101414 HTN cases Flashcards Preview

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Flashcards in 101414 HTN cases Deck (16):
1

risk factors for HTN?

race-African American
family history
high salt diet
sedentary lifestyle
abnormal BMI
smoking
dyslipidemia
alcohol
drug use (cocaine is alpha agonist)

2

what is an initial step in treating HTN?

lifestyle modification

3

before starting medications for HTN, what should you do?

lab for electrolytes and kidney fxn (hyperaldosteronism)

CBC to rule out anemia as cause

urinalysis to look for blood or protein as indicator of kidney disease

4

why are thiazides usually chosen first line for HTN?

lower side effect profile as compared to ACE

however ACE and thiazides are first line meds

5

what are meds best used in pregnancy for HTN?

methyldopa
labetalol
hydralazine

6

what are signs of increased intracranial pressure?

vision changes
slurred speech
vomiting
numbness
tingling
headaches

7

if pt presents with headaches from HTN, what organ systems would you also be concerned about? what should you check?

eye exam

cardiopulmonary exam (delayed S2, S3 or S4, rales, ECG to look for L ventricular hypertrophy)

urine--blood and protein? electrolkytes and kidney fxn.

screen for diabetes and hyperlipidemia

8

if pt is hypertension stage 2 (160/100), what should you start pt on in terms of meds?

two agents simultaneously

9

what anticipatory guidance should there be for HTN pt started on medication?

watch for light headedness, palpitations, weakness, or decreased urine output

HCTZ can cause hyponatremia and hypokalemia
ACE inhibitors can cause hyperkalemia and chronic cough. both can cause kidney injury. --so need to monitor electrolytes and kidney fxn in 1 month along with BP

10

if meds are bringing HTN down to goal, what should you do?

titrate current meds to maximal levels before starting new agents

11

Cushing's triad

combo of elevated BP, low HR, low resp rate

12

what can dark urine suggest in the context of HTN?

renal failure secondary to HTN

13

why are ibuprofen and NSAIDs in general bad for BP?

they raise BP b/c of prostaglandin inhibition (prostaglandins dilate afferent arteriole to increase renal blood flow)

14

what should you be careful of in lowering BP in someone w/ chronically high BP?

not dropping BP too fast because can get hypoperfusion. should not lower systolic BP more than 25% in 24 hrs

15

nitroprusside side effect

cyanide poisoning (peripheral vasodilation and flushing)

16

what would you give to reverse LVH?

ACEi, ARBs best

Ca ch blockers

beta blockers (less effective)