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HTN Flashcards

1
Q

When is angioplasty indicated for RAS?

A

Severe BILATERAL DZ

Unilateral dz w/ solitary kidney

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2
Q

What trial showed that PTCA is not better than OMT for unilateral RAS?

A

CORAL

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3
Q

Which gender has higher incidence of coarctation ?

A

Males

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4
Q

What is Turner’s syndrome associated with?

A

Coarctation

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5
Q

Name 5 things coarctation is associated with

A

Bicuspid AV
VSD, PDA, AS
Intracranial aneurysm

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6
Q

CXR findings for coarctation of Ao

A

Rib notching

3 sign

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7
Q

What is the definitive modality to evaluate for coarctation ? Why?

A

Echo b/c you can messier pressure gradient across it

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8
Q

What peak to peak gradient is significant in coarctation ?

A

20mm Hg

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9
Q

What is a complication of end to end anastomoses surgery for coarctation?

A

Re-coarctation and aneurysm at site of repair

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10
Q

What is treatment of choice for coarctation?

A

Balloon angioplasty with stent

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11
Q

What are top two things to remember that are associated with coarctation?

A

Bicuspid AV

Intracerebral aneurysm

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12
Q

Best test for pheo (highest Sn)?

A

24h urine catecholamines and metanephrines

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13
Q

Triad for pheo

A

Episodic HA, sweating, tachycardia

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14
Q

10% rule for pheo

A

10% malignant
10% multiple
10% extra-adrenal

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15
Q

What is considered a positive test for pheo with 24 h urine metanephrines ?

A

2x ULN

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16
Q

What is wrong with doing plasma fractionated metanephrines for pheo?

A

High false positives

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17
Q

What can falsely elevate levels of catecholamines and metanephrines?

A

Abrupt cessation of clonidine

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18
Q

Name 4 psych drugs that can increase metanephrines and catecholamines

A

Levodopa
Amphetamines
Buspirone
TCAs

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19
Q

What is Sn and Sp of CT/MR for pheo?

A

Sn- 100%

Sp 79% (Incidentalomas)

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20
Q

What radiological test confirms extraadrenal pheo?

A

MIBG

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21
Q

Can you send or to Sx for pheo based on MIBG images alone?

A

No

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22
Q

Which receptor do you block first for pheo preop?

A

Alpha before beta

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23
Q

What is the best alpha blocker to start preop for pheo and when do you start it?

A

Phenoxybenzamine

7-10d preop

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24
Q

What are two pharmacological properties of phenoxybenzamine that make it a good alpha blocker for preop pheo?

A

Irreversible

Nonspecific

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25
Q

Which of the following do you use for preop pheo: prazosin, doxazosin or phenoxybenzamine?

A

phenoxybenzamine

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26
Q

When do you start BB for preop pheo?

A

After alpha blockers

2-3 d preop

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27
Q

Top 3 Meds to use intraop if a pheo squirts and causes hypertensive crisis

A

Nitroprusside
Phentolamine
Nicardipine

28
Q

Phenylalanine MOA

A

Non selective, short acting alpha blocker

29
Q

In primary hyperaldosteronism, what are the levels of renin ?

A

Low

30
Q

In secondary hyperaldosteronism , what will renin levels be?

A

High

31
Q

When to screen hypertensive pt’s for primary hyperaldosteronism?

A

Severe or resistant HTN

Hypokalemia

32
Q

What is the screening test for primary hyperaldosteronism ?

A

PAC/PRA

Plasma Aldo conc)/ (plasma renin activity

33
Q

What plasma Aldo conc/plasma renin activity signifies essential HTN vs primary hyperaldosteronism?

A

Essential: 10

Hyperaldosteronism : 30

34
Q

What is Dx if you have a hypertensive pt and you do an oral sodium load of 5g over 3 days and their Aldo level is >12mcg/24h?

A

Primary hyperaldosteronism

35
Q

What are two tests you can do to diagnose primary hyperaldosteronism ?

A

Oral sodium load
Saline infusion test

(Aldo will be > 10)

36
Q

Which patients get Sx for primary hyperaldosteronism?

A

Unilateral adenoma

37
Q

2 drugs you can give to treat primary hyperaldosteronism

A

Spirinolactone

Eplerenone

38
Q

What are the major components of DASH diet?

A

Fruits, vegetables, fiber, low fat dairy

39
Q

What did ALLHAT show for ACEI, CCB vs diuretics?

A

No difference in reducing CV events

40
Q

What did LIFE trial show for losartan vs atenolol in HTN?

A

Losartan better for LVH and reducing stroke

41
Q

What did ACCOMPLISH trial show for high risk hypertensives and amlodipine/benazepril vs HCTZ/benazepril ?

A

Lower BP and CV events with amlodipine/benazepril

42
Q

According to JNC 7, what is total recommended sodium intake for hypertensives?

A

2400 mg daily

43
Q

where is Beta 1 receptor found and what is its effect?

A

heart

inc inotropy and chronotropy

44
Q

where is Beta 2 found and what is Beta 2 receptor effect?

A

vessels

vasodilation

45
Q

does angiotensin II increase both BP and cardiac output?

A

yes

46
Q

After starting an ACEI, how much Cr rise should make you worry?

A

> 30%

47
Q

Verapamil and diltiazem are ?

A

Nondihydropyridines

48
Q

What adverse effect if alpha antagonists did ALLHAT show for hypertensives?

A

Inc’d CHF

49
Q

Clonidine mech

A

Alpha 2 blocker

50
Q

Main side effect of Hydralazine

A

Lupus like syndrome

51
Q

Main side effect of minoxidil

A

Hirsutism

52
Q

hydralazine mech

A

direct vasodilator (via inc. in NO and cGMP

53
Q

what is hypertensive urgency?

A

BP > 180/120, relatively asymptomatic

54
Q

er how long can you decrease BP in HTN urgency? what med is contraindicated?

A

hours to days

SL nifedipine

55
Q

why is SL nifedipine dangerous?

A

increases risk of MI

56
Q

4 drugs you can use to treat hypertensive emergency

A

Nitroprusside, labetalol, nicardipine, fenoldepam

57
Q

what side effect comes with long term use of nitroprusside?

A

cyanide tox

58
Q

can you give iv nitroprusside in pregnancy?

A

no

59
Q

definition of preeclampsia

A

previously normotensive woman now at least 20 weeks pregnant with new HTN and proteinuria

60
Q

definition of gestational HTN

A

HTN without proteinuria

61
Q

***criteria for preeclampsia

A

SBP>140 or DBP > 90 with 2 measurements at least 6 h apart (within 1 week)
Proteinuria > .3g in 24hrs

62
Q

first line therapy in preeclampsia?

A

bedrest

63
Q

when do you consider giving meds in preeclampsia?

A

when BP 160/105 or sxs

64
Q

drug of choice for preeclampsia?

A

labetalol IV

65
Q

what is the main adverse event of HTN in pregnancy?

A

stroke

66
Q

What part of renal artery will atherosclerosis occur? What about FMD?

A

Proximal

Distal

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