Flashcards in HTN Deck (66):
What part of renal artery will atherosclerosis occur? What about FMD?
When is angioplasty indicated for RAS?
Severe BILATERAL DZ
Unilateral dz w/ solitary kidney
What trial showed that PTCA is not better than OMT for unilateral RAS?
Which gender has higher incidence of coarctation ?
What is Turner's syndrome associated with?
Name 5 things coarctation is associated with
VSD, PDA, AS
CXR findings for coarctation of Ao
What is the definitive modality to evaluate for coarctation ? Why?
Echo b/c you can messier pressure gradient across it
What peak to peak gradient is significant in coarctation ?
What is a complication of end to end anastomoses surgery for coarctation?
Re-coarctation and aneurysm at site of repair
What is treatment of choice for coarctation?
Balloon angioplasty with stent
What are top two things to remember that are associated with coarctation?
Best test for pheo (highest Sn)?
24h urine catecholamines and metanephrines
Triad for pheo
Episodic HA, sweating, tachycardia
10% rule for pheo
What is considered a positive test for pheo with 24 h urine metanephrines ?
What is wrong with doing plasma fractionated metanephrines for pheo?
High false positives
What can falsely elevate levels of catecholamines and metanephrines?
Abrupt cessation of clonidine
Name 4 psych drugs that can increase metanephrines and catecholamines
What is Sn and Sp of CT/MR for pheo?
Sp 79% (Incidentalomas)
What radiological test confirms extraadrenal pheo?
Can you send or to Sx for pheo based on MIBG images alone?
Which receptor do you block first for pheo preop?
Alpha before beta
What is the best alpha blocker to start preop for pheo and when do you start it?
What are two pharmacological properties of phenoxybenzamine that make it a good alpha blocker for preop pheo?
Which of the following do you use for preop pheo: prazosin, doxazosin or phenoxybenzamine?
When do you start BB for preop pheo?
After alpha blockers
2-3 d preop
Top 3 Meds to use intraop if a pheo squirts and causes hypertensive crisis
Non selective, short acting alpha blocker
In primary hyperaldosteronism, what are the levels of renin ?
In secondary hyperaldosteronism , what will renin levels be?
When to screen hypertensive pt's for primary hyperaldosteronism?
Severe or resistant HTN
What is the screening test for primary hyperaldosteronism ?
(Plasma Aldo conc)/ (plasma renin activity)
What plasma Aldo conc/plasma renin activity signifies essential HTN vs primary hyperaldosteronism?
Hyperaldosteronism : 30
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?
What are two tests you can do to diagnose primary hyperaldosteronism ?
Oral sodium load
Saline infusion test
(Aldo will be > 10)
Which patients get Sx for primary hyperaldosteronism?
2 drugs you can give to treat primary hyperaldosteronism
What are the major components of DASH diet?
Fruits, vegetables, fiber, low fat dairy
What did ALLHAT show for ACEI, CCB vs diuretics?
No difference in reducing CV events
What did LIFE trial show for losartan vs atenolol in HTN?
Losartan better for LVH and reducing stroke
What did ACCOMPLISH trial show for high risk hypertensives and amlodipine/benazepril vs HCTZ/benazepril ?
Lower BP and CV events with amlodipine/benazepril
According to JNC 7, what is total recommended sodium intake for hypertensives?
2400 mg daily
where is Beta 1 receptor found and what is its effect?
inc inotropy and chronotropy
where is Beta 2 found and what is Beta 2 receptor effect?
does angiotensin II increase both BP and cardiac output?
After starting an ACEI, how much Cr rise should make you worry?
Verapamil and diltiazem are ?
What adverse effect if alpha antagonists did ALLHAT show for hypertensives?
Alpha 2 blocker
Main side effect of Hydralazine
Lupus like syndrome
Main side effect of minoxidil
direct vasodilator (via inc. in NO and cGMP
what is hypertensive urgency?
BP > 180/120, relatively asymptomatic
er how long can you decrease BP in HTN urgency? what med is contraindicated?
hours to days
why is SL nifedipine dangerous?
increases risk of MI
4 drugs you can use to treat hypertensive emergency
Nitroprusside, labetalol, nicardipine, fenoldepam
what side effect comes with long term use of nitroprusside?
can you give iv nitroprusside in pregnancy?
definition of preeclampsia
previously normotensive woman now at least 20 weeks pregnant with new HTN and proteinuria
definition of gestational HTN
HTN without proteinuria
***criteria for preeclampsia
SBP>140 or DBP > 90 with 2 measurements at least 6 h apart (within 1 week)
Proteinuria > .3g in 24hrs
first line therapy in preeclampsia?
when do you consider giving meds in preeclampsia?
when BP 160/105 or sxs
drug of choice for preeclampsia?