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Internal Medicine > Ambulatory Medicine - Step UP > Flashcards

Ambulatory Medicine - Step UP Flashcards

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1
Q

MCC of secondary HTN

A

renal artery stenosis

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2
Q

what types of medications can cause secondary HTN?

A

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

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3
Q

mechanism of action of OCPs in causing HTN

A

estrogen-mediated increase in synthesis of angiotensinogen in the liver

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4
Q

who should be screened for secondary HTN

A
  • pts with HTN before age 25 or greater than 55 yo
  • key features in hx/PE
  • pts. refractory to standard tx
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5
Q

features of Conn syndrome

A

HTN and hypokalemia due to increased aldosterone

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6
Q

tx. of Conn syndrome

A

K+ sparing diuretics, surgery

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7
Q

malignant HTN

A

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

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8
Q

which hypertensive drugs are contra-indicated in pregnancy?

A

ACEi/ARBs
thiazides
CCBs

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9
Q

what HTN drugs are safe in pregnancy?

A

B-blockers

hydralazine

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10
Q

best initial HTN drug choice for African-American patients

A

thiazide diuretics

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11
Q

who should BB be avoided in?

A

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

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12
Q

what anti-HTN drug is preferred among diabetics?

A

ACEi

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13
Q

when are alpha-blockers considered in tx. of HTN

A

in pt with concurrent BPH

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14
Q

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

A

in combo with BB and diuretics in pts with refractory HTN

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15
Q

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

A

beta blocker

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16
Q

which HTN drugs can decrease LV systolic function in CHF

A

ACEi and/or BB

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17
Q

what drugs are least effective in african americans

A

ACEi

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18
Q

ACCOMPLISH trial

A

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

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19
Q

endocrine secondary causes of hyperlipidemia

A

hypothyroidism
DM
Cushing’s syndrome

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20
Q

renal causes of hyperlipidemia

A

nephrotic syndrome

uremia

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21
Q

medications that can cause hyperlipidemia

A 
steroids
estrogen
thiazide diuretics
B-blockers
HIV protease inhibitors
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22
Q

what levels of LDL significantly predispose to increased CAD risk

23
Q

how can you calculate LDL cholesterol

Study These Flashcards
A

total cholesterol - HDL - TG/5

24
Q

goal for total cholesterol levels

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

Internal Medicine (9 decks)

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