
Atorvastatina: 10-20mg
Sinvastatina: 20-40mg

69
Q

Terapia com estatinas de baixa intensidade

A

LDL < 100-130

Provastatina 10-20mg

Clinica Médica (61 decks)

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