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Fitzgerald Review > Ch 11 HTN, dyslipidemia, HF > Flashcards

Ch 11 HTN, dyslipidemia, HF Flashcards

1
Q

target organ damage form HTN: brain

A

stroke, vascular (multi-infarct) dementia

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2
Q

target organ damage from HTN: cardiovascular system

A

atherosclerosis, MI, Left ventricular hypertrophy, heart failure

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3
Q

target organ damage from HTN: kidney

A

HTN nephropathy, renal failure

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4
Q

target organ damage from HTN: Eye

A

HTN retinopathy with risk of blindness

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5
Q

hypertensive retinopathy

A

retinal vascular damage caused by poorly controlled HTN. if there’s damage in the retinal vessels, there’s damage everywhere else in body. examining eyes are the only way we see blood vessels

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6
Q

hypertensive retinopathy grade 1

A

common in longstanding poorly controlled HTN
reversible when txed

-narrowing of terminal arteriolar branches
-no vision change or permanent findings
ex: 165/98

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7
Q

hypertensive retinopathy grade 2

A

see MORE narrowing of arterioles with severe local constriction
no vision changes or permanent retinal findings

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8
Q

hypertensive retinopathy grade 3

A

DBP is 110 or greater = HTN EMERGENCY

-flame-shaped hemorrhages (bleeding behind eyes)
-potential for visual changes and retinal findings from bleeding scars

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9
Q

hypertensive retinopathy grade 4

A

DBP 130 or more= HTN EMERGENCY

-papilledema (bulging of optic disc; “vessels point arrows that point to optic disc”)
-bleeding behind eyes,
potential for visual change and permanent retinal findings

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10
Q

primary HTN initial diagnostic testing

A

need a baseline for med use and screening for secondary causes of HTN:

  • fasting blood glucose (DM)
    -CBC (anemia)
  • lipid (dyslipidemia)
  • Cr, GFR (renal fxn)
  • Na, K, Ca (e- disorder)
  • TSH
  • UA (proteinuria for HTN nephropathy; usually 1st warning)
  • ECG (arrhythmia, infarction, chamber size)
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11
Q

primary prevention for lifestyle changes in HTN

A

-goal of <130/80
->150 mins/wk exercise or >75/wk vigorous
-low dose aspirin for high risk pts
-metformin (primary) or SGLT-2 or GLP-1 (secondary)
-diet
-tobacco
-cholesterol

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12
Q

BP meds: chlorthalidone (preferred), HCTZ: what are the adverse effects?

A

thiazide diuretics (peripheral vascular resistance reducers)
AE: depletes Na, K, Mg

-calcium SPARING so it’s good for older women who are fracture risk

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13
Q

lisinopril (prinivil), enalapril, losartan, telmisartan adverse effect

A

ace inhibitor / ARB (peripheral vascular resistance reducers)

AE: K sparing (hyperK risk with inadequate fluid intake, over diuresis, renal impairment), use with aldosterone antagonist
ACE: cough, angioedema (Black, Latino, hx of NSAID allergy), use ARB instead

no pregnancy

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14
Q

what HTN med is priority to use in diabetic patients?

A

ACE inhibitors/ARB

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15
Q

CCB (dihydropyridine; Amlodipine (Norvasc) -ipine, NonDHP (diltiazem) adverse effects

A

PVR reducers
-ankle edema with DPH, dose dependent with more edema in higher dose (max 2.5 mg of amlodipine)
-avoid use in HF, renal, hepatic impairment

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16
Q

priority HTN meds

A

diuretics (thiazide)
ACE/ARB
CCB

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17
Q

secondary HTN meds

A

use when pt is on all 3 priority meds but HTN still not under control
-Beta-blockers
-Aldosterone antagonist

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17
Q

for BP: beta adrenergic antagonist (beta blockers , -lol): atenolol, metoprolol, propranolol

A

-secondary HTN meds; not 1st line
-lowers HR and Stroke volume
do NOT use non cardioselective beta blockers (propranolol,pindolol, sotalol, timolol (O thru Z letters) in lower airway disease (asthma, COPD)

BB with 1st letter A-N are cardioselective

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18
Q

aldosterone antagonist: Spironolactone (Aldactone), eplerenone (Inspra) adverse effects

A

-secondary HTN meds; not 1st line
-hyperK risk, esp with ACE/ARB use or volume depletion, excessive diuresis
-gynecomastia risk with prolonged use

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19
Q

if pt on 1 HTN medication and still not under control, what can you do?

A

add a 2nd HTN drug. it’s usually more effective than increasing 1st drug dose (also minimizes side effects from 1st med). 2nd med can cause 10-15 mmgh drop.

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20
Q

which medication should be avoided with a pt with HTN?

A

a systemic vasoconstrictor: pseudoephedrine

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21
Q

hypertensive urgency

A

severe BP >180/>120
STABLE pt w/o acute or impending change in HTN target organ dysfunction
-long-standing stopped/nonadherent with meds, no labs or progressing HTN

22
Q

hypertensive emergency

A

severe BP >180/>120
pt has evidence of impending or progressive HTN target organ dysfunction
-long-standing stopped/nonadherent, evidence of rapidly progressing TOD (SOB, crackles, vision changes)HF, pulmonary edema, retinopathy, intracranial hemorrhage, etc)

23
Q

hypertensive urgency intervention

A

NO indication for immediate in-office BP reduction with short-acting antihypertensive meds (clonidine, hydralazine, nitroglycerine)

NO need to send to ED

tell them to get BACK on the meds they were on before. if they ran out, give them a diff or increase dose

NOT an emergency

24
Q

hypertensive emergency intervention

A

NO indication for immediate in-office BP reduction with short-acting antihypertensive meds (clonidine, hydralazine, nitroglycerine) bc lowers BP too quickly and can lead to cardiovascular event

SEND TO ED ASAP!!

25
Q

when to check BP again after prescribing HTN meds

A

4 weeks/1 mo

26
Q

dysplipidemia screening

A

strong family hx, DM, HTN, obesity
-TC, LDL, HDL, TG

FASTING DOESN’T MATTER!
-triglycerides are affected if non fasting but only need to repeat in fasting state if TG are 400 or more

27
Q

high-intensity statin therapy: caution

A

reduces LDL by 50% or more
-atorvastatin 40-80 mg
-rosuvastatin 20-40 mg

-avoid with higher risk for statin adverse effects: rhabdomyolysis, > 75 yrs, impaired renal/low GFR, frailty, multiple comorbidities, with fibrates

28
Q

moderate intensity statin therapy: caution

A

reduces LDL by 30-49%
-atorvastatin 10-20mg
-rosuvastatin 5-10 mg
-simvastatin 20-40mg
-pravastatin 40-80 mg

preferred when there is high risk of adverse events with high intensity statins

29
Q

which meds not advised in dyslipidemia therapy?

A

niacin, resins

30
Q

HMG-CoA reductase inhibitor (statin): simvastatin (Zocor), atorvastatin (Lipitor), rosuvastatin (Crestor)

how much LDL does it lower? cautions/AE?

A

lowers LDL 50% or more
-check hepatic enzymes baseline before starting; no monitoring afterward
-caution grapefruit juice

AE: rhabdomyolysis, myositis (muscles inflamed)

31
Q

selective cholesterol absorption inhibitor:
Ezetimibe (Zetia)

A

lowers LDL by 20%
-works at gut only, not systemically
-Zetia + simvastatin = Vytorin

32
Q

proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors :
-cumab, Evolocumab, alirocumab

A

monoclonal antibody = $$$$
-lowers LDL 60% or more
for pts already on statin therapy
-SC injection only
-use as ADD ON to statin for hypercholesterolemia or clinical atherosclerotic.
ex: if uncorrectedLDL is 300 gets down to 150 with high intensity, then add in zetia to lower LDL 20% more, THEN consider PCSK9 inhibitor

33
Q

adenosine triphosphate citrate lyase (ACL) inhibitors (non statin): Bempedoic acid (Nexletol)

A

-lowers LDL 33%
-adjunct to max tolerated statin and/or ezetimibe therapy , also able to use in statin intolerant pts

34
Q

if statin intolerant and says they have muscle aches from going on statin but not a true rhabdo,

A

treating vitamin D deficiency usually takes care of it.
use rosuvastatin or pravastatin (less likely to get muscle aches)

35
Q

which medication lowers triglycerides by 30%? and AE?

A

Omega 3 fatty acids at 4g/d dose at PRESCRIPTION strength (not OTC)

-AE: increase bleeding risk/antiplatelet effect.

36
Q

which medication lowers triglycerides by 50% and increases HDL by 20%? and AE?

A

-fibric acid derivatives (fibrates): fenofibrate, (Tricor), Fenofibric acid

AE: myopathy (rhabdomyolysis esp if taken with statins)

37
Q

what is the purpose of the ASCVD ?

A

use to estimate pt’s 10 year ASCVD risk at initial visit as a reference point and clinical pt discussion on risk and risk lowering interventions.

38
Q

if have LDL 190 or more…

A

start on HIGH intensity statin
no risk assessment needed

39
Q

if have diabetes mellitus and age 40-75 yrs old…

A

start on moderate-intensity statin

40
Q

if 40-75 yrs old, with LDL 70-190, without diabetes, and is >20% “high risk” for ASCVD…

A

start HIGH intensity statin to reduce LDL by 50% or more

41
Q

hypertriglyceridemia
mild, mod, severe

A

mild: 150-199
moderate: 200-999
severe: 1000-1999
-mod and severe is at risk for CVD
very severe = risk of CVD, acute pancreatitis

42
Q

common causes of secondary hypertriglyceridemia

A

-DM with poor control
-untreated hypothyroidism
meds (2nd gen antipsychotics, systemic corticosteroids, estrogen supps, systemic retinoids)
-high carb diet, excess alcohol
-sedentary/obesity

43
Q

hypertriglyceridemia intervention

A

-if moderate TG 199-499: (reduce sat fat, inc fish, alcohol, statin (lower LDL)

-if TG 500+: reduce risk of ASCVD and pancreatitis!! diet, alcohol, STATIN, consider omega 3 or fibrate therapy

44
Q

familial hypercholesteremia

A

genetic coniditon causing super high LDL (LDL > 190)
-swollen or bumps around knuckles
-statin first line (then ezeteimab add on, then -umab (PSCK9) add on if LDL still no under control)

45
Q

statin therapy lab monitoring

A

no need to monitor serum transminases if there are no sx’s or concerns from pt

46
Q

Stage A & B of HF are goals of avoiding C &D HF. Stage B,C,D need cardiology consult

Stage A:

A

stage A: high risk but NO structureal or sx’s (HTN, atherosclerotic disease, DM, obesity, metabolic syndrome or using cardiotoxins, family hx of cardiomyopathy)

-Goal: good BP control to avoid LVH
-START ON ACE/ARB, statins are HEROS

47
Q

stage B: if pt develops structural heart disease, such as having previous MI, LV remodeling with LVH and low EF, asx vascular disease…what is the goal?

A

goal: prevent HF sx’s, further remodeling

-ACE/ARB, Beta blockers

-in specific ptss…ICD, revascularization or vascular surgeries

48
Q

ANYONE (doesn’t matter ethnicity) can benefit from ___ if have HTN, CKD

A

statins

protects kidney, brain, heart

49
Q

suspected heart failure symptoms

A

dyspnea
fatigue
edema

50
Q

HF clinical examination

A

tachycardia
increased JVP
displaced apex
S3 heart sounds
murmur
pulmonary crackles
dependent edema

51
Q

HF labs

A

ECG
chest x ray
echo
hemoglobin
blood chemistry
thyroid function tests

52
Q

if pt is 60 and OLDER, start BP meds if bp is…

A

SBP is 150+ or when DBP is 90+
target: < 150 and < 90

53
Q

if pt is YOUNGER than 60 years old, start BP meds if bp is…

A

SBP 140 + or DBP is 90 +
target: < 140 / DBP < 90

Fitzgerald Review (22 decks)

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