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Flashcards in Ambulatory Medicine - Step UP Deck (54):
1

MCC of secondary HTN

renal artery stenosis

2

what types of medications can cause secondary HTN?

OCPs, decongestants, estrogen, appetite suppressants, chronic steroids, TCAs, NSAIDs

3

mechanism of action of OCPs in causing HTN

estrogen-mediated increase in synthesis of angiotensinogen in the liver

4

who should be screened for secondary HTN

- pts with HTN before age 25 or greater than 55 yo
- key features in hx/PE
- pts. refractory to standard tx

5

features of Conn syndrome

HTN and hypokalemia due to increased aldosterone

6

tx. of Conn syndrome

K+ sparing diuretics, surgery

7

malignant HTN

sufficient elevation of BP to cause papilledema and other manifestations of vascular damage (encephalopathy, nephropathy)

8

which hypertensive drugs are contra-indicated in pregnancy?

ACEi/ARBs
thiazides
CCBs

9

what HTN drugs are safe in pregnancy?

B-blockers
hydralazine

10

best initial HTN drug choice for African-American patients

thiazide diuretics

11

who should BB be avoided in?

pts with hx. of asthma, COPD, heart block and depression

12

what anti-HTN drug is preferred among diabetics?

ACEi

13

when are alpha-blockers considered in tx. of HTN

in pt with concurrent BPH

14

when are vasodilators like hydralazine and minoxidil used to tx. HTN

in combo with BB and diuretics in pts with refractory HTN

15

what drug is used for tx of HTN in pts post-MI

beta blocker

16

which HTN drugs can decrease LV systolic function in CHF

ACEi and/or BB

17

what drugs are least effective in african americans

ACEi

18

ACCOMPLISH trial

tx. with ACEi benazepril PLUS CCB amlodipine was more effective than tx. with ACEi + diuretic

19

endocrine secondary causes of hyperlipidemia

hypothyroidism
DM
Cushing's syndrome

20

renal causes of hyperlipidemia

nephrotic syndrome
uremia

21

medications that can cause hyperlipidemia

steroids
estrogen
thiazide diuretics
B-blockers
HIV protease inhibitors

22

what levels of LDL significantly predispose to increased CAD risk

> 160 mg/dL

23

how can you calculate LDL cholesterol

total cholesterol - HDL - TG/5

24

goal for total cholesterol levels

< 200 mg/dL

25

goal for LDL in a diabetic? for diabetic and CAD?

1) < 100 mg/dL
2) < 70 mg/dL

26

effect of HDL on cholesterol

every 10 mg/dL increase in HDL, reduces CAD risk by 50%

27

which lipid lowering drugs can induce transient elevations in LFTS

statins and fibrates

28

what other tests should you order if a patient has hyperlipidemia?

TSH - hypothyroidism
LFTs - chronic liver disease
BUN, Cr, urinary proteins
glucose levels

29

effects of Statins

lower LDL levels
- reduce mortality from cardiovascular events and significantly reduce total mortality

30

side effects of statins

monitor LFTs - monthly for first 3 months, then every 3-6 months
monitor CPK- decrease CoQ in muscle cells= myopathy

31

side effects of niacin

lower TG levels, lowers LDL levels, increases HDL

32

note about use of niacin

- do not use in diabetics (may worsen glycemic control)
- most potent agent for increasing HDL
- flushing effect
- check LFTs and CPK levels

33

effects of bile-acid binding resins

lower LDL and increase TG levels
- effective when used in combo with statins or niacin in high risk pts

34

effects of fibrates (gemfibrozil)

lower VLDL and TG
increase HDL
- primarily for lowering TG

35

side effects of fibrates

gynecomastia
gallstones
mild GI side effects
weight gain
myopathies

36

first line therapy for high TG levels

weight loss, aerobic exercise, glycemic control in DM and low fat-diet

37

medications to lower TG levels

fibrates
fish oils
nicotinic acid

38

what kind of headache causes pain that is tight and a band-like pattern around the head most intense in the neck or back of head and can be accompanied by tight posterior neck muscles?

tension headache

39

what are tension headaches commonly associated with?

anxiety, depression and stress

40

tx of tension headaches

eliminate causal factor
NSAIDS, acetaminophen and aspirin

41

man experiences excruciating periorbital pain unilaterally along with ipsilateral lacrimation, facial flushing and nasal stuffiness/discharge - dx?

cluster headache

42

characteristics of pain in cluster headache

usually awakens the patient form sleep and attacks can occur nightly for 2-3 months and then disappear; worse with alcohol and sleep

43

DOC for acute cluster headache attack

sumatriptan (Imitrex)
- O2 inhalation can be beneficial

44

prophylaxis of cluster headaches

verapamil -daily

45

alternate agents for prophylaxis of cluster headaches

ergotamine,methysergide, lithium, prednisone

46

classic presentation of a visual aura in migraine

bilateral homonymous scotoma
- bright, flashing crescent-shaped images with jagged edges that often appear on a page obscuring the underlying print

47

characteristic pain in a migraine

severe, throbbing, unilateral headache that is aggravated by coughing, physicial activity and bending down; may be accompanied by photophobia, NV or increased sensitivity to smell

48

first line therapy for a migraine

NSAIDs - ibuprofen, naproxen

49

2nd line therapy for moderate-severe migraines

triptans or dihydroergotamine

50

contraindications of dihydroergotamine

CAD
pregnancy
TIAs
PVD
sepsis

51

contraindications of sumatriptan

CAD, pregnancy, uncontrolled HTN, MAOIs, SSRIs, lithium, basilar artery migraine, hemiplegic artery

52

what is the best drug for tx. of migraine severe migraine symptoms

sumitriptan
- should not be used > 1-2x/week

53

best drug for prophylaxis of a migraines

propranolol
- TCAs are also first line

54

second-line agents for migraine prophylaxis

methysergide
verapamil
valproic acid