HTN

Question 1

S4 gallop?

Answer 1

Atrial kick

Question 2

Flame hemmorhages with what?

Answer 2

HTN, DM, central vein occlusion

Question 3

ACEi is stopped when?

Answer 3

hyperkalemia

Question 4

Renal artery stenosis less than 25 caused by what?

RAS over 50 is what?

Answer 4

Fibromuscular dysplasia of renal artery

Atherosclerosis

Question 5

Renal artery stenosis findings?

Test for it?

Answer 5

HTN, bruit, HYPOKALEMIA b/c RENIN ANGIOTENSIN ANDROGEN SYSTEM

Dx for MRA

Question 6

What can’t you give when bilateral renal stenosis?

Answer 6

ACEi b/c need distal construction to maintain GFR. Otherwise renal failure will happenq

Question 7

Turner syndrome has what heart abnormality?

Answer 7

Coarctation (think a coarct looks like an X and turner is an X)

Question 8

Hypertensive urgency?

Answer 8

180/120

No symptoms of end organ damage

IF end organ damage, it is an emergency!

Renal failure, papilledema, MI, dissection, pulm edema, angina

Question 9

Tx of hypertensive emergency?

Answer 9

Only lower 25% of first 2 hours. But eventually getDBP to 100 otherwise can cause ischemia

Question 10

Thiazides increase what?

Answer 10

Hyper GLUC

Glucose, lipids, urate, calcium

Question 11

Loops lose calcium and potassium and sodium

What do thiazides lose?

Answer 11

K+ and H+

Question 12

Alpha 1 blockers are what?

Answer 12

azosins

Use with other drugs, unless they have BPH

Question 13

What causes first dose hypotension?

Answer 13

Azosins.

Also get rebound when you stop

Question 14

Beta blockers that end in olol are blocking what? What if the end in something else?

Answer 14

If start with first half of alphabet they are B1, if second hal they are non selective

Labetalol and cavedilol are b1 and alpha1 selective (so can use in cocaine or pheo)

Question 15

Dihidropiridines are what?

Answer 15

pines. HTN as a first line option

Use for prinzmetal
Esophageal spasm
Migraine

can cause constipation, reflux (makes sense, they are smooth muscle relaxers!)

Question 16

Nitroprusside unique side effect?

Answer 16

Cyanide

Question 17

Vasodilator concern for heart? Solution?

Answer 17

reflex tachy, meaning more O2 demand and adverse events

So combine with beta blocker

Question 18

ACEi contraindication?

Answer 18

hyperkalemia (Think it causes worse renal insufficiency by decreasing GFR)

Question 19

JNC8 if over 60 is bp of what?

less than 60?

Or if diabetes or CKD?

Answer 19

140/90 for everyone EXCEPT for otherwise healthy 60 or older (so no diabetes or CKD)

Question 20

Anti htn in chronic kidney disease?

Answer 20

ACE/arb

Question 21

HTN in black?

Answer 21

Thiazide or CCB. Works better

Question 22

HTN in nonblack?

Answer 22

Thiazide, CCB, ACE, ARB

Question 23

Diabetes should be on what?

Answer 23

ACE or arb

Question 24

CHF HTN tx?

WHAT IS CONTRAINDICATED for htn med?

Answer 24

ACE, ARB
Aldosterone
Certain beta blockers (B,C Met)

Nondihydropyridine contraindicated b/c less cardiac ability. No Beta in acute setting

Question 25

Post MI htn meds?

Answer 25

Beta blocker, ACE or ARB, Aldosterone antag

Question 26

Osteoporosis ht. drug?

Answer 26

thiazide, retain calcium

Question 27

contraindicated htn drug in COPD or asthma?

Answer 27

Nonselective beta blockers b/cbronchospasm

Question 28

Gout contraindicated hth drug?

Answer 28

diuretics (remember the u in hyper GLUC)

Question 29

Migraine patient with HTN?

Answer 29

beta blocker

Question 30

HTN drugs that are sulfa?

Answer 30

Diuretics

Question 31

SHOCK IS 5 star topic

Answer 31

oh my

Question 32

Shock workup is shot gun approach

Answer 32

CBC, electrolytes, renal, liver, ABG, cardiac, coag, tox screen UA, lactic acid

Question 33

Tx of cardiogenic shock?

Answer 33

Dobutamine (strict beta 1) Intra-aortic balloon pump PTCA if MI Careful with fluids!!

Question 34

Septic shock skin is what? Tx?

Answer 34

war, vasodilation and loss of resistance causes it Gram negative DIC Endotoxin Tx: treat infection, IV FLUIDS and maybe vasopressor. NE is choice for vasopressor

Question 35

Nuerogenic shock mechanism? Tx?

Answer 35

Peripheral vasodilation and bradycardia Tx with fluids, vasopressors, atropine

Question 36

Swan ganz tells left atrial pressure

Answer 36

Left ventricular failure causes high atrial pressure But if low fluids, low atrial fluid! helps figure out how to treat it

Question 37

Capilarry wedge pressure in tampanade?

Answer 37

It is high b/c pressures normalize in all chamber of heart (b/c pushing in the sac)

Question 38

Table on page 184!!

Answer 38

SUPER IMPORTANT