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Cardio-Renal I Midterm > Therapeutics - Hypertension (Ginzburg) > Flashcards

Therapeutics - Hypertension (Ginzburg) Flashcards

1
Q

what is a normal BMI and what is considered obses

A

around 19-25

obese is over 30

(between 25 and 30 is overwight)

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2
Q

what is considered normal BP

A

systolic less than 120 and diastolic less than 80

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3
Q

what numbers are considered “ELEVATED” blood pressure (not hypertension yet)

A

120-129 systolic

less than 80 diastolic

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4
Q

what numbers are considered stage 1/stage 2 hypertension?

A

stage 1: 130-139 systolic
80-89 diastolic

stage 2: 140 and over
90 and over diastolic

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5
Q

3 general organs/systems that can be affected by high blood pressure

A

cardiovascular disease

kidney disease

retinopathy

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6
Q

explain how high BP affects the cardiovascular system

A

double the risk for stroke and heart attack for every 20 points systolic and 10 points diastolic over 115/85

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7
Q

how are high BP and kidney disease related

A

CKD can cause HBP and HBP can cause CKD

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8
Q

how does HBP affect vision

A

can lead to bleeding, blurred vision, or complete vision loss

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9
Q

true or false

being male is a risk factor for HBP

A

true

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10
Q

is diabetes a risk factor for HBP?

Is it considered modifiable?

A

yes and yes

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11
Q

name a class of drugs that is a risk factor for developing HBP

A

NSAIDS like naproxen

can also affect the kidneys and cause renal issues

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12
Q

prior to assigning a HBP diagnosis, it is very important to do what?

A

DO NOT RELY ON JUST 1 NUMBER!!!!!!

ask the pt if they had caffeine, smoked, or exercised in past 30 mins, potentially have white coat HTN and need to check at hoome as well

also make sure the BP was taken properly and recheck 15-20 min later

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13
Q

true or false

caffeine is a risk factor for developing hypertension

A

FALSE

it can increase the numbers if you drink it right before taking, but it won’t actually cause HTN

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14
Q

explain how to get an ACCURATE BP reading

A

dont talk. empty bladder, put cuff on BARE ARM and use correct size

support the arm at heart level
do not cross legs, support your back and feet

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15
Q

true or false

being in pain does not affect blood pressure readings

A

FALSE - it does significantly

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16
Q

can environmental exposures be the cause of high BP?

A

YES

ie - having too much salt, not enough K, Ca, mgphysically inactive, or drinking tooo much alc

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17
Q

can genetic predisposition be a cause of high BP?

A

yes

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18
Q

true or false

drugs cannot be the cause of hypertension

A

FALSE - they van!!

so many drugs can cause - NSAIDS, drinking LOT of caffeine a day, immunosuppressants, PO contraceptives (only high doses), oral corticosteroids, amphetamines, etc

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19
Q

name 2 types of “out of office” blood pressure monitoring

A

ambulatory care pressure monitoring - continuous readings every 24 hours (best method)

home BP monitoring (more practical)

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20
Q

best NON pharmacologic interventions for preventing AND treating hypertension

A

weight loss, DASH diet, reduced sodium and enhanced potassium, physical activity, reduce alc intake

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21
Q

what is DASH diet

A

fruit, vegetables, whole grains, decreased salt and fat

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22
Q

to prevent/treat HBP, men should reduce alcohol to ____ drinks daily what about women>

A

men - 2 or less
women - 1 or less

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23
Q

salt can be changed to what other seasoning

A

fresh herbs and spices, onion powder, garlic powder, mrs dash

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24
Q

name 4 seasonings that should be avoided

A

sazon
adobo
onion salt
garlic salt

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25
Q

how many mg sodium is maximum:

-per day
-per meal
-per snack

A

per day - 1500mg or less

meal - 500mg or less

snack - 140mg or less

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26
Q

true or false

if a can of soup says “heart healthy” recommend a patient to purchase it

A

FALSE - you need to look at the ingredients

most are still extremely high in salt

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27
Q

true or false

high potassium levels can be a cause of HBP

A

FALSE

low potassium levels

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28
Q

name some causes of secondary hypertension

A

renal disease
drugs
OSA (sleep apnea)
cushings
thyroid
alodosteronism

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29
Q

what are some basic lab tests that should be conducted for someone wiht primary HTN

A

glucose - check for diabetes

lipids
serum creatinine
sodium, postassium, calcium levels
TSH
urinalysis
CBC
electrocardiogram for baseline

30
Q

3 OPTIONAL tests for primary hypertension

A

echocardiogram
uric acid
albumin: creatinine

31
Q

what is considered the “trifecta” and all should be checked for if a patient has 1 of the 3 conditions

A

hypertension
hyperlipidemia
diabetes

32
Q

if the patient has a normal BP, what is the action taken?

A

promote lifestyle habits for prevention (optional) And reassess them in 1 year

33
Q

patient has ELEVATED bp

what is the plan of action?

what numbers are considered “elevated”

A

120-129 systolic and less than 80 diastolic

nonpharm therapy, and reassess in 3-6 months

NO DRUGS YET

34
Q

patient has stage 1 HTN

what is plan of action?

as recap - what numbers are considered stage 1 hypertension

A

130-139 systolic
80-89 diastolic

use the risk calculator for 10 year CV disease risk

if GREATER THAN 10% — non pharm therapy AND start BP lowering medication and reassess in 1 month

if LESS than 10% — nonpharm therapy and reassess in 3-6 months

35
Q

as mentioned, if a patient has stage 1 hypertension and a CV disease risk over 10%, we start nonpharm therapy, AND a BP lowering medication and reassess them in 1 month

what happens at this 1 month visit

A

if the BP goal has been met, reassess them in 3-6 months

if it hasn’t been met - assess their adherence and consider raising dose

36
Q

patient has stage 2 hypertension

what is the plan of action?

what numbers are considered stage 2?

A

140 and greater over 90

non pharm therapy AND Bp lowering medication — 2 agents of different classes

then we reassess in 1 month, and follow same plan as greater than 10% risk in stage 1

37
Q

patient is a candidate for pharmacologic treatment for their hypertension

they have no compelling indication (ie - caused by chronic kidney disease)

what are considered the 1st line agents?

A

thiazide (chlorthalidone preferred - most potent)

dihydropyridine calcium channel blocker

ACE inhibitor or an ARB (NEVER BOTH)

38
Q

if the hypertensive patient ahs chronic kidney disease (esp albuminuria) also, what drug(s) is (are) recommended? why?

A

an ACE inhibitor or an ARB

because they decrease thhe progression of CKD and also help with the blood pressure

39
Q

hypertensive patient has diabetes with albuminuria (over 30)

what is recommended treatment

A

ACE inhibitor or ARB

if no albuminuria - any of the 3 1st line agents

40
Q

antihypertensive treatment can be initiated with TWO agents, especially if,,,,,,

A

the systolic is over 20 and the diastolic is over 10 above goal

41
Q

note to self

A

i skipped all the specific conditoins - waiting for email back

42
Q

true or false

meds alone are enough to recommend to a patient to lower their BP

A

FALSE

the meds must go along with lifestyle modifications

43
Q

true or false

if a patients BP is controlled, they can be weaned off the medicaiton

A

FALSE

the meds are typically life long

if you stop, the BP will shoot up again

since they are life long, make sure the pt is adherent and give combo pills if available

44
Q

name 4 thiazide/thiazide-like diuretics

A

chlorthalidone
hydrochlorothiazide
indapamide
metolazone

45
Q

ALL of the thiazide/thiazide-likes are doses how?

A

once a day

46
Q

usual dosage range for chlorthalidone

A

12.5-25

47
Q

usual dosage range for HCTZ

A

25-50

48
Q

usual dosage range for indapamide

A

1.24-2.5 mg ( a day)

49
Q

usual dosage range for metolazone

A

2,5-10mg/day

50
Q

why is chlorthalidone considered the preferred diuretic

A

has a long half life and better potency - proven in trials to lower the risk of CV disease

51
Q

4 things that should be monitored when a patient is on a thiazide diuretic

A

hyponatremia
hypokalemia
high uric acid and calcium levels

52
Q

thiazide diuretics should be used in caution in which patients

A

with history of acute gout!
(unless pt is on uric acid lowering therapy)

bc diuretics can increase uric acid levels

53
Q

MOA thiazide diuretics and where do they work

A

inhibit Na and Cl reabsorption into the body in the aascending loop of henle (in the DCT)

54
Q

thiazide diuretics:

which is ineffective at an eGFR below 30mL/min?

which can be used until the eGFR is all the way down to 10mL/min?

A

HCTZ cannot be used below 30

chlorthalidone can be used all the way down to 10

55
Q

ACE inhibitors should not be used in combo with ___ or ___

A

ARBS or direct renin inhibitors

56
Q

ACE inhibitors should NOT be used in patients with a hisotry of….

A

angioedema!!!!! (with ACE inhibitors)

if they get angioedema wiht an ACE inhibitor, can wait 6 WEEKS and then start ARB

BUT if they get angioedema on an ARM, CANNOT GO ON ACE INHIBITOR OR ARB

57
Q

increased risk of ____ when on ACE inhibitors, especially in patients….

A

hyperkalemia

with CKD or on potassium supplements or potassium sparing drugs

58
Q

ACE inhibitors have a risk of acute ____ in patients with severe bilateral renal artery stenosis

A

renal failure

59
Q

true or false

both ACEI’s and ARBSs cannot be used in preganncy

A

true

60
Q

when taking ACE inhibitors or ARBS, the patient may get an initial increase in serum creatinine

if the bump is above ____%, it’s an issue, but if lower it’s fine

A

30%

61
Q

how often should electrolytes and renal function be monitored for patients on ACE inhibitors and ARBS

A

baseleine, then 2-4 weeks after starting or increasing therapy, and then just periodically

62
Q

true or false

ACE inhibitors can be renal protective, yet also renal toxic

A

TRUE

can be renal protective in diabetic patients - no proteinuria

in a case of shock (LOW pressure in kidney) - can be toxic

63
Q

dihydropyridine calcium channel blockers should be avoided in patients with _______

ONLY if required, which 2 may be used?

A

HFrEF

amlodipine or felodipine

64
Q

dihydropyridine calcium channel blockers are associated with _____ (adverse effect)

is this more common in men or women?

A

dose-related pedal edema (swelling in feet and ankles)

more common in women

if it happens, cut back dose

65
Q

true or false

lab monitoring is needed for calcium channel blockers

A

FALSE - not needed

66
Q

is dyhydro or nondihydro recommended

A

dihydro - it’s 1 of the 23 1st lines

67
Q

which type of calcium channel blockers are centrally acting? which are peripherally acting?

A

central - non dihydropyridines

peripheral - dihydropyridine

68
Q

true or false

non dihydropyridine calcium channel blockers are NOT used in patients with HFrEF

A

true

69
Q

are nondihydropyridines and beta blockers used together?

A

not routinely

can increase risk of bradycardia and heart block

70
Q

major concern with nondihydropyridine calcium shannel blockers

A

DDI CONCERN!!! majorCYP3A4 substrate and moderate inhibitor of CYP

71
Q
A

Cardio-Renal I Midterm (14 decks)

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