Thompson

Question 1

What happens when the kidneys crump

Answer 1

• electrolyte imbalances (phos get high, potassium high, calcium gets LOW)
• anemia
• blood pressure irregularities
• MEDS HANG AROUND

Question 2

JNC 8 Recommendations

Answer 2

• > 60 years = 150/90
• < 60 years = 140/90
• > 18 years with CKD = 140/90
• > 18 with diabetes = 140/90

Question 3

Risk factors of HTN

Answer 3

• AGE
• smoking
• DM
• high lipids
• inactivity/weight
• family history
• race

Question 4

secondary causes of HTN

Answer 4

• sleep apnea
• primary hyperaldosteronism (low K, HTN resistant)
  
  • DIAGNOSE WITH HIGH ALDOSTERONE/RENIN RATIO (there K will often be LOW)
  • Consider in patients with resistant HTN and low potassium
• CRF
• thyroid
• renal vascular disease
• pheochromocytoma
• cushings or steroid therapy

Question 5

when to suspect secondary causes

Answer 5

• age extremes (very young or old)
• severity
• lack of family history
• does not respont to tx
• sleep apnea

Question 6

Beta blockers

Answer 6

• Cause dizzy/syncope, fatigue, LOW HR, impotence, makes working out difficult
• very effective; always used in MI or CAD

Question 7

ACE inhibitors

Answer 7

• Side effects
  
  • increases K
  • Angioedema (asian/blacks are more likely)
  • cough
  • increase Creatinine
    
    • can increase 30% before stop or big w/u

Question 8

HTN take away medications

Answer 8

• WHites = ACE/ARB, thiazides
• Blacks = aoid ACE
• Diabetics/CRF = ACE
• Post MI/CVA = beta blocker/ace
• CHF = beta blocker + ACE, plus thiazise plus spiranolactone

Question 9

HTN emergencies

Answer 9

• Malignant Hypertension
• Any increase in BP that results in ACUTE END ORGAN DAMAGE
  
  • encephalopathy, stroke, CHF, aortic dissection, MI, ARF
  • Nosebleed
• STILL WANT TO LOWER THE BP SLOWLY

Question 10

Suspect RAS???

Answer 10

• Doesn’t respond to reatment
• intermittent claudication
• sudden worsening of HTN
• image abnormality
• ACE leads to worsening creatinine