Clinical: Hypertension Flashcards
(74 cards)
1
Q
What drugs are used for Migraine prevention, even if a PT does not have HTN?
A
BB and CCB are first line therapy for migraine prevention (with/without HTN)
2
Q
How does Chronic HTN relate to pregnancy?
A
- tldr
- HTN Dx in 1st 20 weeks
- 5% of pregnancies
- Increased with older women
- Mild/Moderate: Do Not Treat
- Severe: Treat
- Over 160 SBP or 110 DBP
3
Q
How does each of the following conditions relate to secondary HTN?
- End-stage renal disease (ESRD)
- Renal Artery Stenosis
- Pheochromocytoma (a rare tumor that usually starts in the cells of one of your adrenal glands)
A
4
Q
Describe the Tx plan for a Hemorrhagic stroke
A
5
Q
Give the Tx and BP Goals for this Pregnancy-related-HTN
A
6
Q
What are Eclampsia and Pre-Eclampsia?
A
- Eclampsia
- the onset of seizures/convulsions in a woman with pre-eclampsia.
- Pre-eclampsia
- a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction. Onset may be before, during, or after delivery.
7
Q
Describe how “Bad Kidneys” are related to secondary HTN
A
8
Q
- Which of the following is the best predictor of stress on arterial walls?
- Systolic BP
- Diastolic BpP
- Mean Arterial Pressure
A
MAP
9
Q
How do genetics play a part in HTN?
A
- Parental HTN increases the chance of HTN in children
- Chance increase more with age compared to others
- Anywhere between 65% to 27% of essential HTN due to genetics.
10
Q
Give the Tx and BP Goals for this Pregnancy-related-HTN
A
11
Q
How is Cushing’s Syndrome related to secondary HTN?
A
12
Q
Why were the classes of HTN changed in 2017?
A
13
Q
- In HTN crisis, what is considered HTN Urgency?
- Who does it affect most?
A
14
Q
What are the common reasons for HTN for the following age group?
0-18 year olds
A
15
Q
Concerning reasons for secondary HTN and the memory device “ABCD”, what does B stand for?
A
- B
- Bruits (suggests RAS)
- Bad kidneys
- Blood Cells (Erythropoietin)
16
Q
What are the current measurements for HTN stage 2?
What percentage of adults in America has HTN stage 2?
A
17
Q
What areas of America have the highest prevalence of HTN? What about the world?
A
Southeast USA
Russia + Africa
18
Q
Concerning reasons for secondary HTN and the memory device “ABCD”, what does D stand for?
A
- D
- Drugs
- Diet
- Dysfunctional Endocrine System
19
Q
What is phentolamine used to treat?
A
Sympathetic Overdrive but has rebound tachycardia
20
Q
If a PT has diabetes with no nephron disease, what drugs can you start them with?
A
- ACE, ARBs or CCBs
-
AVOID Diuretics
- Diabties =/= Diuretics
-
AVOID Diuretics
21
Q
Concerning reasons for secondary HTN and the memory device “ABCD”, what does C stand for?
A
- C
- Catecholamines
- Coarctation of aorta
- Cushing’s Syndrome
22
Q
How do ACEI/ARB’s cause renal function to decline in RAS?
A
23
Q
Describe how Aldosteronism can cause secondary HTN
A
- Excessive secretion of aldosterone.
- This disturbs the balance of sodium, potassium, and water in the blood and so leads to high blood pressure.
- Primary Hyperaldosteronism aka (Conn’s Syndrome)
- low K+
- Resistant HTN on 3 meds
- Due to
- solitary adrenal tumor
- bilateral adrenal hyperplasia
24
Q
How do you treat HTN without Rx in pregnant women?
A
25
How does a **D**ysfunctional Endocrine cause secondary HTN?
26
What are the common reasons for HTN for the following age group?
19-35 year olds
27
Describe the directed PE for HTN crisis
* BP measurements?
* Pulses
* Eye Exam?
* Other Exams
28
What is Gestational HTN?
* HTN after 20 weeks
* 1/2 of women get it
* Usually resolves 6 weeks after birth
29
Concerning reasons for secondary HTN and the memory device "ABCD", what does A stand for?
* A
* Accuracy of measurement
* Aldosteronism
* Apnea
30
How does Pre-Eclampsia or Eclampsia relate to HTN during pregnancy?
* Multi-organ disease that may be related to the placenta and autoimmunity
* Need BP to be over 140/90 AND one of:
* Protein**uria**
* **Liver enzyme** elevations
* **Renal** insufficiency
* Visual/**Cerebral** changes
* Pulmonary **edema**
31
What kind of drug is **Chlorthalidone**?
Diuretic
32
What percentage of HTN emergency is cardiac related and what percentage is cerebral related?
33
* In HTN crisis, what is considered HTN Emergency?
* What symptoms are associated with it?
* What subset of HTN Emergency is associated with death if undiagnosed if not treated correctly/right away?
34
If has a history of Gout and has HTN, what drugs do you not give them?
Diuretics
35
Give the Tx and BP Goals for this Pregnancy-related-HTN
36
What are the most common drugs that cause secondary HTN?
Tobacco, alcohol, anti-inflammatories
37
Describe the Tx plan for an aortic dissection
38
If a PT is African America, what is drugs do you avoid when starting Tx for HTN? What drugs do you start them with?
* African Americans
* less responsive to ACEI & ARB’s
* **_A_**frican **_A_**merican =/= **_A_**CEI or **_A_**RB
* Start with diuretics and CCB
39
When do you treat pre-eclampsia?
* Can use baby aspirin too
40
Describe how Bruits is related to secondary HTN
* Bruit
* turbulent flow in peripheral vessels
* Suggested of Renal Artery Sclerosis
* Difficult to control HTN with 3 meds
* Older age with multiple risk factors for CAD
* ***_DO NOT GIVE PTs with Renal Artery Sclerosis an ACE inhibitor_***
* *_This will lead to kidney failure and will be seen as a 20% drop in eGFR or 30% rise in serum Cr_*
* Also suggestive of Fibromuscular dysplasia
* Seen in **young, healthy women.**
* **Fibrous changes in** **lumen****,** narrowing of renal arteries
* 2/3 of PTs have multiple arteries involved causing **arterial aneurysms/narrowing/ tortuosity**
* “**string of pearls**” appearance angiographically
* Fenetics (**PHACTR1** gene/**rs9349379** variant)
41
How does Diet cause secondary HTN?
42
Describe how "Catecholamines" are related to secondary HTN
43
What is the nocturnal dip?
What groups of people show a decreased nocturnal dip
44
Describe how Apnea can cause secondary HTN
* Sleep apnea is the **most COMMON cause of resistant hypertension (64%).**
* Until addressed, BP’s will not reach ideal BPs
* **See nocturnal dip**
45
What is the amount of salt req. every day?
1500 mg but people on average have 3400 mg
46
Describe how "Blood Cells" are related to secondary HTN
47
Give the Tx and BP Goals for this Pregnancy-related-HTN
48
Besides Rx, what other things do you recommend a PT who has HTN do?
DASH-1 decreases Bp by 11, DASH-2 by 16
49
What are the 4 types of HTN that are related to pregnancy?
1. Chronic HTN
2. Pre-Eclampsia or Eclampsia
3. Pre-Eclampsia or Eclampsia + Chronic HTN
4. Gestational HTN
50
Describe how the "Coarctation of the aorta" is related to secondary HTN
51
What are the hallmarks of Cushing's Syndrome?
52
What are the safe options for Rx in pregnant women with HTN?
(Give the name of the drug as well as the class)
**Nice Meth Labs**
* Labetalol
* **First Choice**
* NS Beta blocker with alpha 1 activity
* Methyldopa
* Alpha 2 agonist
* Nifedipine
* CCB
53
What particular group of people has the worst control of HTN? What group has the best control of HTN?
Worst: Asian men
Best: White women
54
What is the first choice of drugs for HTN when a patient doesn't have any medical contraindications?
Which drug is usually started first and what other drug is commonly taken with it?
What is important to keep in mind when prescribing these drugs?
55
How do you confirm HTN?
56
If a PT has diabetes with nephron disease, what drugs can you start them with?
ARBS, or ACEI
57
What labs do you consider when you find that a PT has HTN?
58
If has a history of coronary artery disease or an MI and has HTN, what drugs can you start them with?
* BBs are 1st line after MI
* **Met**oprolol, **n**adolol, **bis**oprolol, **propanol** or **tim**olol ONLY
* **ACE/ ARB**
* Use for stable **CAD or Left ventricular heart failure**
* Can add **thiazide diuretic or CCB** (**dihydropyridine** only) if BP goal is not reached
59
Give the Tx and BP Goals for this Pregnancy-related-HTN
60
Describe the Tx plan for an ischemic stroke
61
If you suspect an underlying cause of secondary HTN, what specific evaluations or labs do you want to find/conduct?
62
* What is HELLP syndrome?
* How does it relate to HTN?
* How many PTs with HELLP die?
63
What are the common reasons for HTN for the following age group?
40-64 year olds
64
What glaring statistic shows that age greatly influences HTN?
A healthy 65-year-old who has no sign of HTN has a 95% chance of developing HTN in 20 years.
65
What are the common reasons for HTN for the following age group?
Anyone over the age of 65
66
What kind of drug is **Hydrochlorothiazide**?
diuretic
67
Explain the process of a Directed Physical Exam for HTN patients
68
What are the pearls of HNT crisis Tx and what are the exceptions?
69
Why has primary HTN increased in pediatric PTs and what would make you suspect secondary HTN in a pediatric PT?
70
If has a history of chronic kidney disease and has HTN, what drugs can you start them with?
ACE, ARB are 1st line therapy
71
What drugs do you avoid when prescribing Rx for pregnant women with HTN?
Played on my **Ni**ntendo**-DS** while waiting for **AAA**
1. **A**CEI
2. **A**RBS
3. **A**tenolol
* Beta Blocker
4. **N**itroprusside
* Cyanide
5. **S**pironolactone
* Anti-androgenic
6. **D**ieretics
* Lowers placental perfussion
72
* When do BPs in pregnant women drop and when do they return to normal?
* How is the prevalence of HTN-related pregnancy problems?
* When do you treat chronic HTN in pregnant women?
73
At what age do you treat pediatric HTN the same as adult HTN?
13
74
Give the Tx and BP Goals for this Pregnancy-related-HTN
