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Renal 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is White Coat vs masked hypertension?

A

WC: Consistently elevated by office readings but not out of office.
Masked is the opposite

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2
Q

What is a hypertensive emergency?

A

Severe hypertension with evidence of End organ damage (diastolic > 120)

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3
Q

What is hypertensive Urgency?

A

Severe hypertension w/ Diastolic >120 in asymptomatic Pts

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4
Q

What are the different types of Target organ damage in HTN?

A 
LVH, MI, CHF
Stroke, TIA
CKD
Retinal Complications
Peripheral Artery Dis
Death: Cerebral Vascular Accident, CV event, renal failure
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5
Q

How can LVH be diagnosed?

A

ECG or Echocardiography

Echo more sensitive but more $$

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6
Q

What are the different grades of HTN Retinopathy?

A

Gr 1 Generalized Retinal arteriolar narrowing
Gr 2 More severe narrowing, AV nicking
Gr 3 Previous + Hemorrhage, aneurism, hard exudates, cotton wool spots
Gr 4 Gr 1-3 + Optic disc swelling and macular edema

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7
Q

What are the Renal consequences of Hypertension?

A 
Decrease in GFR
Dec Tubular Funct
Proteinuria
GBM changes
Expanded mesangial matrix
Focal Segmantal GS
Tubulointerstitial Fibrosis
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8
Q

How is Peripheral Arterial Disease Diagnosed?

A

Screen- Ankle Brachial Index

Arteriography for surgical candidates

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9
Q

What are the causes of Secondary Hypertension?

A 
Apnea, Aldosteronism
Bruits, Bad  kidneys
Catecholemines, Coarctation, Cushing's synd
Drugs, Diet
EPO, Endocrine disorders
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10
Q

What are clues suggestive of secondary HTN?

A

Worsening of control in previously stable Pt
No FHx
BP >180 syst >120 diast
Onset 50

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11
Q

How is Obstructive Sleep Apnea Diagnosed?

A

Formal Sleep Study

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12
Q

How is Primary Aldosteronism Diagnosed?

A

Aldosterone:renin ratio

PAC/PRA ratio: (Plasma aldosterone: Plasma renin activity ratio)

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13
Q

What are clues of Renovascular HTN?

A

Jump in 30% of Creatinine

May present as Acute/chronic Renal failure with HTN

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14
Q

How is Renovascular HTN Diagnosed?

A

Abdominal Bruit
-Screen duplex Doppler Ultrasonography
50+ yo MRAngiogrphy
Computed Tomographic Angiography

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15
Q

What is the Tx of Renal Vascular Hypertension?

A

Medical Therapy
Percutaneous Angioplasty
Surgery

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16
Q

How is Renal Parenchymal Disease Diagnosed?

A

Inc Creatinine
Dec GFR
Ultrasound (Det chronicity)

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17
Q

How is Coarctation of the Aorta diagnosed?

A 
Physican Exam
Pulses/Arm/Leg BP
>20 systolic difference => Echo
Children: Echo
Adult- Consider MRA
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18
Q

How is Cushings syndrom diagnosed?

A

24hr Urin Cortisol
Dexameth Supression test
Check 8am cortisol

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19
Q

What drugs can contribute to HTN?

A 
Antidepressants: Tricyclics
Venlafaxine, fluoxetine
NSAIDS
Oral Contraceptives: combined
Steroids
Decongestants 
Triptans
Wt loss
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20
Q

How does Elevated EPO Cause HTN?

A

Can elevate BP by polycythemia/hypervisc or direct pressor effects

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21
Q

How is Pheochromocytoma Diagnosed?

A

24hr Metanephrines and catecholamines

Plasma for fractionated metanephrines

22
Q

What is the Tx of Pheochromoctoma?

A

Alpha Blocker (phenoxybenzamine) THEN Beta Blocker

23
Q

How does Hyperparathyroidism cause HTN?

A

Primary
Secondary to chronic renal Insufficiency
Tx with surgery if clinically sig

24
Q

What are the Steps of Diagnosis of HTN?

A

Step 1: Accuracy: BP cuff size, sleeves, brachial artery compressable. BP up on 2 visits
Step 2: BP Classification
Step 3: Look for CVD RF
Step 4: Target Organ Damage?
Step 5: IDable Causes of HTN?
Step 6: JNC8 Goals, LS mod, Meds, Followup and monitor

25
Q

How are steps 3-5 done?

A

History
Physical
Ancillary Studies

26
Q

What are the ancillary tests done to Diagnose HTN?

A 
ECG
UA
Blood Glu, HCT
Serum K, Creat, or GFR and Ca
Lpid Profile
Opt: Urinary Albumin or Alb/Creat ratio
27
Q

What do the JNC8 Reccomendations address?

A

Thresholds for Tx
Pharm Tx
Not Definitions (JNC7)

28
Q

What are the LS Mods made for HTN?

A 
Weight Reduction
Adopt a DASH diet
Na Restriction
Physical Activity
Moderation in EtOH
29
Q

What are the Advantages of Diuretics in Pts with HTN?

A

Cost effective
Works in Blacks and Af Amer
Dec M and M

30
Q

What are the Limitations of Diuretics in Pts with HTN?

A

Require monitoing of K, Glu, Lipids
Risk for reduced GFR/HypoNa
Hyperglycemia in high doses

31
Q

What are the Adv and Limitations of Ca Channel Blockers in Pts with HTN?

A

Antianginal
Can be used in Pts that cant use other drugs
White and AA Pts

DONT use Short acting w/ HTN
Edema in high doses
Cardiac Cond abn

32
Q

What are the Adv and Limitations of ACE-Inhibitors in Pts with HTN?

A 
Preferred in HTN Pt with HF from systolic dys 
Diabetes + Proteinuria
COUGH
HYPERKALEMIA
Not as good in Af Am
33
Q

What are the Adv and Limitations of AT II Blockers in Pts with HTN?

A

Dec cough
Well tolerated
Uricosuric

Long term effects?
Hyperkalemia

34
Q

What are the Adv and Limitations of B-Blockers in Pts with HTN?

A 
Dec CV M and M in non Elderly
Risk of Re-infarct
 DEC Insulin Sense
Inc TRG, Dec HDL
Caution in Pts with Reactive AW
35
Q

What are the Adv and Limitations of a-1 Blockers in Pts with HTN?

A 
Pts with Dislipidemia
HTN + BPH
Dec Cough, Well Tolerated
1st dose syncope
OHypotention
Rarely used in monotherapy
36
Q

What are the Adv and Limitations of A2 Agonists in Pts with HTN?

A

Clonidine quick onset for HTN urgency, Also in patch form
Methyldopa in Pregnancy

MANY SE
Rebound HTN in abrupt Withdrawl. Stroke?

37
Q

What are the Adv and Limitations of Virect Vasodilators in Pts with HTN?

A 
Potent Vasodilators
Hydralazine for Eclampsia
Minoxidil in Resistant HTN
Minox: Hirsuitism
Hydra: Headache, N/V/D
Tachycardia
38
Q

WHat are the best drug options for HTN in Pts WITHOUT CKD

A

AA: Thiazide or CCB

Non-AA: Thiazide, Ace/ARB, or CCB

39
Q

WHat are the best drug options for HTN in Pts WITH CKD

A

ACE/ARB

40
Q

What are the options in Multiple drugs for HTN?

A

A: Max each drug in sequence b4 adding another
B: Start a second drug b4 max dose
C: start 2 drugs at the same time

41
Q

What are the special considerations in Dementia Pts?

A

HTN can make Dementia worse!

42
Q

What are the special considerations in Pregnant Pts?

A

ACEI and ARB contraindicated

43
Q

What are the special considerations in Hypertensive Pediatric Pts?

A

HTN = BP > 95th percentile

lifestyle modifications FIRST

44
Q

What are the special considerations in Hypertensive Urgency?

A

Caused by non-adherence Reduce BP to

45
Q

What are the special considerations in Hypertensive Emergency?

A

Evidence of Acute end-organ damage in setting of Elev BP

IMMEDIATE BP reduction

46
Q

What pts are eligible for Lytic therapy in Acute Stroke?

A

BP 220/120

47
Q

What does MY CAST stand for?

A 
Medications/tx
Years diagnosed
Control
Appointment, last
Specialists
Symptoms of Disease
Testing- 
Satisfaction- Hows it going
48
Q

What does MOTHERR stand for?

A 
Meds
OMM
Testing/Labs/xray
Holistic
Empathy
Referrals 
Return
49
Q

What is the goal BP for an Elderly Diabetic Pt?

A
50
Q

What is the definition of Stage 1 vs Stage 2?

A

Stage 1: 140-159 or 90-99mmHg

Stage 2: >160 or >100 mmHg

51
Q

What are considerations in Hypertensive EMergency if Pt using Cocaine?

A

Give Alpha Blockers BEFORE BB.

52
Q

WHat is the appearance of Pulmonary Edema on CXR?

A

Bat wings of fluid extending out from the heart

Renal 2 (13 decks)

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