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Therapeutics Test 2 > special considerations of htn > Flashcards

special considerations of htn Flashcards

1
Q

what is the BP goal for pt’s with diabetes

A

140/90

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2
Q

what is the treatment for nonblack population for HTN with DM in JNC8?

A
  1. ACEI/ ARB
  2. Thiazides
  3. CCB’s
  4. Beta-Blockers
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3
Q

what is the general treatment for the black population for HTN with DM

A

thiazides

CCB’s

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4
Q

for every 10 ml you decreases diastolic bp what happens for DM pt’s

A

decrease mortality by 50%

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5
Q

what is the JNC 8 BP goal with CKD?

A

140/90

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6
Q

anyone with HTN and CKD should have what medications started?

A

ACEI/ARB for renal

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7
Q

what is the most common cause of death with pt’s with CKD?

A

cardiovascular disease

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8
Q

what are for criteria for patients at risk of HTN crisis?

A
  1. men
  2. elederly
  3. African americans
  4. low SES
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9
Q

what percent of patients with HTN experience HTN crisis?

A

1-2%

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10
Q

the majority of HTN crisis’ are caused by what

A

idiopathic causes

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11
Q

what is a hypertensive crisis?

what level BP is considered this?

A

acutely elevated BP
either systolic over 180 or diastolic over 120
>180/120

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12
Q

what is the term for elevated BP without acute end organ damage in HTN Crisis?

A

hypertensive urgency

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13
Q

what is the term for HTN crisis with acute end-organ damage?

A

hypertensive emergency

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14
Q

what is the difference in HTN urgency vs. emergency?

A

urgency doesn’t have acute end organ damage

emergency has acute end organ damage

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15
Q

what are the target organs in a hypertensive emergency?

A
  1. Brain
  2. eyes
  3. peripheral vasculature
  4. heart
  5. kidney
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16
Q

what are 3 types of eye damage seen in a HTN emergency

A
  1. narrowing of retinal arteries
  2. flame shaped hemorrhage
  3. cotton wool spots (not unique to HTN crisis)
17
Q

how is mena arterial pressure calculated?

A

MAP= CO x SVR

18
Q

what is the cerebral venous pressure (CVP) generally seen in HTN crisis

A

0-1

19
Q

what levels should MAP be above to keep blood flow to vital organs?
what is the normal range of MAP

A 
above 60
(normal = 60-120)
20
Q

in clinical practive how is MAP calculated?

A

((2 x diastolic pressure) + systolic)/3

21
Q

why is diastolic multiplied by 2 when calculating MAP

A

diastolic lasts twice as long as systolic

22
Q

why does MAP stay high overtime in unmanaged patients?

A

MAP will autoregulate to a higher level, possibly leading to end organ damage

23
Q

what happens to vascular resistance in HTN crisis?

What causes this

A

abrupt increase in vascular resistance

do to an increase in vasoconstrictors

24
Q

what happens in response to vascular resistance?

A

endothelial cells release vasodilatiors

25
Q

overtime, what happens with response to increased vascular resistance

A

endothelial cells become damaged and cant release vasodilators
causes loss of normal autoregulatory function

26
Q

what can occur with increased vasoconstriction without opposition

A

ischemia and infarction

27
Q

endothelial damage causes what 4 specific, negative things leading to vasoconstriction

A

increased permability
increased nitric oxide
activates coagulation cascade
fibrin deposits

28
Q

if a patient has BP that is greater than 180/120 what should be done to confirm it clinically?

A

confirm it in both arms

29
Q

what are 3 clinical presentations common in emergency HTN?

A
  1. chest pain
  2. dyspnea
  3. neurological deficits
30
Q

what are the physical exams needed to identify end organ damage for an emergency HTN pt.

A
  1. pulse evaluation
  2. auscultation of ungs, heart and renal arteries
  3. neurological exam
  4. eye exam
  5. CV exam
31
Q

what labs should be evaluated during HTN emergency

A
  1. SCr
  2. BUN
  3. urinary analysis (UA)
  4. electrolytes
  5. CBC
32
Q

encephalopathy, and eclampsia indicate what HTN urgency or emergency?

A

HTN emergency

33
Q

as a pharmacist what should be evaluated with a HTN emergency

A

medication history and compliance

34
Q

what is the mortality rate for HTN crisis left untreated?

A

79%

35
Q

what are 4 common most common causes of death with HTN crisis

A
  1. renal failure (40%
  2. stroke (23%)
  3. MI (11%)
  4. heart failure (10%)

Therapeutics Test 2 (31 decks)

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