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NURS 503 > HTN, dyslipidemia, obesity, metabolic disorder > Flashcards

HTN, dyslipidemia, obesity, metabolic disorder Flashcards

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1
Q

What is the definition of hypertension?

A

Defined by determining the levels of BP that cause target organ damage, morbidity, and mortality as material flow is delivered

  • CO x PVR = BP
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2
Q

How would a provider diagnose HTN?

A

Two elevated BP readings on two separate occasions at least two weeks apart

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3
Q

Primary vs secondary HTN

A

Primary - 95% of all HTN, there is no known cause (due to genetics, environment)

Secondary - directly attributable to structural, circulatory, or chemical abnormalities (e.g. pheochromocytoma)

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4
Q

What should the provider do if primary HTN is diagnosed in children at 10 years old?

A

Order initial labs (CBC, ESR, CRP, UA, renal function panel)

  • Start screening at 3 years old or earlier if there is a clinical concern
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5
Q

How does DBP change later in life?

A

DBP levels off or drops in the 50th decade of life

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6
Q

How does SBP change later in life?

A

SBP rises with advanced age

  • If SBP is =/> 160 in the elderly (older than 85 years old), will have increased risk of stroke
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7
Q

True/false: HTN symptoms usually only occur after end organ damage

A

True - may also be asymptomatic

  • End organ damage signs: diabetic nephropathy, Cushing’s syndrome
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8
Q

HTN risk factors

A
  • Genetics
  • Obesity
  • Dyslipidemia, LVH, glucose intolerance, OSA, family history
  • Metabolic syndrome
  • High dietary fat and sodium
  • Lower potassium and magnesium intake
  • Physical inactivity
  • Excessive alcohol intake
  • Smoking
    • Stress
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9
Q

HTN physical exam components

A
  • Obtain BP and HR in each arm twice
  • Auscultate carotid and aortic arteries
  • Perform fundoscopy
  • Obtain height and weight
  • Assess for evidence of end organ impairment and secondary causes for HTN
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10
Q

HTN diagnostic studies

A
  • UA
  • CBC, potassium, BUN, serum creatinine, calcium, uric acid
  • Fasting blood glucose
  • Lipoprotein
  • EKG (to identify LVH)
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11
Q

JNC 8 HTN diagnostic criteria

A
  • Under 60 years - BP >140/90
  • +60 years - BP >150/90
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12
Q

ASH/ISH HTN guidelines

A

BP >130/80 in adults and elders

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13
Q

African Americans respond better to what classification of BP medication? Asian Americans?

A

African Americans - diuretics (thiazides), CCB

Asian Americans - CCB, ARB

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14
Q

First line HTN medication for patients with diabetes and CKD

A

ACE inhibitor (including black patients)

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15
Q

If patient’s BP continues to be >160/100, they will need to start combo therapy with which two medication classes?

A

Thiazide and ACE inhibitors

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16
Q

When should a patient with HTN go to the ED?

A
  • BP >180/120
  • Individual has signs of target organ dysfunction
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17
Q

When is a specialist referral indicated for patients with HTN?

A

If HTN is resistant to therapy (failure of three full dose, or maximally tolerated, antihypertensive drugs, including a diuretic)

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18
Q

Non pharmacologic management of HTN

A
  • Lifestyle modifications
  • Regular exercise
  • Healthy weight
  • Tobacco cessation
  • Reduction of daily dietary sodium to <2,300 mg
  • Moderation of alcohol intake
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19
Q

Four common medication classes used to treat HTN

A
  • ACE inhibitors
  • ARBs
  • Thiazide diuretics
  • CCB
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20
Q

True/false: For non-orthostatic patients whose BP are >160 or 100 mmHg diastolic, two drug therapy is suggested as initial pharmacological treatment

A

True - If BP not at goal, may increase initial drug dose or add a new drug

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21
Q

What labs should be ordered to monitor the patient on ACE inhibitors or ARBs?

A

Serum potassium

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22
Q

Expected normal values for LDL, TGs, and HDLs

A
  • LDL: <130 (book says <100)
  • TGs: <150
  • HDL: females >50, males >40
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23
Q

When is universal screening for dyslipidemia indicated for pediatric patients?

A

Universal screening in children 9-11 years old

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24
Q

Four target population groups for statin therapy

A
  1. CV disease (HTN, CAD, HF, etc.)
  2. LDL 190 mg/dL or higher
  3. Type 2 DM who are ages 40-75 years old
  4. Estimated 10 year risk of CV disease of 7.5% or higher who are 40-75 years of age
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25
What medication can be started for patients who cannot tolerate statin therapy?
Ezetimibe (especially for patients with DM)
26
What intensity of statin therapy (high, moderate, low) should be prescribed to patients with very high risk ASCVD (\>20%)?
High intensity or maximal statin
27
Name two high intensity statins
* Atorvastatin 40-80 mg * Rosuvastatin 20-40mg
28
Dyslipidemia clinical presentation
S/s do not appear unless other co-morbidities are associated with elevated lipids (e.g. heart disease) * Xanthomas - present only when the disease is severe and prolonged * Signs of exertion angina or claudication
29
Dyslipidemia PMH components
* Perform complete medical and family history (HTN, diet and exercise patterns, smoking, drug and alcohol history, etc.) * Screen for obesity, DM, hypothyroidism, liver and renal disease * Document any known arterial sclerotic CVD * Assess lifetime risk of ASCVD
30
Dyslipidemia physical exam components
* Serial measurement of cardiac rate and rhythm * BP * Height and weight * Waist-to-hip ratio * BMI indicated in hyperlipidemia and ASCVD * Xanthomas may be present on areas such as Achilles tendon and on elbows, knees, and metacarpal joints
31
Dyslipidemia diagnostic labs
Fasting lipid panel (total blood cholesterol, LDL, HDL, TGs) for all adults \>20 years of age, every 5 years
32
After starting lipid lowering drugs, should a second lipid panel be obtained?
Yes - should be obtained in 4-12 weeks to ensure adherence and efficacy followed by case dependent quarterly to yearly lab testing
33
Should baseline LFTs be obtained BEFORE statin therapy is initiated?
Yes - stop statin therapy if LFTs increase 2-2.5 times during therapy * Do not need to check LFTs for bile acid sequestrants
34
True/false: Therapeutic lifestyle changes remain the first and most important intervention for dyslipidemia
True - heart healthy diet, exercise, weight loss, avoidance of tobacco
35
Is it recommended to titrate stain drugs?
Titrating statin drugs is no longer recommended to achieve goal levels of LDL
36
What is next in terms of dyslipidemia management after therapeutic lifestyle changes are made?
Moderate to high intensity statin drugs to lower total cholesterol and LDL, and to prevent coronary heart disease
37
What is the definition of BMI?
Surrogate measure of adiposity calculated by weight (kg) divided by height (m) squared * Screening tool
38
What is the definition of bioimpedance analysis (BIA)?
Non-invasive alternating current predictor of body fat and lean mass (frequently used in weight loss research)
39
What is the definition of anthropometric measures?
Low cost easy to use measurement of skin folds, body circumference (waist to hips), height and weight * Waist circumference is a strong predictor of CV and cancer outcomes
40
Obesity: pathophysiology (multifactorial causes)
* Increased energy intake and reduced energy expenditure * Sedentary environment/insufficient physical activity * Genetic predisposition * Complex CNS pathways interact with satiety and inhibition threshold * Gut hormones
41
Obesity: pathophysiology (maternal influences)
* Leptin in breast milk supports neonate satiety * Formula fed infants have higher serum ghrelin (hunger hormone) levels
42
Obesity: pathophysiology (other causes)
* Smoking cessation (average of 10 lbs weight gain) * Nicotine is a stimulant → when patients stop smoking they tend to gain 10 lbs
43
How do insulin and insulin analogues cause obesity?
* Increase recovery of glycosuria calories * Inhibits lipolysis * Upregulate TG cholesterol and glucose storage in adipocytes * Increase appetite * Increase anabolic protein and adipose synthesis
44
How do antidepressants lead to obesity?
* TCAs decrease resting metabolic rate * SSRIs induce carb cravings
45
How to neuroleptic medications lead to obesity?
Lithium increases carb cravings, increase storage of carbs and lipids, and lower BMR
46
How to seizure medications lead to obesity?
Atypical antipsychotics stimulate appetite and cause insulin resistance
47
How to antihistamines cause obesity?
Blocks H1 receptor activity → increasing appetite and carb craving
48
How to hormonal preparations cause obesity?
Cause insulin resistance
49
How to cardiac medications (e.g. beta blockers) cause obesity?
* Inhibit satiety and lipolysis * Reduces BMR * Increase insulin resistance * Increases TGCs
50
How to antiretroviral medications cause obesity?
Causes redistribution of fat to visceral organs
51
How does tamoxifen cause obesity?
Causes visceral and intra-abdominal fat accumulation
52
How do corticosteroids cause obesity?
Impairs glucose tolerance
53
Obesity diagnostic studies
* UA, *serum glucose* * Uric acid * *BUN, creatinine (kidney)* * CBC, *TSH*, lipid profile, LFTs * Alkaline phosphatase level (2 hour postprandial glucose for hyper insulinemia or insulin resistant patients)
54
Obesity management
* Reduce energy intake * Eating for weight loss “diets” * Weight loss maintenance diets * Medication and/or dietary supplements * Bariatric surgery
55
What medications are available for patients with obesity and wish for weight loss?
If BMI \>30 or \>27 with co-morbidities * Orlistat * Controlled substances: lorcacerin, naltrexone/bupropion
56
What is metabolic syndrome?
A cluster of disorders characterized by **insulin resistance** with… * Hyperinsulinemia * HTN * Abdominal (central or visceral) obesity * Dyslipidemia Additionally can have elevated CRP, increased PAI-1, microalbuminuria
57
Metabolic syndrome clinical presentation
Based on clinical findings and lab studies * Abdominal obesity * Increased TGs * Low HDL cholesterol * HTN * Acanthosis nigricans * Skin tags
58
Metabolic syndrome physical exam components
* Obtain BP, height, weight, BMI * Ratio of waist to hip * Fat distribution pattern * Acanthosis nigricans
59
If a patient presents with (+) features of metabolic syndrome, screen annual for…
* Hyperglycemia * Glucose intolerance * Type 2 DM
60
Metabolic syndrome lab studies
* Fasting glucose * Microalbumin level * CRP level
61
Metabolic syndrome management
* Exercise for 30 minutes for 5 days/week * Weight reduction * Medication (as indicated) * Antihypertensives * Antidyslipidemics * Aspirin → reduce inflammation * Antidiabetics * Surgery

NURS 503 (10 decks)

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