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Clin Med II- Exam 1 > HTN > Flashcards

HTN Flashcards

1
Q

Increases risk of HTN

A

AGE!

blacks > whites > hispanics

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2
Q

Normal BP

A

<120 systolic AND

<80 diastolic

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3
Q

Pre HTN

A

120-139 systolic OR 80-89 diastolic

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4
Q

HTN Stage 1

A

140-159 systolic OR 90-99 diastolic

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5
Q

HTN Stage 2

A

> 160 systolic OR >100 diastolic

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6
Q

BP =

A

CO x systemic vascular resistance

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7
Q

CO =

A

SV x HR

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8
Q

Major factors of BP

A

SNS, RAA (renin, angiotensin, aldosterone), and plasma volume

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9
Q

Risk factors for primary HTN

A 
age (>55 yo)
Race (african american)
family hx.
smoking
high sodium diet 
excess alcohol intake 
obesity/weight gain
physical inactivity
dyslipidemia 
personality traits
vitamin D deficiency
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10
Q

What is secondary HTN?

A

Increased BP resulting from an identifiable medication or medical condition

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11
Q

Secondary HTN Etiology

A

Renal disease
Renovascular disease
Meds (NSAIDS, steroids, estrogen)
thyroid/parathyroid disease
coarctation of aorta
primary hyperaldosteronism (w/ hypokalemia, metabolic alkalosis)
Cushing (skin atrophy, striae, proximal muscle weakness)
Pheochromocytoma (h/a,s, sweating, tachy)
Obstructive sleep apnea

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12
Q

Signs w/ primary hyperaldosteronism

A

hypokalemia, metabolic alkalosis

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13
Q

Sigsn w/ cushings

A

sin atrophy, striae, proximal muscle weakness

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14
Q

Signs w/ pheochromocytoma

A

h/a, sweating, tachycardia

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15
Q

Screening for HTN

A

18 yo
40 years old should begin annually
Between 18-40 annually if: risk factors or previously high BP was 130-139/85-89
Everyone else with normal BP: screen every 3 years between 18-39

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16
Q

Dx of HTN (gold standard)

A

ambulatory blood pressure monitoring (ABPM)

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17
Q

White coat HTN

A

high BP in clinic due to anxiety

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18
Q

Masked HTn

A

low BP in clinic

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19
Q

Nocturnal monitoring

A

useful in predicting cardiovascular events

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20
Q

Alternatives to ABPM

A

home BP monitoring

in office monitoring

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21
Q

PE for HTN

A

evaluate signs of end organ damage

evaluate for signs of secondary causes of HTN

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22
Q

Hypertensive retinopathy

A 
cotton wool spots
AV nicking
Hemorrhage
copper wiring
hard exudates
edema (severe retinopathy)
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23
Q

Labs for HTN

A 
"LUCBEE"
Lipid profile
Urinalysis
Creatinine (GFR)
Blood glucose
E-lytes
EKG
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24
Q

First line management for HTN

A 
LIFESTYLE:
lower sodium, DASH diet (inc. veggies, fruits, low-fat dairy, whole grains, poultry, fish and nuts, alcohol reduction)
exercise 3-4 x/week
healthy weight
smoking cessation
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25
Q

When to give meds >60 YO

A

150/90

DM/CKD: 140/90

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26
Q

When to give meds <60 YO

A

140/90

DM/CKD: 140/90

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27
Q

Medication for nonblack, general population (including those with DM)

A

Thiazide diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) [ANY OF THE FOUR ]

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28
Q

medication for black population

A

thiazide diuretic or CCB

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29
Q

Medication for those with CKD

A

ACEI or ARB

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30
Q

Reaching goal BP

A

if one drug doesn’t work, up dose or add another drug from the list. If 2 drugs don’t work, add and titrate third drug from list provided. NEVER USE ACEI and ARB TOGETHER. If 3 drugs don’t work, add other type of drug from different class or refer (beta-blocker, alpha blocker, central alpha agonists, direct renin inhibitor)

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31
Q

3 drug regimens

A

thiazide, CCB, ACE

Thiazide, CCB, ARB

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32
Q

Resistant HTN

A

BP not controlled despite adherence to 3-drug regimen or required 4 meds to control; refer

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33
Q

Types of diuretics

A

Thiazide
Loop diuretics
Potassium sparing diuretics
aldosterone antagonists

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34
Q

MOA of diuretics

A

decrease body sodium stores by inhibiting sodium reabsorption in the nephron; reduces plasma volume and peripheral vascular resistance

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35
Q

Thiazide diuretics

A

Hydrochlorothiazide (HCTZ):
SEs: HYPOKALEMIA, hypomagnesemia, hypercalcemia, hyponatremia, hyperuricemia (gout), hyperglycemia, dyslipidemia ED, rash

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36
Q

Contraindications of thiazide

A

sulfa hypersensitivity

37
Q

Loop diuretics

A

Furosemide (Lasix):

SEs: HYPOKALEMIA, hypomagnesemia, hypocalcemia, sexual dysfunction; SUPPLEMENT POTASSIUM

38
Q

Contraindications of loop diuretics

A

sulfonamide sensitivity

39
Q

Potassium sparing diuretics

A

Triamterene (dyrenium):
weak antihypertensive
SEs: HYPERKALEMIA (esp. with CKD, DM), nephrolithiasis, renal dysfunction
CAUTION COMBINING WITH ACEI, ARB, DRI, K SUPPLEMENTS

40
Q

Aldosterone Antagonists

A

Spironolactone (aldactone):
SEs: hyperkalemia, gynecomastia

technically a potassium sparing diuretic but more potent as an antihypertensive

41
Q

Contraindications of Aldosterone Antagonists

A

renal impairments, DM with proteinuria

42
Q

Causes hypokalemia

A

Thiazide and loop diuretics

43
Q

Causes hyperkalemia

A

Potassium sparing and Aldosterone diuretics

44
Q

Causes kidney issues (nephrolithiasis, renal dysfunction)

A

Potassium sparing diuretics

45
Q

Causes gynecomastia

A

Aldosterone antagonists

46
Q

Renin angiotensin system

A

BP falls –> kidney releases renin (and also increase salt retention) –> renin converts angiotensinogen to angiotensin I –> ACE converts Angiotensin I to angiotensin II –> leads to increased BP (vasoconstriction)

47
Q

ACE inhibitors drugs

A

(-pril)

Lisinopril, quinapril, enalapril

48
Q

MOA of ACEI

A

inhibit RAAS system, and stimulate bradykinin (vasodilator effect)

49
Q

SEs of ACEI

A

COUGH, hyperkalemia, ANGIOEDEMA, dizziness, acute renal failure, taste alteration, rash (captopril)

50
Q

Contraindications of ACEI

A

pregnancy, angioedema, renal artery stenosis

51
Q

Indications for ACEI

A

DM, CKD, post-MI, heart failure

52
Q

ARB drugs

A

(-sartan)

Losartan, valsartan, olmesartan, telmisartan, candesartan, irbesartan

53
Q

MOA of ARBs

A

inhibit RAAS system

54
Q

When are ARBs indicated

A

CKD, DM, heart failure

55
Q

SEs of ARBs

A

hyperkalemia, acute renal failure, angioedema

56
Q

Contraindications of ARBs

A

pregnancy, renal artery stenosis

57
Q

CCB types

A

Non-dihydropyridine: cardiac depressant effect

Dihydropyridine: vasodilators, less cardiac depressant effect

58
Q

Non-dihydropyridine CCB drugs

A

verapamil

diltiazem

59
Q

Dihydropyridine CCB drugs

A 
(-pine)
amlodipine
felodipine
isradipine
nicardipine
nifedipine
nisoldipine
60
Q

MOA of CCB

A

inhibition of calcium influx into smooth muscle cells, which reduces peripheral vascular resistance

61
Q

SEs of CCB

A

H/A, constipation, peripheral edema, bradycardia, flushing, dizziness, nausea

62
Q

Contraindications of CCB

A

non-dihydropyridine: severe left ventricular dysfunction, sick sinus syndrome, 2nd or 3rd degree AB block, flutter/afib in the setting of an accessory bypass tract (WPW)

Dihydropyridine: acute MI

63
Q

Beta blocker types

A

cardioselective (B1)

non-cardioselective (B1 and B2)

64
Q

Beta blocker drugs

A 
(-lol)
propanalol
nadolol
atenolol
metoprolol
nabivolol
65
Q

MOA of beta blockers

A

block activity of catecholamines at beta-adrenoreceptors, which leads to decreased CO, some decreased PVR, and decreased renin activity (propranolol)

66
Q

Indications for beta-blockers

A

stable HF, post-MI, high CAD risk, often used in pregnancy

avoid abrupt withdrawal- can precipitate acute coronary events and severe increases in BP (ween off)

67
Q

SEs of beta blockers

A

bronchospasm, bradycardia, AV block, fatigue, sleep disturbance, depression, ED

68
Q

Contraindications of beta blockers:

A

bronchospastic disease, conduction abnormalities, acute decomp of CHF

Caution: renal impairment, DM, depression

69
Q

Central Alpha Agonist drugs

A 
Clonidine
Methyldopa (pregnancy)
70
Q

MOA of Central alpha agonist

A

stimulate alpha-2 adrenergic receptors in brain which reduce CNS sympathetic outflow; avoid abrupt cessation (rebound HTN)

71
Q

Avoid abrupt cessation

A

beta blockers and alpha agonists

72
Q

SEs of central alpha agonists

A

anticholinergic side effects, depression, orthostatic hypotension, dizziness, h/a, sexual dysfunction, bradyarrhythmia

Methyldopa: hepatitis, hemolytic anemia, fever

73
Q

Contraindications of central alpha agonists

A

methyldopa in liver disease

74
Q

alpha blocker drugs

A

(-zosin)
doxazosin
terazosin
prazosin

75
Q

MOA of alpha blockers

A

targer alpha 1 receptors on VSM, causing PVR to decrease, thus decreasing blood pressure

76
Q

SEs of alpha blockers

A

orthostatic hypotension, reflex tachycardia, dizziness

77
Q

When are alpha blockers used

A

mild-moderate HTN and not for monotherapy; compelling indication = BPH!!!

78
Q

What to use in HTN with BPH

A

alpha blocker!

79
Q

Direct renin inhibitor drug

A

aliskiren

80
Q

MOA of direct renin inhibitor

A

inhibit enzyme activity of renin, reducing activity of angiotensin I and II and aldosterone

81
Q

SEs of direct renin inhibitors

A

hyperkalemia, renal impairment, hypersensitivity (anaphylaxis, angioedema)

82
Q

Contraindications for direct renin inhibitors

A

use w/ an ACEI or ARB in diabetics; pregnancy

83
Q

Safe in pregnancy

A

Diuretics, CCB, beta-blocker, methyldopa (CAA), alpha blockers

84
Q

hypertensive urgency

A

ASYMPTOMATIC severe HTN (diastolic >120) and no evidence of end organ damage; usually do to nonadherence to HTN meds or low sodium diet

85
Q

Hypertensive emergency

A

severe HTN (diastolic >120) and evidence of acute end-organ damage

86
Q

Causes of hypertensive crisis

A 
abrupt d/c of meds
high salt food
neuro emergency (stroke, trauma)
cardiac emergency (HF, MI)
Vascular emergencies (aortic dissection)
Pregnancy (pre-eclampsia)
SNS overactivity (rebound HTN, pheo)
renal emergency
87
Q

Hypertensive urgency goals

A

reduce BP <160/120 over hours to days

88
Q

Hypertensive emergency goals

A

hospitilized in ICU
address underlying cause
reduction of BP: no more than 25% within minutes to 1 hours

stable: BP goal is 160/100-110 over 2-6hours; decrease to normal BP over 24-48 hours
IV nitrates: CCBs: adrenergic blockers: hydralazine

89
Q

Contraindication in hypertensive emergency

A

sublingual nefidipine

Clin Med II- Exam 1 (7 decks)

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