HTN Flashcards Preview

Cardiology > HTN > Flashcards

Flashcards in HTN Deck (66):
0

What part of renal artery will atherosclerosis occur? What about FMD?

Proximal
Distal

1

When is angioplasty indicated for RAS?

Severe BILATERAL DZ
Unilateral dz w/ solitary kidney

2

What trial showed that PTCA is not better than OMT for unilateral RAS?

CORAL

3

Which gender has higher incidence of coarctation ?

Males

4

What is Turner's syndrome associated with?

Coarctation

5

Name 5 things coarctation is associated with

Bicuspid AV
VSD, PDA, AS
Intracranial aneurysm

6

CXR findings for coarctation of Ao

Rib notching
3 sign

7

What is the definitive modality to evaluate for coarctation ? Why?

Echo b/c you can messier pressure gradient across it

8

What peak to peak gradient is significant in coarctation ?

20mm Hg

9

What is a complication of end to end anastomoses surgery for coarctation?

Re-coarctation and aneurysm at site of repair

10

What is treatment of choice for coarctation?

Balloon angioplasty with stent

11

What are top two things to remember that are associated with coarctation?

Bicuspid AV
Intracerebral aneurysm

12

Best test for pheo (highest Sn)?

24h urine catecholamines and metanephrines

13

Triad for pheo

Episodic HA, sweating, tachycardia

14

10% rule for pheo

10% malignant
10% multiple
10% extra-adrenal

15

What is considered a positive test for pheo with 24 h urine metanephrines ?

2x ULN

16

What is wrong with doing plasma fractionated metanephrines for pheo?

High false positives

17

What can falsely elevate levels of catecholamines and metanephrines?

Abrupt cessation of clonidine

18

Name 4 psych drugs that can increase metanephrines and catecholamines

Levodopa
Amphetamines
Buspirone
TCAs

19

What is Sn and Sp of CT/MR for pheo?

Sn- 100%
Sp 79% (Incidentalomas)

20

What radiological test confirms extraadrenal pheo?

MIBG

21

Can you send or to Sx for pheo based on MIBG images alone?

No

22

Which receptor do you block first for pheo preop?

Alpha before beta

23

What is the best alpha blocker to start preop for pheo and when do you start it?

Phenoxybenzamine
7-10d preop

24

What are two pharmacological properties of phenoxybenzamine that make it a good alpha blocker for preop pheo?

Irreversible
Nonspecific

25

Which of the following do you use for preop pheo: prazosin, doxazosin or phenoxybenzamine?

phenoxybenzamine

26

When do you start BB for preop pheo?

After alpha blockers
2-3 d preop

27

Top 3 Meds to use intraop if a pheo squirts and causes hypertensive crisis

Nitroprusside
Phentolamine
Nicardipine

28

Phenylalanine MOA

Non selective, short acting alpha blocker

29

In primary hyperaldosteronism, what are the levels of renin ?

Low

30

In secondary hyperaldosteronism , what will renin levels be?

High

31

When to screen hypertensive pt's for primary hyperaldosteronism?

Severe or resistant HTN
Hypokalemia

32

What is the screening test for primary hyperaldosteronism ?

PAC/PRA

(Plasma Aldo conc)/ (plasma renin activity)

33

What plasma Aldo conc/plasma renin activity signifies essential HTN vs primary hyperaldosteronism?

Essential: 10
Hyperaldosteronism : 30

34

What is Dx if you have a hypertensive pt and you do an oral sodium load of 5g over 3 days and their Aldo level is >12mcg/24h?

Primary hyperaldosteronism

35

What are two tests you can do to diagnose primary hyperaldosteronism ?

Oral sodium load
Saline infusion test

(Aldo will be > 10)

36

Which patients get Sx for primary hyperaldosteronism?

Unilateral adenoma

37

2 drugs you can give to treat primary hyperaldosteronism

Spirinolactone
Eplerenone

38

What are the major components of DASH diet?

Fruits, vegetables, fiber, low fat dairy

39

What did ALLHAT show for ACEI, CCB vs diuretics?

No difference in reducing CV events

40

What did LIFE trial show for losartan vs atenolol in HTN?

Losartan better for LVH and reducing stroke

41

What did ACCOMPLISH trial show for high risk hypertensives and amlodipine/benazepril vs HCTZ/benazepril ?

Lower BP and CV events with amlodipine/benazepril

42

According to JNC 7, what is total recommended sodium intake for hypertensives?

2400 mg daily

43

where is Beta 1 receptor found and what is its effect?

heart
inc inotropy and chronotropy

44

where is Beta 2 found and what is Beta 2 receptor effect?

vessels
vasodilation

45

does angiotensin II increase both BP and cardiac output?

yes

46

After starting an ACEI, how much Cr rise should make you worry?

> 30%

47

Verapamil and diltiazem are ?

Nondihydropyridines

48

What adverse effect if alpha antagonists did ALLHAT show for hypertensives?

Inc'd CHF

49

Clonidine mech

Alpha 2 blocker

50

Main side effect of Hydralazine

Lupus like syndrome

51

Main side effect of minoxidil

Hirsutism

52

hydralazine mech

direct vasodilator (via inc. in NO and cGMP

53

what is hypertensive urgency?

BP > 180/120, relatively asymptomatic

54

er how long can you decrease BP in HTN urgency? what med is contraindicated?

hours to days
SL nifedipine

55

why is SL nifedipine dangerous?

increases risk of MI

56

4 drugs you can use to treat hypertensive emergency

Nitroprusside, labetalol, nicardipine, fenoldepam

57

what side effect comes with long term use of nitroprusside?

cyanide tox

58

can you give iv nitroprusside in pregnancy?

no

59

definition of preeclampsia

previously normotensive woman now at least 20 weeks pregnant with new HTN and proteinuria

60

definition of gestational HTN

HTN without proteinuria

61

***criteria for preeclampsia

SBP>140 or DBP > 90 with 2 measurements at least 6 h apart (within 1 week)
Proteinuria > .3g in 24hrs

62

first line therapy in preeclampsia?

bedrest

63

when do you consider giving meds in preeclampsia?

when BP 160/105 or sxs

64

drug of choice for preeclampsia?

labetalol IV

65

what is the main adverse event of HTN in pregnancy?

stroke