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htn + GN Flashcards

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1
Q

first line therapy

A
  1. long acting thiazide/thiazide like diuretics > hctz
  2. ACEi
  3. ARB
  4. BB ( Long acting)
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2
Q

what medication should you not use in isolated systolic HTN

A

acei

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3
Q

electrolote abN with thiazides monotherapy ?

A
  1. HypoNA
  2. Hypo K
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4
Q

age cut off for BB consideration?

A

60

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5
Q

second line regimen

A

thiazide + DHPCCB
ACEI + DHPCC

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6
Q

r/a pt wth uncontrolled BP how often

A

q1-2 months

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7
Q

first line options if isolated systolic htn

A
  1. long acting DHP CCB
  2. Thiazide
  3. ARB
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8
Q

diastolic HTN options

A
  1. TZD
  2. BB ( < 60 y)
  3. CCB
  4. ACE/ARB
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9
Q

what meds do you not use in isolated systolic htn

A

alpha B
BB`
ACEi

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10
Q

LVH htn meds

A

thiazide
acei/arb
long acting ccb

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11
Q

non t2dm , CKD + proteinuria

A

ACEI
Thiazide ( if EGFR ok)

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12
Q

CAD + HTN< what to use ?

A

ACE/ARB
BB
CCB

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13
Q

med to avoid in CAD + HTN

A

short acting nifedipine

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14
Q

stable angina + HTN ? what;s the caveat ?

A

CCB
BB

no hx of MI, cabg, or CHF

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15
Q

recent MI /+ HTN

A

BB + ACEi

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16
Q

first line in HFrEF

A

BB + ACEI

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17
Q

if can’t use ACEI, optins?

A

Hydralazine or ISDN

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18
Q

high risk patients defined as what . target ?

A
  1. 50
  2. SBP 130-180
  3. following risk factors
    * Clinical or subclinical cardiovascular disease
    * CKD (non diabetic, proteinuria < 1g/day, GFR 20-60 ml/min)
    * Estimated 10 year global cardiovascular risk ≥15% * Age≥75

Target : 120 sbp

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19
Q

excluded from sprint

A

Diabetes
history of stroke
GFR < 20
proteinuria > 1g/day
GN
PKD

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20
Q

target BP for polycystic kidney disease ?

A

SBP <110

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21
Q

DB + HTN, first line ? if do combvinbation which one ?

A

acei/ARB
dhp ccb
tzd

combo : dhp ccb + ace

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22
Q

prefered regimen long term for ischemic stroke ?

A

Acei and tzd

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23
Q

hmrg stroke target

A

acute <SBP 140-160 first 24-48H

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24
Q

long term hmrg stroke target

A

130/80

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25
who to screen for hyperaldosteronism htn + 1 out of 3
1. Unexplained spontaneous hypokalemia <3.5 or marked diuretic related hypokalemia <3.0 2. Htn & resistant to treatment with ≥ 3 drugs 3. Incidental adrenal adenoma AND Htn
26
how to screen for hyperaldosteronism
1. plasma aldosterone 2. plasma renin activity or plasma renin concentration
27
who do you avoid measuring plasma renin concentration and why ?
women on ocp bcs high rate of false +
28
drugs that interfere wth hyperaldosteronism testing and drugs that it's fine
1. MRA > ACE/ARB > BB/CCB 2. alpha blockers, non dhp ccb , hydralazine
29
how long should hold MRA/ k wasting and K sparing diuretics ?
at least 4 weeks
30
how long should hold ace/arb , dhp/ccb ?
at least 2 weeks
31
plasma aldost to renin ratio with plasma aldost values
1400 pmol/L/ng/ml/h ( or 270 pmol/l/ng/l) w/ plasma aldosterone >440 pmol/L
32
what to do before adrenalectomy and why
adrenal vein sampling to check laerilization of aldosterone hypersecretion
33
what's the difference between hyperaldosteronism that and primary aldosteronism when it comes to adrenal venous sampling ?
differentiate unilateral frm bilat aldost production
34
who to screen pheo
– Paroxysmal,unexplained,labile,and/orsevere(≥180/110)sustainedHTNrefractorytousual therapy –HTN+symptomsofcatecholamineexcess(headaches,palpitations,sweating,flushing) – HTNtriggeredbybeta-blockers,MAO-Is,surgery,anesthesia,micturition – Incidentaladrenaladenoma – Hereditarycauses–suchasVon-Hippel-Lindau,MEN2Aor2B,neurofibomatosistype1
35
how to sceen pheo the best way
24H urine and catecholamine ( and creat)
36
who to screen renovasc htn
* Sudden onset or worsening HTN age >55 or <30 * Abdominal bruit * HTN resistant to ≥ 3 drugs * Increase in Cr ≥ 30% with ACEi or ARB * Other atherosclerotic vascular disease, particularly in smokers or dyslipidemia * Recurrent pulm edema associated w/ Hypertension emergency
37
how to screen renovasc htn
1. renal doppler US 2. captopril renogram 3. MRA, CTA
38
when do you avoid captopril renogram test in renovasc HTN ?
when GFR <60
39
angioplasty/stenting considered in renovascuklar htn per guideline?
1. uncontrolled htn resistnat to max tol pharmacotherapy 2. decline in renal function 3. acute pulmo edema
40
in FMD, what procedure for renovascular htn ?
angioplasty without stent bcs risk of periprocedural dissection
41
work up for FMD if htn and what else ? ( 1 out of 4 )
kidney assym >1.5 cm fam hx of FMD confirmed FMD in another bed abdo bruit without atherosclerosis RF
42
conditions requiring rapid bp decrease ? 2 ex
1. aortic dissection 2. eclampsia
43
general rule for htn emergency management ?
decrease 20-25% in first 1-2 hours then aim <160/110 for next 2-6 hpurs and progressively lower after that
44
IV med options for hypertensive emergency
IV labetalol Hydralazine nitro, nicardipine, esmolol
45
HTN urgency meds : cocaine user
IV phentolamine + benzo - if no phentolamine IV labetalol
46
HTN urgency meds : MI/CHF
1. nitroglycerin
47
HTN urgency meds : dissection
IV labetalol then iv nitro
48
HTN urgency meds : preeclampsia
IV labetalol/hydrralazine chew IR nifedipine
49
if have scleroderma renal crisis , what do you give ?
IV enalapril or captopril
50
what do you expect to observe with 1. nephritic 2. nephrotic 3. AIN/pyelo 4. ATN
1. RBC cast , dysmorphic rbc 2. oval fat bodies or fatty casts 3. WBC casts 4, muddy brown casts
51
bp target for kidney bx
<140-160 SBP
52
in nephritic syndrome - low c3 - low c4 - low c3 and c4 - normal complement
- PIGN - MPGN - lupus - IgA
53
difference between anti gbm vs good pastures
antigbm = only kidneys goodpastures = renal + pulmo hmrg
54
tx of antigbm ?
steroid + cyclophophamide + pLEX
55
maintenance therapy in anti GBM ?
no
56
if serology and clinical presentation compatible wiht anca vasculitis, do you need bx ?
no
57
ANCA TX - induction - maintenance
- induction *steroids + ritux *steroids + cyclophosphomide - maintenance ( while you taper steroids) *ritux ( continue) *azathioprine ( continue)
58
ritux in anca prefered when ?
young, fertility preservation, relpase, pr3 anca, frail old
59
alternative to steroids in anca vasculitis tx ?
avocopan
60
when to consider plex in anca vasculitis?
rapidly rising creat, cr >300, new need for HD, alv hmrg w/ hypoxemia , co positive with anti gbm
61
when do PSGN manifest
usually 2-3 post infection ( strep, strep cellulitis, chronic abscess, endocarditis, etc)
62
low C4 means what
MPGN
63
MPGN is associted with what
hep C HIV cryo infection
64
low c4 and etiology is complement mediated, what do you tx with
MMF+steroids/eculizumab
65
if have low c4, and not immune complex or complement mediated, what are your etiologies
1. APLA 2. TMA 3. Sickle cell
66
subtype of MPGN
1. immune complex mediated - supportive + tx underlying cause *infection *autoimmune *monocolonal gammopathy *fibrillary GN 2. complement mediated : c3 GN, DDD 3. non immune, non complement -TMA, APLA< sickle cell
67
so if havce hep C + CKD , how to tx ?
antiviral + immunosuppresson (ritux) +/- plex
68
low c3, low c4 = which time of issue ?
lupus !
69
cyclophosphamide safe in pregnancy ?
no
70
lupus nephritis drug option safe in pregnancy
hydroxytchloro tacro azathio cyclosporin steroids
71
pregnancy delay in Lupus nephritis ?
>6M-1Y after LN inactive
72
lupus nephritis treatment for all ?
hydroxychloroquine and bp control
73
class 3-4 lupus tx ?
induction : steroid + MPAA/Cyclophosphamide maitain : MPAA + taper steorids
74
class 5 lupus tx - non nephrotic - nephrotic
- RAAS, immunosup if extra renal - RAAS, steroid MPA/cyclophosphamide/azathi/ritux/cnI
75
if class 5 with worsening AKI , what do you want to rule out ?
rule out renal vein thrombosis
76
lupus wth TMA - tx - low adamst - normal adamst with no APLA - normal adamst13, + apla
- plex + gc + ritux - consider eculizumab if primary or secondary complement mediated TMA - anticoagulation & plasma exchange
77
immune complex - normal c3-c4
IgA nephropathy
78
IgA nephropathy S&S
1. microscopic hematuria 2. gross hematuria 3. proteinuria 4. RPGN or nephrotic syndrome
79
management of IgA nephropathy - usual - high risk pt
- usual *bp<120 *AceI/ARB if proteinuria >0.5 high risk patients *6M steroids *gfr <30 : mmf, hydroxychloroquibne , tonsilectomy
80
2nd cause of minimal change nephrotic syndrome
Heme Cancer- Hodgkins & Leukemias Drugs- NSAIDs, COX2i, Li, Infections (rare), including TB
81
2nd cause of fsgs
Infxn: HIV, parvoB19, EBV Drug: heroin, pamidronate, anabolic ‘roids Hyperfiltration: obesity, single kidney, reflux nephropathy
82
2nd causes of membranous nephrotic syndrome
SLE CANCER- solid tumors> heme malignancy (CLL) Infection: HBV, HCV, Syphilis, HIV Drugs: NSAIDs, anti TNFs, gold, penacillamine Sarcoidosis
83
why doacs not ideal in NS ?
bcs highly protein bound and not cool if hypoalbuminemia
84
when do you want to ppx full anticoag with warfarin in nephrotic syndrome
hypoalb <20-25 any of the following * obese *thrombophylia *prolonged immobilization *prot > 10 *ortho surgery or abdo surgery
85

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