Week 1 Flashcards
adult BMI >25
overweight
adult BMI >30
obesity
pediatric BMI at 95th percentile for age and gender or BMI>30
obesity
differential diagnosis for obesity
PCOS
hypothyroidism
cushing’s syndrome
pharmacologic treatment for obesity
orlestat (xenical) prevents dietary fat absorption .
phentermine/ topiramate for longterm use in obese patients; appetite suppression.
nonpharmacologic treatment for obesity
bariatric surgery for pts with BMI 40 or higher
hypertension diagnosis ACC/AHA
2 BP measurements at different office visits (2 weeks apart). normal BP: 120/80 pre htn: 120-139/80-89 < 60 y/o: goal is a BP less than 130/80 > 60 y/o: htn is 150/90 or higher.
hypertension management
calculate ASCVD risk score:
if ASCVD is < 10, lifestyle management. check bp in 3-6 months.
stage 1 htn and ASCVD >10: lifestyle modifications and 1 BP med and f/u with BP in 1 month.
stage 2 htn: lifestyle modifications and 2 drugs from different classes and f/u with BP in 1 month.
prompt antiHTN meds if bp > 180/110 (don’t wait for 2nd bp. EKG and labs)
adults with well controlled HTN can be followed annually
Stage 1 htn is classified as
130-139/80-89
stage 2 htn is classified as
> 140/90
ASCVD goal percentage
<10 %. devised of BP, LDL, age, ethnicity and sex.
JNC guidelines 2014 role in HTN
does not help to diagnose. only management of HTN, less aggressive
heart failure
ACE/ARB and BB and diuretic and spironolactone
post MI
ACE/ ARB and BB
CAD
ACE, BB, Diuretic, CCB
diabetes
ACE/ARB, CCB, diuretic
CKD
ACE/ARB
pregnant women
labetalol (1st line), nifedipine, methyldopa
recurrent stroke prevention
ACE, diuretic
management with diuretics
labs for hypokalemia
management with ACE inhibitors
labs for hyperkalemia
HTN evaluation
H&P , UA, electrolytes, CBC, fasting glucose, hgb a1c, lipid pannel, echocardiogram, tsh, uric acid
hydrochlorothiazide 25mg
if unsuccessful, add a new med. do not increase HTZ, because it will increase hypokalemia
risk factors for hyperlipidemia
increased age, male, genetic disorders of lipid metabolism, family hx of CAD, smoking, obesity, htn, elevated LDL, low HDL, diabetes.
hyperlipidemia screening guidelines
fasting lipids on all adults > 20 q 5 years.
asymptomatic adults: age 40-79 perform 10 year ASCVD risk score.
high risk patients: LDL >190
diabetics: LDL > 70-189 with or without ASCVD
without DM 70-189 and ASCVD >7.5
ACC/ AHA guidelines 2018 hyperlipidemia
clinical ASCVD ( >7.5), or LDL >190, then use high intensity statin. diabetics 40-75 with LDL < 70, moderate intensity statin
high intensity statin
atorvastatin 40-80, rosuvastatin 20-40 mg
low intensity statin
simvastatin/ pravastatin 10-20 mg
moderate intensity statin
atorvastatin 10-20, simvastatin 20-40, pravastatin 40-80
hyperlipidemia management
lifestyle modification, diet, exercise, and pharmacologic management, educating about side effects, take meds as prescribed, follow up for lab tests, smoking cessation
hyperlipidemia diagnosis
fasting lipid panel HDL, LDL, triglycerides. check CK if on statins
pediatrics with BMI between 85 and 95th percentile
considered overweight
metabolic syndrome
ATP 3 criteria
presence of 3 of the following traits:
abdominal obesity (waist circumference > 40 inches in men and >35 inches in women), AND triglycerides >150 or on pharmacologic tx for triglycerides AND HDL <40 in males and <50 in females or on drug treatment for HDL AND BP > 130/85 or being treated for HTN AND fating glucose > 100 or on antidiabetics
treatment of metabolic syndrome
statin, antihypertensive, aspirin, metformin, lifestyle changes, thiazolidinediones, glipizide, consult for surgery
HTN management in pediatrics
BP measures annually on all 3+ and older
