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H+P (Exam 4) Hypertension > Hypertension > Flashcards

Hypertension Flashcards

(47 cards)

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1
Q

what is normal classification of HTN?

A

SBP < 120
DBP < 80

s2

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2
Q

what are clinical consequences of chronically elevated BP assoc w?

s3

A

ischemic heart disease, stroke, renal failure, retinopathy, PVD, and overall mortality

s3

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3
Q

what is considered isolated systolic HTN?
isolated diastolic HTN?
combined sys and diastolic HTN?

s3

A
  • isolated systolic HTN - SBP >130 mm Hg and DBP <80 mm Hg
  • isolated diastolic HTN - SBP <130 mm Hg with DBP >80 mm Hg
  • combined systolic and diastolic HTN - SBP >130 mm Hg and DBP >80 mm Hg

s3

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4
Q

what are (3) genetic and lifestyle risk factors for HTN?

s4

A

obesity, alcoholism and tobacco

s4

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5
Q

what is also a risk factor for cardiovascular morbitity (in addition to SBP and DBP elevation)?
and why?

s3

A

widened pulse pressure because it correlates w/vascular remodeling and “stiffness”

s3

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6
Q

what herbals elevate BP?

s4

A

ephedra, ginseng, ma huang

s4

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7
Q

What are contributing factors for primary HTN?

s4

A
  • SNS activity
  • dysregulation of the RAAS
  • deficiency in endogenous vasodilators

Actual cause of primary HTN is unclear!

s4

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8
Q

What are (5) common causes of secondary HTN in middle-aged adults?

s4

A

hyperaldosteronism, thyroid dysfunction, OSA, Cushings, and pheochromocytoma

s4

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9
Q

What are 2 causes for children w/ secondary HTN?

s4

A

renal parenchymal disease or coarctation of the aorta

s4

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10
Q

what are correlations seen in this image?

A
  • Top L: Correlation btw SBP and Ischemic heart dz mortality across 5 age groups
  • Top R: Correlation btw DBP and Ischemic heart dz mortality across 5 age groups
  • Bottom L:Correlation btw SBP and Stroke mortality across 5 age groups
  • Bottom R: Correlation btw DBP and stroke mortality across 5 age groups

s5

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11
Q

what is an Anti-infective that elevates BP?

s6

A

Ketoconazole

s6

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12
Q

what are the 2 anti-inflammatory classes that elevate BP?

s6

A

NSAIDs and COX-2 inhibitors (-coxib’s)

s6

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13
Q

what 2 illicit drugs elevate BP?

A

amphetamines and cocaine

s6

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14
Q

list 3 immunosuppresive agents that may elevate BP

A

cyclosporine, sirolimus, tacrolimus

s6

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15
Q

what 2 steroids may elevate BP?

A

methylprednisolone and prednisone

s6

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16
Q

what 2 random sympathomimetics elevate BP?

s6

A

decongestant and diet pills

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17
Q

list hormones and psych meds that may elevate BP

A
  • hormones: oral contraceptives (estrogen and progesterone), androgens
  • psych: buspar, carbamazepine, lithium, clozapine, MAO-Is, SSRIs, TCAs

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18
Q

Per ACC/AHA guidelines, there is a moderate evidence to support antihypertensive therapy with which medications in those w/ CKD to improve kidney outcomes?

A

ACE-I or ARB

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19
Q

what are 3 causes of secondary HTN in older adults (>65 yo)?

s7

Study These Flashcards
A

atherosclerotic renal artery stenosis, renal failure, hypothyroidism

s7

20
Q

What does chronic HTN lead to? (vascularly..)

Study These Flashcards
A

remodeling of small & large arteries, endothelial dysfunction, and potentially irreversible end-organ damage

s8

21
Q

What plays a major role in ischemic heart dz, LVH, CHF, CVA, PAD, aortic aneurysm, and nephropathy?

Study These Flashcards
A

Disseminated vasculopathy

s8

22
Q

what 2 ultrasound measurements can provide an early dx of vasculopathy?

Study These Flashcards
A
  1. common carotid intimal to medial thickness
  2. arterial pulse-wave velocity
23
Q

what tests can track progression of LV hypertrophy?

Study These Flashcards
A

Echocardiographic and electrocardiographic indexes

s8

24
Q

what imaging can be used to identify cerebrovascular damage?

Study These Flashcards
A

MRI - to follow microangiopathic changes

s8

25
What are the 4 examples of end-organ damage due to HTN?
Vasculopathy Cerebrovascular damage Heart disease Nephropathy ## Footnote S9
26
What is the therapeutic goal for HTN treatment?
<130/<80 ## Footnote S10
27
How many people in the US have untreated HTN? How many patients have their BP above their goal?
28 million people in US have untreated HTN 29 million treated pts are above their BP goal ## Footnote S10
28
What is resistant HTN? What is the treatment for resistant HTN?
Above-goal BP despite 3+ antihypertensive drugs at max dose. Tx usually includes a LA CCB, an ACI-I or ARB + a diuretic ## Footnote S10
29
How would you define the controlled resistant HTN?
Controlled BP requiring 4+ medications ## Footnote S10
30
What is refractory HTN? How many patients present w/ refractory HTN?
Uncontrolled BP on 5+ drugs, present in 0.5% of pts ## Footnote S10
31
What is pseudo-resistant HTN? What are the causes of pseudo-resistant HTN?
Intolerance to drugs that can result from BP inaccuracies (including white-coat syndrome) or medication noncompliance ## Footnote S10
32
What are some lifystyle modifications recommended for patients w/ HTN?
Weight loss,↓ETOH, exercise, and smoking cessation There is a continuous relationship btw ↑BMI and HTN. ## Footnote S11
33
What is the most effective nopharmacological intervention for HTN?
Weight loss (expect a 1 mmHg reduction in BP for every 1 kg of weight loss) *- weight loss can synergistically enhance the drug efficacy.* ## Footnote S11
34
What other factors can increase or decrease the BP?
Increase BP: - Increase in physical activity - Excessive alcohol use Decrease BP: - Dietary potassium and calcium intake - Salt restriction ## Footnote S12
35
Which drug is reserved as the 1st line therapy for pts w/ hx of CAD or tachydysrhythmia or those w/ resistant HTN?
β blockers ## Footnote S15
36
How many drug classes have been approved for HTN?
15 ## Footnote S15
37
When are HTN pts hemodynamically vulnerable during anesthesia and why?
during induction of GA Induction drugs produce HoTN while Direct Laryngoscopy & intubation elicit HTN & tachycardia ## Footnote S22
38
Poorly controlled hypertension is often accompanied by what volume status and how can you fix it?
-volume deficit, especially if pt is on diuretic! *-volume loading prior to induction might provide hemodynamic stability however careful in left ventricular hypertrophy and diastilic dysfunction* ## Footnote 22
39
When considering vasoactive drugs, consider what 4 factors?
Pt's age, functional reserve, medications and the planned surgery ## Footnote 22
40
Induction causes what 3 changes in vital signs ? Which drug may be use after induction?
hypotension, direct laryngoscopy and intubation elicit hypertension and tachycardia -esmolol! and consider a pre induction a line ## Footnote 23
41
Women with pregnancy induced hypertension show evidence of organ damage dysfunction, especially encepalopathy at which diastolic value? In peripartum HTN, when should you intervene?
DBP >100 Intervene immediatly for SBP >160/ DBP >110! ## Footnote 23
42
Hypertensive crisis is categorized either urgent or emergent, and is based on organ damage. Which organ injuries is the patient at risk for?
CNS injury, kidney injury , and cardiovascular insult! | Pt w/ chronic HTN may tolerate higher SBP than normal pt ## Footnote 23
43
For rapid arterial dilation, which drug is **gold standard?** which other 2 drugs have become available as well?
-**sodium nitroprosside**! fast & easily titratable **-clevidipine** (CCB, short DOA ~ 1 min half life) has selevtive vasoarterial but it's expensive! **-nicardipine** (CCB, 1/2 life 30 min) less easy to titrate | 24
44
When treating HTN r/t aortic dissection, what can vasodilators cause? What is the treatment goal
Vasodilators may cause hypotension--> end organ ischemia :( *treatment goal is lessening pulsatile force of LV conraction* ## Footnote 25
45
When treating preeclampsia and eclamsia, BB may cause what 2 things? What 2 groups of drugs are teratogenic so contraindicarted w pregnancy?
uterine blood flow and they might inhibit labor! ACE inhibitors and ARBS! *delivery is the only ultimate treatment :(* ## Footnote 25
46
When treating pheo and cocaine intoxication for, what do you watch for when giving beta blockers?
unopposed alpa adrenergic stimulation after BB makes HTN worse! ## Footnote 25
47
What are the factors of Left Ventriucular Hypertension (LVH) and what does LVH cause ?
see chart

H+P (Exam 4) Hypertension (7 decks)

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