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Clinical Medicine Lecture - Professor Kramer > HTN Exam 5 > Flashcards

HTN Exam 5 Flashcards

(90 cards)

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1
Q

Angiotensin causes adrenal glands to secrete ?

A

aldosterone - increases sodium reabsorption

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2
Q

kidneys secrete ______ if the blood pressure falls below normal.

A

renin

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3
Q

Hypotheses for idiopathic HTN?

A

reduced renal sodium excretion

genetic variations of the renin-angiotensin system

Environmental factors like obesity and smoking

Chronic vasoconstriction

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4
Q

secondary HTN caused?

A

Renal - CKD, RAS ( renal artery stenosis)

Endocrine - adrenal , thyroid dysfunction

Cardiovascular - MI and aortic dissection

Neurologic - stroke and dementia

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5
Q

Normal systolic and diastolic ?

A

<120 , <80

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6
Q

Prehypertension systolic and diastolic ?

A

120-139 / 80-89

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7
Q

Stage 1 Hypertension systolic and diastolic ?

A

140-159 / 90-99

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8
Q

Stage 2 Hypertension systolic and diastolic ?

A

> 160 / >100

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9
Q

Essential HTN

A

90% of cases
usually asymptomatic

sx - non specific HA

any other symptoms then may indicate secondary HTN or complications

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10
Q

Secondary HTN

A

another primary medical condition created the HTN

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11
Q

Malignant HTN syndrome

A

retinopathy and encephalopathy or nephropathy and a very high high of complications

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12
Q

Urgency HTN

A

acutely elevated BP W/O evidence of end organ damage

S: >220
D: >125

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13
Q

Emergency HTN

A

acutely elevated BP WITH evidence of end-organ damage

such as: Heart attack, Stroke, Renal failure

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14
Q

Metabolic syndrome findings that increase the risk of CVD and DM?

A 
Central obesity 
Hypertriglyceridemia
Low HDL
Hyperglycemia
Hypertension
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15
Q

what can you see on PE or eye if HTN is considered?

A

Rentiopathy - retinal exudates or hemorrhages

Papilledema

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16
Q

usually you run no tests if BP is significantly elevated or if patient is symptomatic ? T to F

A

T

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17
Q

For a new diagnosis what basic labs do we want to run?

A

EKG
BUN/creatinine

Optional: CXR

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18
Q

If HTN the on a EKG we will see?

A

Left ventricular Hypertrophy

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19
Q

If HTN the on a CXR we will see?

A

ventricular hypertrophy (cardiomyopathy)

severe: aortic tortuosity

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20
Q

IF HTN then what blood tests will be increased

A 
BUN
creatinine
Potassium
Calcium
Uric acid
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21
Q

What is evidence of metabolic syndrome?

A

elevated serum and urine glucose

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22
Q

if end organ brian damage what will we see on the CT?

A

Hemorrhage

increased ICP

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23
Q

End organ cardiac disease what will we test ?

A

EKG and troponin

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24
Q

Essential HTN diagnosis?

A

at least 2 visits with elevated BP over a period of weeks to months

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25
Secondary HTN diagnosis?
at least 2 visits with elevated BP over a period of weeks to months with underlying cause.
26
IF you suspect White coat syndrome HTN then what do you do?
home BP monitoring
27
IF malignant HTN what is diagnostic and what will we see?
retinopathy, HTN, encephalopathy | neuropathy
28
IF urgency HTN what is diagnostic and what will we see?
S: >220 or D: >125 w/ no end organ damage
29
IF emergent HTN what is diagnostic and what will we see?
acutely elevated BP w/ end organ damage
30
Typical management of 1 high reading?
Lifestyle modifications education - DASH (dietary approaches to stop hypertension) - low total fat - low sodium
31
Typical management of 2 high reading?
# CHOOSE ONE OR TEO: ace inhibitor calcium channel blocker diuretic
32
what are the treatment/management goals for HTN?
BP less than 140/90 if over 60 y.o. : BP less than 150/90
33
social life style modifications?
smoking cessation | decrease alcohol
34
Physical life style modifications?
weight loss | aerobic exercise
35
If patient fails life style modifications then what are the primary choices for tx?
Diuretic ACE inhibitor CCB
36
If Stage 1 start with a ______ medication
single
37
IF stage 2 or above start with ___ medications
two
38
Examples of Diuretics?
Thiazide diuretics (Chlorthalidone) Loop Diuretics (Furosemide) Lasics Potassium-sparing diuretics (Triamterene) Aldosterone Receptor Blockers (Spironolactone)
39
Thiazide diuretics ?
(Chlorthalidone)
40
Loop Diuretics?
Furosemide) Lasics
41
Potassium-sparing diuretics
Triamterene
42
Aldosterone Receptor Blockers
Spironolactone
43
Examples of Renin- Angiotension system
Angiotensin Converting Enzyme Inhibitors (ACEI) (Lisinopril) Angiotensin Receptor Blockers (ARB) (Losartan)
44
Examples of Vasodilators?
Calcium Channel Blockers* (Amlodipine) Alpha 1 Blockers (Doxazosin) - prostate Alpha 2 Agonists (Clonidine) - knock it down fast but pos the time we do want to drop the BP to fast Direct Vasodilators (Hydralazine) - vasodilator
45
Rate control? heart rate
Beta-blockers (Metoprolol) - rate control is not great; v so the rate down o the stroke volume is more effective - not pushing out as much blood - used mostly with people with true heart disease ( CHF) - decreases demand of the heart
46
Thiazide diuretics MOA
Blocks sodium resorption at the distal tubule of kidney nephrons Causes increase salt concentration in urine Water follow salt for increased diuresis SE: gout, hypokalemia
47
Angiotensin Converting Enzyme Inhibitors (ACEI) MOA?
Inhibits conversion of angiotensin I to angiotensin II Inhibits vasoconstriction by angiotensin II Increases kidney blood flow increasing diuresis SE: cough
48
Beta-blockers MOA?
Blocks sympathetic beta receptors Decrease heart rate which decreases cardiac output this also messes with the kidney beta cells best for pregnancy
49
Calcium Channel Blockers (CCB) MOA?
Inhibit calcium influx smooth muscle relaxation and arterial dilation best for AA and elderly and if renal failure
50
CHF
loop diuretic, ACEI, BB
51
Post- MI
ACEI, BB
52
Renal disease
ACEI
53
Diabetes
ACI
54
Pregnancy
beta blocker ( labaetalol?)
55
BPH
alpha 1 antagonist
56
Liver Disease, ascites
aldosterone antagonist
57
African americans
diuretic, CCB
58
Elderly
diuretic, CCB
59
If acute HTN that is asymptomatic consider giving?
meds only
60
If acute HTN that is symptomatic consider giving?
meds to lower BP by 25-33% or treat underlying casue
61
One thing we have to be careful of when prescribing BP meds?
Do NOT decrease the BP to rapidly cause we can cause a stroke
62
Emergency HTN medical management Step 1 ?
Initiate antihypertensive by end organ damage
63
Emergency HTN medical management Step 1 goal?
Goal typically 20-30% reduction
64
Emergency HTN medical management Step 2?
Treat underlying condition | Hypertensive urgency
65
Emergency HTN medical management Step 3, if symptomatic?
Initiate treatment - antihypertensive by end organ damage
66
Emergency HTN medical management Step 4 ?
consider discharge | Initiate antihypertensive by comorbidities
67
Hypertensive emergency First Line options IV CCB?
Nicardipine
68
Hypertensive emergency First Line options IV Beta Blocker?
Labetalol
69
Hypertensive emergency First Line options IV, especially if MI?
Nitroglycerin
70
Hypertensive emergency First Line options IV additional choices?
Sodium nitroprusside ACEI (Enalaprilat) Anticholinergic (Trimethaphan) Loop diuretics (Furosemide)
71
Hypertensive urgencies/emergencies - Aortic dissection?
beta blocker - labetalol, esmolol
72
Hypertensive urgencies/emergencies - Acute renal failure?
dopamine 1 receptor agonist
73
Hypertensive urgencies/emergencies - Pregnancy?
direct vasodilator
74
Hypertensive urgencies/emergencies - Oral options for less severe emergencies
CCN Clonidine Captopril Nifedipine
75
Hypertensive Emergency - Aortic dissection tx?
B-Blocker ( labetalol, esmolol) then, Nicardipine, nitroprusside
76
Hypertensive Emergency - Pulmonary edema tx?
Nitroglycerine | Enalaprilat or Nicardipine
77
Hypertensive Emergency - MI tx?
Nitroglycerine
78
Hypertensive Emergency - Sympathetic crisis (cocaine OD) tx?
Benzodiazepine (decrease stimulation) Nitroglycerine No BB cause it causes severe HTN
79
Hypertensive Emergency - Renal failure tx?
Labetalol | Nicardipine
80
Hypertensive Emergency - Severe preeclampsia, HELLP syndrome, eclampsia tx?
Labetalol | Nicardipine
81
Hypertensive Emergency - Hypertensive encephalopathy tx?
Nicardipine | Labetalol
82
Hypertensive Emergency - Subarachnoid hemorrhage tx?
Labetalol | Nicardipine
83
Hypertensive Emergency - Intracranial Hemorrhage tx?
Labetalol | Nicardipine
84
Hypertensive Emergency - Ischemic stroke tx?
Labetalol | Nicardipine
85
Hypertensive Emergency - Postoperative tx?
Nicardipine | Labetalol
86
Outpatient treatment initiation for 120-140/80-90 ?
Advise follow-up
87
Outpatient treatment initiation for 140-160/90-100 ?
advise follow-up within 2 mo.
88
Outpatient treatment initiation for >160/ >100 ?
advise follow-up within 1 mo.
89
Outpatient treatment initiation for >180/ >110 ?
Consider initiating therapy at discharge, follow-up in 1 week.
90
Outpatient treatment initiation for >220/ >120 ?
begin antihypertensive therapy at discharge, follow-up in 1 week

Clinical Medicine Lecture - Professor Kramer (28 decks)

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