Cardio 10

Question 1

Regulation of blood pressure (BP)

Answer 1

Baroreceptors
Endothelial factors
Kidneys
Genetic influences

Question 2

BP =

Answer 2

cardiac output (CO) x pulmonary vascular resistance (PVR)

Question 3

Most essential: patients with hypertension

Answer 3

(HTN) have increased peripheral resistance and normal CO

Question 4

Baroreceptor how do they work

Answer 4

Baroreceptor exerts control of mean arterial pressure as a negative feedback loop. Nerve impulses from arterial baroreceptors are tonically active; increases in arterial blood pressure will result in an increased rate of impulse firing.

Question 5

Endotheial Factors how do they work

Answer 5

These endothelial factors modulate the effects of norepinephrine (NE) released by sympathetic nerves (SN), and the effects of tissue metabolites and humoral factors. The three most important endothelial-derived substances are: nitric oxide (NO), endothelin (ET-1), and prostacyclin (PGI2).

Question 6

Most common cause of HTN

Answer 6

primary (95%) caused by atherosclerosis

Question 7

other kind of HTN

Answer 7

secondar (5%) caused by adrenal, renal factors

Question 8

BP relies on

Answer 8

balance of CO and PVR

Question 9

HTN lab workup 7 items

Answer 9

Electrocardiography (ECG)
Urine analysis
Blood glucose
Serum potassium, creatinine, calcium
Lipid profile
C-reactive protein
Homocysteine

Question 10

When can you dx HTN

Answer 10

HTN on two separate readings

Question 11

Single high reading on one occasions

Answer 11

dx elevated BP

Question 12

normal BP

Answer 12

less than 120 and less than 80

Question 13

early HTN

Answer 13

120 to 139 and 80 to 89

Question 14

stage 1

Answer 14

140 to 159 and 90 to 99

Question 15

stage 2

Answer 15

greater than or equal to 160 or greater than or equal to 100

Question 16

The old term “pre-hypertension” no longer used

Answer 16

Patients did not appreciate degree of risk or true impact of being outside of normal range

new term is early hypertension

Therapy adherence there an issue

Question 17

National Guidelines Updates older adults

Answer 17

Changes definitions of control for older adults to allow higher values to avoid orthostatic falls and increase adherence

Question 18

National Guidelines Updates medications (two items)

Answer 18

Beta blockers no longer first-line drugs

Emphasis on multiple therapeutic agents at lower doses rather than one agent at maximum dose

Question 19

Goal of HTN treatment

Three items

Answer 19

Prevent the rise of BP with age.

Improve control of HTN to below 140/90 mm Hg

The primary focus should be on obtaining the systolic blood pressure (SBP) goal

Question 20

In patients with concurrent HTN

Answer 20

and diabetes or renal disease, the BP goal is less than 130/80 mm Hg

Question 21

There is a little correlation of ___ with HTN

Answer 21

Vit D3

Question 22

Goals of Treatment Continued for HTN Two Items

Answer 22

Improve recognition of the importance of risk factors on the development of HTN.
Reduce ethnic, socioeconomic, and regional variations in HTN care.

Question 23

Step one and two of treatment of HTN

Answer 23

lifesytle

medication

Question 24

Benefits of Lowering BP

Answer 24

Storke reduced 35 to 50%
MI by 20% to 25%
Heart Faliure 50%

Question 25

In stage 1 HTN and more cardiovascular disease risk factors, achieving a sustained 12 mm Hg reduction in SBP over 10 years will prevent

Answer 25

1 death/11 patients treated.

Question 26

DASH diet

Answer 26

Dietary Approaches to Stop Hypertension (DASH) diet Dietary sodium reduction (most consume too much; not a restriction, but conscious effort) Limit alcohol consumption Physical activity

Question 27

For every 10% reduction in BMI over 30 you will see

Answer 27

a significant reduction in risk for cardiovascular disease

Question 28

ETOH to recomendations

Answer 28

0 to 1 for women | 0 to 2 for men

Question 29

What is very important to lower BP

Answer 29

physical activity. This works even if you are overweight

Question 30

physcial activity recomendation

Answer 30

150 min a week

Question 31

Stepped Therapy (first 4 steps)

Answer 31

Set an appropriate minimum therapeutic BP goal: no longer less than 120/80. (under 140/90 RESTING) Be patient, and work on attaining the BP goal over many weeks to months. Titrate BP medications no more often than every 4 to 6 weeks. Do not automatically assign to the drug symptoms reported by patients.

Question 32

Lisinopril side effect

Answer 32

cough

Question 33

Stepped therapy (5 through 7)

Answer 33

Plan at the beginning of therapy for the use of more than one drug. Treat to achieve goal SBP in older adults even if diastolic blood pressure is normal, but go more slowly, allowing SBP of 150 to 160 mm Hg if asymptomatic. Extracellular fluid volume must be controlled to achieve BP goals.

Question 34

Initial therapy for HTN

Answer 34

Angiotensin-converting enzyme inhibitors (ACEIs), or calcium channel blockers (CCBs) if:

Question 35

ACE or CCB is used if

Answer 35

BP is more than 20 mm Hg above the systolic goal or 10 mm Hg above the diastolic goal

Question 36

early HTN you may want to

Answer 36

start with a mild diuretic or add on quickly to achieve goals

Question 37

Drugs that work on cardiac output

Answer 37

Beta blockers Calcium channel blockers Diuretics

Question 38

Drugs that work on total peripheral resistance

Answer 38

``` ACEIs Angiotensin II receptor blockers (ARBs) Direct renin inhibitors Beta blockers Alpha agonists CCBs Diuretics Sympatholytics Vasodilators ```

Question 39

Drugs indicated for Heart Failure

Answer 39

Diuretics, beta blockers, ACEIs, ARBs, aldosterone antagonists

Question 40

Drugs indicated post MI

Answer 40

Beta blockers, ACEIs, aldosterone antagonists

Question 41

Drugs indicated for High coronary disease risk

Answer 41

Diuretics, beta blockers, ACEIs, CCBs

Question 42

early hypertension probably will use

Answer 42

diuretic

Question 43

stage one HTN will likely use

Answer 43

ACE or CCB

Question 44

Drugs indicated for Diabetes and HTN

Answer 44

Diuretics, ACEIs, ARBs, CCBs

Question 45

Drugs indicated for CKD and HTN

Answer 45

ACEIs, ARBs until stage 3 chronic kidney disease (CKD)

Question 46

Drugs indicated with recurrent stroke prevention and HTN

Answer 46

Diuretics, ACEIs