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MDT's > HTN > Flashcards

HTN Flashcards

1
Q

What are the 4 levels of HTN?

A

Normal
Elevated
Stage I HTN
Stage II HTN

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2
Q

Values for Elevated HTN

A

120-129 / <80

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3
Q

Stage I HTN Values

A

130 - 139 / 80 - 90

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4
Q

Stage II HTN values

A

> /= 140 / >/= 90

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5
Q

What is the term applied to 95% of htn patients with no single cause? (Basically can’t really find a reason)

A

Essential HTN

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6
Q

What is secondary HTN?

A

Has an identified cause

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7
Q

What are the factors contributing to essential HTN?

A

Genetic and Environmental

Ages 22-55

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8
Q

When is secondary HTN suspected?

A
  • Early age HTN
  • First symptoms after 50
  • Meds aren’t able to control HTN
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9
Q

What are the identifiable causes of Secondary HTN?

A
  • Renal disease
  • renal artery disease
  • Pregnancy
  • Cushing syndrome
  • Hyperthyroidism
  • Estrogen use
  • drug induced
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10
Q

Physical findings of essential htn?

A

usually asymptomatic

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11
Q

DDx for secondary htn?

A
  • Hyperthyroidism
  • Stimulant (cocaine)
  • Adrenal Steroids
  • OTC suplements
  • Anorexic Meds
  • NSAIDS
  • Oral contraceptives
  • Alcohol withdrawal
  • Obesity
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12
Q

Labs for HTN

A
  • UA: proteinuria, hematuria, casts
  • Fasting glucose
  • CBC
  • Chemistry
  • Lipid panel
  • EKG
  • 10-year atherosclerotic risk”
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13
Q

Assessment of HTN?

A

Rule out causes of secondary HTN

  • Must have HTN readings on 3-5 separate visits
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14
Q

Treatment for HTN?

A

Lifestyle

Pharm

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15
Q

Lifestyle treatments of HTN?

A
  • Diets rich in fruits and vegetables, low sat fats
  • Weight reduction (10 kg can lower 5-20 Systolic)
  • Reduce alcohol use ( no more than 2 per day)
  • Increase physical activity
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16
Q

What is the pharmacological goal for HTN?

A

<140/90 or <130/90 in patients with diabetes or kidney disease

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17
Q

What is your first line treatment for HTN?

A

Diuretics - HCTZ
12.5 - 25mg PO daily

ACEi - 5-10 mg daily up to 40mg daily PO

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18
Q

How do diuretics help with HTN?

A
  • Initially lower plasma volume

* Long term is reduction of peripheral vascular resistance

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19
Q

How do diuretics help with HTN?

A
  • Initially lower plasma volume

* Long term is reduction of peripheral vascular resistance

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20
Q

Labs for using Diuretics

A

Initial chemistry and then follow up in 3 months to check electrolytes

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21
Q

What is your first line therapy for HTN that isn’t a diuretic?

A

ACE inhibitors (lisinopril)

5 - 10mg PO max 40mg

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22
Q

How do ACE inhibitors help with HTN?

A
  • Stimulate synthesis of vasodilating prostaglandins

* Reduces sympathetic nervous system responses

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23
Q

How is Lisinopril administered?

A

5-10 mg up to 40mg daily via titration

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24
Q

Remaining meds for HTN treatment other than Diuretics and ACEi?

A
  • ARBs - Angiotensin receptor blockers
  • CCBs
  • Alpha blockers
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25
Q

What is the suffix for ARBs?

A
  • sartan

* Losartan 50mg daily

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26
Q

If a pt is responding well to ACEi but develops a cough, what can we switch them to?

A

ARB - Losartan 50mg daily PO

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27
Q

How do CCBs work?

A

Prevent calcium from entering the muscle which prevents contractions

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28
Q

Contraindications for CCBs?

A

Causes heart issues

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29
Q

Dosing for CCBs?

A

Diltiazem - 180mg daily PO up to 360mg

Amlodapine - 2.5mg PO up to 10mg

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30
Q

When should you re-evaluate pt’s for when prescribing HTN meds?

A

1 month after any med change and allow 3 months before adjusting dosing

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31
Q

What are the long term complications due to sustained HTN?

A
  • Cardiovascular Disease
  • Renal failure
  • Aortic dissection
  • Cerebrovascular disease
  • Peripheral vascular disease
  • Eye - retinal damage
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32
Q

What is the big difference between HTN urgency and HTN Emergency?

A

Pt will have symptoms, specifically signs of end organ damage ( mental status changes, etc.)

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33
Q

What is the BP on the TG for HTN urgency?

A

> 220 / > 125

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34
Q

What is the BP of the TG for HTN emergency?

A

Diastolic > 130

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35
Q

How fast does urgent HTN need to be reduced?

A

Within a few hours

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36
Q

How fast does Emergent HTN need to be reduced?

A

15-25% within 1 hour, THEN <160/110 within 24 hours

  • Slowly after 25% because you want to prevent ischemia
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37
Q

What are the 3 big exams you’re doing to identify end organ damage?

A
  • Neuro
  • Cardio/Pulmonary
  • Fundoscopic (papilledema)
38
Q

Labs for urgent for emergent HTN?

A
  • UA - proteinuria or hematuria
  • Metabolic panel
  • Troponins
  • EKG
  • CXR
  • CT head or aorta
39
Q

Medication route difference between HTN urgency and Emergency?

A 
Urgency = PO
Emergency = IV
40
Q

What is the goal for PO meds regarding HTN urgency?

A

Reduce DBP <110 over 24 hours

41
Q

How do you treat HTN urgency?

A
  • Goal is for DBP to be <110
  • Continue diuretic of HCTZ 25mg PO
    OR
  • Begin anti-hypertensives:
  • Alpha Blocker (Clonidine) 0.1mg PO
  • Beta Blocker (Labetalol/Metoprolol)
42
Q

Adverse reaction for Alpha Blockers

A

Rebound HTN, Tachycardia, and other cardiac issues

43
Q

When do we provide O2?

A

Sats <94%

44
Q

Full treatment for HTN Emergency?

A
  • IV access and O2 for <94%
    to 160/100
  • Begin Labetalol 20mg IV over 10 minutes, then 40-80mg every 10 min
  • Reduce BP by 25% within 1 hour
  • Slow reducing of BP over 24 hour period
  • Once stable start Metoprolol 25-50mg PO bid
45
Q

What does atherosclerotic disease usually effect?

A

Primarily the arterial endothelium

46
Q

What arteries are commonly affected by atherosclerotic disease?

A 
Coronary
Aorta
Carotid
Cerebral
Lower Extremity
47
Q

What are big ticket items that cause atherosclerotic disease

A

Smoking
Immune issues
Dyslipidemia

48
Q

What is happening in atherosclerotic disease?

A

Plaques are invading the tunica intima of arteries and then cause thickening of the tunica media which cause the arteries to narrow

49
Q

What is the number one killer in the U.S.?

A

CAD

50
Q

What are the physical findings of CAD?

A

They look like shit and have chest pain

51
Q

Labs for CAD?

A
  • Lipids (Dyslipidemia?)
  • EKG (Chest pain, S3 heart sounds)
  • Fasting Glucose (diabetes?)
  • Troponin (cardiac markers for MI)
52
Q

How is CAD treated?

A
  • Lifestyle changes
  • Low fats
  • STOP FUCKING SMOKING
  • Alcohol reduction
  • Control HTN, Diabetes, cholesterol
53
Q

Meds for CAD treatment?

A

*HMG-CoA reductase inhibitors (STATINs)
lowering the lipids
10mg before bed PO

  • Aspirin 81mg with >10% 10 year risk
54
Q

What is CAD?

A

Coronary Artery Disease

  • Coronary arterial narrowing
55
Q

What is PAD?

A

Peripheral Vascular Disease

  • occlusive atherosclerotic lesions that develop in the peripheral regions (legs and arms)
    • this causes decreased perfusion of the extremities
56
Q

What are signs of claudication?

A

Cramping pain or tiredness in the thigh, calf, or foot with walking or exercise

57
Q

So what’s a hallmark of PAD?

A

Basically poor perfusion to the lower extremities. Claudication is a good indication. Just think of the cardio exam involving the arteries and veins.
CHESS
CVES

58
Q

Labs for PAD?

A

Lipids
Chemistry for renal dysfunction
CT

59
Q

What is acute arterial occlusion of a limb?

A

Embolism that gets thrown and occludes a vessel.

  • Most from the heat go to the lower extremities.
60
Q

What is the common cause of arterial occlusions of limbs from embolisms?

A

A Fib or valvular heart disease

61
Q

Claudication is usually a precursor of what condition?

A

Acute arterial occlusion

62
Q

What is the hallmark of an acute occlusion?

A

Sudden onset of extremity pain with loss or reduction of pulses

63
Q

Along with acute arterial occlusions, what are the 6 p’s that signify severe arterial ischemia?

A
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis
  • Poikilothermia (coolness)
64
Q

Go to meds for acute arterial occlusions?

A

Anticoagulants

  • Enoxaparin 1mg/kg SC
  • Heparin 5k-10K IV
65
Q

What is the revascularization goal for acute arterial occlusions?

A

3 hours immediately

** Irreversible damage in 6 hours

66
Q

What causes stroke or TIAs?

A

Emboli from either A Fib or proximal carotid artery

67
Q

How long does a TIA last?

A

Neurological deficits for less than 24 hours

68
Q

What is a stroke that lasts longer than 24 hours

A

CVA

69
Q

What is a sound you may here when auscultating for TIA/CVA?

A

Carotid bruits

70
Q

What labs are you running for TIA/CVA?

A
  • Blood glucose
  • CBC
  • Lipids
  • CT head
  • MRI brain
71
Q

Meds for TIA/CVA?

A
  • Aspirin
  • STATINS
  • Thrombolytics for within 6 hours of onset
  • Long term anticoagulation for A FIB patients
72
Q

How can you rule out hypoglycemoa?

A

Glucose levels

73
Q

Other labs/rads for CVA/TIA

A
  • Ok to keep SBP at 180 for perfusion
  • Head CT
  • Blood work
74
Q

What is dyslipidemia?

A
  • Elevated total or LDL

* Low HDL

75
Q

What is hyperlipidemia?

A

High concentrations of fats or lipids in the blood

  • High LDL
    or
  • Low HDL
76
Q

What is cholesterol used for>

A
  • Hormone production
  • Fat-soluble vitamins
  • Bile acids to digest foods
77
Q

Triglycerides are used for what?

A

Energy between meals

78
Q

What is cholesterol carried primarily on?

A

Lipoproteins;

  • VLDL
  • LDL
  • HDL
79
Q

What is the primary lipoprotein targeted to reduce plaque formation?

A

LDL

80
Q

What is your primary prevention for dyslipidemia?

A

(Someone that has never had an atherosclerotic event)

  • Use the ASCVD Risk calculator for 10 year risk of having an MI
81
Q

What is your secondary prevention for preventing dyslipidemia?

A

(Someone already diagnosed with atherosclerotic plaques (CHD) )

  • They already have issues so now you’re just going to treat the underlying conditions
82
Q

What are your 2 indicators for people aged 40-79 to initiate drug therapy in reducing the risk of MI?

A

Using the ASCVD 10 year risk calc;

  • > 5% risk = start STATINs
    • > 10% risk start STATINS for 20-39yos
  • > 10% risk = start aspirin
83
Q

What is a symptoms if a pt has triglycerides >1000mg/dl?

A

Eruptive Xanthomas (redish yellow papules, on the butt usually)

84
Q

What is a symptom of triglycerides >2000mg/dl?

A

Lipemia retinalis (cream colored blood vessels in the fundus of the eye)

85
Q

What can high triglycerides precipitate

A

Acute pancreatitis

86
Q

Labs for suspected dyslipidemia?

A

Lipid panel

A1C?

87
Q

Non_Pharm treatments for high cholesterol?

A
  • low fat diet (fat 25-30%)
  • med diet (no sat fats)
  • high fiber (40-45 grams)
  • aerobic exercise (40 min 3-4x a week)
  • Weight loss
  • Alcohol down to 1-2 drinks/day
88
Q

Drugs for dyslipidemia?

A

STATINs 5-10mg at bedtime

89
Q

So what age should you start screening patients?

A

20

90
Q

What follow ups are required for dyslipidemia?

A
  • Lipids and ASCVD yearly

* LFTs yearly if on STATINs

91
Q

What labs are you perfoming yearly if on STATINs?

A

LFTs

MDT's (14 decks)

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