Hypertension Pales CIS Flashcards by Bryce Harmon

Definition of Htn

Normal:

Systolic

How well did you know this?

Not at all

Perfectly

What are the contributing (risk) factors for developing essential HTN?

Genetic predisposition
Abdominal Obesity
Salt intake
Alcohol intake
Age

How well did you know this?

Not at all

Perfectly

HTN is a risk factor for:

Stroke
Myocardial Infarction
Heart Failure
ESRD
Atrial Fibrillation
Aortic Dissection
PVD

How well did you know this?

Not at all

Perfectly

older patients with HTN?

lder patients have atherosclerosis in larger vessels, aorta

high systolic and lower diastolic

How well did you know this?

Not at all

Perfectly

What is the likely mechanism of this patient’s blood pressure elevation?

vasoconstriction of capillaries, or vasospasm

How well did you know this?

Not at all

Perfectly

physical activity

Modification: engage in regular aerobic physical activity such as brisk walking 30 min every day

Approximate systolic bp reduction range: 4 to 9 mmHg

How well did you know this?

Not at all

Perfectly

Weight reduction

Modification: maintain normal body weight

Approximate systolic bp reduction range: 5-20 mmHg per 10kg of weight loss

How well did you know this?

Not at all

Perfectly

adopt a dash eating plan

Modification: consume a diet rich in fruits beggies and low fat dairy products with a reduced content of saturated and total fat

Approximate systolic bp reduction range: 8 to 14 mmHg

How well did you know this?

Not at all

Perfectly

dietary sodium reduction

Modification: Reuce dietary sodium intake to no more than 100meq/day (2.4 g sodium or 6 g sodium cholride

Approximate systolic bp reduction range:2 to 8 mmHg

How well did you know this?

Not at all

Perfectly

Moderation of alcohol consumption

Modification: limit consumption to no more than 2 drinks per day in most men and no more than 1 drink per day in women and ligther weight persons

Approximate systolic bp reduction range: 2 to 4 mmHg

How well did you know this?

Not at all

Perfectly

Initial Recommended HTN treatment for Non-Black population

ACE Inhibitors
ARB
CCB
Thiazide diuretics

How well did you know this?

Not at all

Perfectly

Initial Recommended HTN treatment for Black population

CCB

Thiazide diuretics

How well did you know this?

Not at all

Perfectly

When should we suspect secondary HTN?

Compelling finding on initial evaluation
Hard to control HTN (either new onset or well controlled HTN becoming hard to control)
Atypical age of diagnosis (less than 30)
Absence predisposing factors

How well did you know this?

Not at all

Perfectly

Diagnosis of Renovascular Hypertension

Captopril Test (reactive rise in renin and large fall in BP after administration)
DSA
MRI –angiography
Arteriography
Renal vein renin ratio (ratio of 1.5 or greater)

How well did you know this?

Not at all

Perfectly

2 main cuases of renovascular hypertension

atherosclerosis

fibromuscular dysplasia

How well did you know this?

Not at all

Perfectly

Atherosclerosis over view

Age - >50
sex - male
bilaterality33% - 
progressive - +++
response to angioplasty - +
associated risks, tobacco, lipids, diabetes, etc - +++

How well did you know this?

Not at all

Perfectly

fibromuscular dysplasia overview

Age -

How well did you know this?

Not at all

Perfectly

3 types of renovasuclar htn

Unilateral
bilateral
one kidney

How well did you know this?

Not at all

Perfectly

Unilateral renovascular htn

decreases intravascular volume

more renin mediated than the others

bp usually falls with ACEI

How well did you know this?

Not at all

Perfectly

Bilateral renovasuclar htn

increase intrabascular volume

renin mediation is more varied

ace response unpredicatlbe and may worsen htn

How well did you know this?

Not at all

Perfectly

One kidney renovascular htn

increased intravascular volume

renin mediation is more varied

ace response unpredicatable andy may worsen htn

How well did you know this?

Not at all

Perfectly

graves disease tests

tsh should be low, t3 would be high and antibodies will be high

How well did you know this?

Not at all

Perfectly

meds for graves (hyperthyroidism)

beta blockers for htn

How well did you know this?

Not at all

Perfectly

hypertensive urgency

A systolic BP > 180 or a diastolic BP > 130 and NO evidence of end organ damage.

How well did you know this?

Not at all

Perfectly

hypertensive emergency

May occur at any BP, but involves ACUTE DAMAGE to at least one organ system.

Signs of Target Organ Involvement Acute and Chronic cardiovascular

MI (A), Angina (A), Aortic dissection (A), Aneurysmal dilatation of large vessels (C), LVH (C), CHF (A)

Signs of Target Organ Involvement Acute and Chronic CNS

Cerebral edema (A), Altered mental status (A), Bleed (A), Stroke (A) or TIA (A)

Signs of Target Organ Involvement Acute and Chronic renal

Hematuria (C), Proteinuria (C), ARF (A)

Signs of Target Organ Involvement Acute and Chronic ophthalmologic

Retinal hemorrhages or exudates (A or C), Papilledema (A) | A-V nicking (C)

primary hyperaldosteronism cons disease

1. Located in adrenal gland without exogenous stimulus. | 2. Elevated aldosterone and low renin levels

Primary hyperaldosteronism types

1. Aldosterone producing adenoma 2. Idiopathic Hyperaldosteronism 3. Bilateral adrenal hyperplasia 4. Aldosterone producing Ca 5. Aldosterone producing renin-responsive adenoma 6. Ectopic aldosterone producing tumor 7. Dexamathasone suppressible hyperaldosteronism

Secondary hyperaldosteronism

``` Elevated aldosterone and elevated renin levels Causes are: 1. Diuretics 2. CHF 3. Cirrhosis 4. Ascites 5. ```

why are pts with hyperaldosteronism weak

hypokalemia

how do you treat hyperaldosteronism?

aldosterone blockers spironolactone

secondary hypertension causes

1. Sleep apena 2. Drug induced causes 3. Chronic kidney disease 4. Primary aldosteronism 5. Renovascular disease 6. Steroid therapy or Cushing’s syndrome 7. Pheochromocytoma 8. Coarctation of the aorta 9. Thyroid disease 10. Parathyroid disease 11. Pain induced

coarctation of aorta

1) Narrowing of medial layer of aorta. 2) Commonly at ligamentum arteriosum. 3) 3 types: A) Interrupted B) Preductal C) Postductal

Diagnosis of Coarctation

1. Differences in upper and lower extremities 2. Blood Pressure 1. systolic hypertension in an infant 2. 20mm hg between arms 3. Heart Sounds –if isolated a systolic ejection murmur in the aortic outlet and between scapulae. 4. Radiology – 1. Cardiomegaly 2. Rib notching

Suffices acei

pril

suffixes b blockers

lol

suffixes dihydropyridines ccb

pine

suffixes arbs

sartan

suffixes alpha blockers

zosin

suffixes thiazides

hctz chlorthalidone

suffixes direct vasodilators

hydralazine and minoxidil

suffixes central sympatholytics

clonidine methyldopa

DRI suffixes

aliskiren

Nondihydropyridine ccb

verapamil diltiazem

Cough is the most annoying side effect of which BP med

lisinopril

This BP medication may lead to severe symptomatic bradycardia including heart block when added to a Beta blocker

verapamil

Hyperkalemia is a possible life-threatening side effect of which blood pressure medication

valsartan arbs block k secretion

This medication is a drug of choice for treatment of blood pressure for patients with mild to moderate kidney disease (especially with proteinuria), but in patients with severe kidney disease it may tip patient into the ESRD

ramipril

How can ACE Inhibitors help/hurt the kidneys

they dialate efferent arteriole high pressure will cause sclerosis but if gfr is too low it will hurt the kidney

Patients with severe sulfa allergies should avoid this BP medication

hctz

Alcoholic withdrawals symptoms are helped with this blood pressure medication

clonidine

Patients with history of severe asthma could get an asthma exacerbation with initiation of this blood pressure medication

labetalol

This medication precipitated condition shown on this picture.

chlorthalidone thiazides increase uric acid

This medication may help with symptoms of prostate enlargement, but may cause reflex tachycardia

terazosin

``` All of these medications may cause lower extremities edema, except which one? Amlodipine Hydralazine Metoprolol Minoxidil Terazosin ```

metoprolol the other ones are all peripheral vasodilators so they cause edema

Watch out for drug induced lupus when you use this Blood Pressure medication at high doses

hydralazine diagnosed by antihistones

This medication may worsen blood sugar control in diabetic patients

hctz

Also used as a hair growth product for alopecia, this BP medication should be used with caution in women not desiring hursitism.

minoxidil or rogaine

This diuretic blood pressure medication should be used in patients with systolic heart failure and in patients with one specific cause of secondary HTN, though it may cause gynecomastia in men

spironolacton

According to JNC-VIII guidelines, this medication class is recommended for initial treatment of HTN in non-black population, but not in African-American patients.

ace inhibtiors

In patients with diabetes, the best initial choice of an antihypertensive medication is 

acei or arbs

Patient with recent heart attack, should be on this BP medication

metoprolol

In patients with systolic congestive heart failure, all but one of these blood pressure medications should be the first ones to be prescribed

nifedipine

These combination pill is frequently used in treatment of HTN. Each of the medication within the combination often cancel each other’s opposing effect on serum potassium level.

Lisinopril/hydrochlorothiazide (Zestoretic)

In pregnant patients, this medication is preferred to treat HTN because it’s one of the oldest and the most studied in pregnancy

methyldopa

Angioedema is a rare but scary and life threatening side effect of this medication, especially in patients with C1 esterase deficiency.

ramipril

Cocaine addict coming with severe HTN should not be treated with this medication alone

propranolol, cocain is alpha beta agonism so if you block beta 2 alpha 1 is unopposed and things may get worse

Patients with hypertensive emergencies can be treated with all of the below medication except for this one.

losartan it doesnt come in iv

Thiazide diuretics may decrease all of the following electrolytes in the blood except

calcium

If you abruptly stop this medication, it may cause severe rebound hypertension

clonidine

meds that cause angioedema

acei

meds that causeankle edema

amlodipine

After MI

Agent:Beta Blocker, ACE Inhibitor Caution:Direct Vasodilators (may worsen coronary insufficiency)

CHF

Agent: ACE Inhibitor, Diuretics; Beta blockers (no pulm edema) Caution: Beta Blockers, CCB

Hypertrophic cardiomyopathy

Agent:Beta Blockers, CCB Caution: Diuretics, ACE Inhibitors, direct vasodilators

Bradycardia, Heart Block

Agent: Caution: Beta Blockers, CCB non dihydropyridines

Tachyarrhythmias

Agent:Beta Blockers, verapamil

Angina

Agent: Beta Blockers, CCB, Nitroglycerin, Caution: Direct Vasodilators (

COPD/ROAD

Agent: ccb Caution: bet blockers

Aortic Disecction

Agent: Nitroprusside, Beta Blocker | Caution: Drugs that > cardiac output Increased shear stress

bilateral renal artery stenosis

Agent: Caution:: Ace Inhibitors, Angiotensin Blockers (May worsen renal function)

chronic renal insufficiency

Agent: Ace Inhibitors (With serum creatinine

Renal Transplants

Agent: Caution: ACE Inhibitors (may worsen renal function)

Migraine headaches

Agent:Beta Blockers, CCB (may relive migrai ne symptoms) non dihydropyridines Caution:

Stroke or TIA

Agent: ACE Inhibitors (may allow reestablishment of cns autoregulation) Caution: Vasodilators may increase intracranial pressure

Diabetes

Agent: ACE inhibitor (delay renal failure; decrease proteinuria) Condition:

Pregnancy (preeclampsia, eclampsia)

Agent: Methyldopa, Hydralazine; Beta blockers with caution Caution: ACE Inhibitors, Angiotensin blockers, (may cause renal agenesis) Diuretics

gout

Agent: Caution: Diuretics (worsen joint pain or precipitate gout)

Cocaine use

Agent: Labetalol, Clonidine Caution: Selective B-blockers (unopposed cocaine induced Alpha agonism)

GI BLeed

Agent: Non-selective Beta Blocker (lower portal blood pressure) Caution: Beta Blockers (may mask signs of acute bleeding)

Pheochromocytoma

Agent: Alpha Blocker –then –Beta blockade Caution: Selective Beta Blocker (unopposed alpha agonism)

Bening prostatic hypertrophy

Agent: Alpha-1 antagonist Caution: Selective Beta Blocker (unopposed alpha agonism)

Hypertension Pales CIS Flashcards

(95 cards)