IM Flashcards
(24 cards)
Clinical definition of Hypertension
Level of blood pressure where institution of pharmacotherapy will lead to decrease cardiovascular morbidity and mortality
White Coat Hypertension vs Masked Hypertension
White coat - high at office, normal at home
Masked - normal at office, high at home
Criteria that needs to be fulfilled in order to diagnose Hypertension in just one visit
BP > 180/110
with evidence of cardiovascular disease
Ranges for: Normal BP Pre-hypertension Hypertension Stage I Hypertension Stage II
Normal BP: <120/<80
Pre-hypertension: 120-39/80-89
Stage I: 140-59/90-99
Stage II: 160/100
Definition of Isolated Systolic Hypertension
Systolic BP of >140, with Diastolic BP <90
What is the difference between a high-renin activity hypertension and low-renin activity hypertension
High-renin - hypertension is mainly from increased vascular resistance
Low-renin - hypertension is mainly from increased volume
Relationship between BMI and Hypertension?
Studies have shown that higher BMI is correlated with increased risk of hypertension
Components of Metabolic Syndrome
Hypertension
Dyslipidemia
Obesity
Insulin Resistance
2 etiologies of Renovascular Hypertension?
Atherosclerosis
Fibromuscular dysplasia
Gold standard for investigations of Renal Artery Disease
Contrast Arteriography
What is primary aldosteronism?
Increased production of aldosterone independent of Renin and Angiotensin
2 most common etiologies of primary aldosteronism?
What are their key differences?
Aldosterone-producing adenoma
- more responsive to ACTH
- hypertension is particularly worse in the morning
- either surgical or medical treatment
Bilateral adrenal hyperplasia
- more responsive to Angiotensin
- orthostatic hypertension is common
- medical treatment
Most common congenital cause of hypertension?
Coarctation of the Aorta
Examples of monogenic forms of hypertension?
How do they cause hypertension?
What are some of their clinical features?
17a-hydroxylase deficiency
- decreased production of both cortisol and sex hormones
- increased production of deoxycorticosterone (mineralocorticoid)
- hypokalemia
- absent secondary sexual development
11B-hydroxylase deficiency
- decreased production of cortisol and estrogen
- increased production of deoxycorticosterone and androgens
- hypokalemia
- ambiguous female genitalia, enlarged male genitalia
11B-dehydroxysteroid dehydrogenase deficiency
-decrease in degradation of cortisol
What are the phases in the pathogenesis of Lobar Pneumonia? (4)
Describe each phase
Edema Phase
Red Hepatization
Gray Hepatization
Resolution Phase
CURB 65 Criteria for CAP prognosis
C - Change in mental status U - Urea > 7 mmol/L R - RR > 30 B - BP < 90/60 65 - Age > 65 yrs old
Common clinical manifestations of CAP
Acute Cough
Tachypnea
Tachycardia
Fever
w/ abnormal chest findings on PE
Criteria for discharge of admitted CAP patients
Temp: 36 - 37.5 C RR: 16 - 24 cpm HR: < 100 bpm SBP: > 90 mmHg O2: > 90% Able to take oral medications
Enumerate the criteria for:
CAP - LR
CAP - MR
CAP - HR
CAP - LR
Normal vital signs, no aspiration, no change in mental status, stable comorbids, no abscess, no effusion
CAP - MR
Abnormal vital signs, aspiration component, change in mental status, unstable comorbids, w/ abscess, w/ effusion
CAP - HR
CAP - MR + sepsis, mechanical ventilation requirement
Empiric antibiotic treatment for:
CAP - LR
CAP - MR
CAP - HR
CAP - LR
w/o comorbids - amox OR extended macrolide
w/ comorbids - co-amox/sultamicillin OR extended macrolides
CAP - MR
IV non-pseudomonas Beta-Lactam PLUS
extended macrolides OR
respiratory fluoroquinolones
CAP - HR
w/o pseudomonas - IV non-pseudomonas Beta-Lactam PLUS IV extended macrolide
OR IV respiratory fluoroquinolones
w/ pseudomonas 1 - IV anti-pseudomonas Beta Lactam
PLUS IV extended macrolide
PLUS IV aminoglycoside
w/ pseudomonas 2 - IV anti-pseudomonas Beta Lactam
PLUS IV respiratory fluoroquinolones
w/ MRSA - Vancomycin, Linezolid, or Clindamycin
Differentiate HAP and VAP
HAP
- not associated with ventilator use
- lower risk of having MDR pathogen
VAP
- associated with ventilator use
- higher risk of having MDR pathogen
Risk factors for MDR VAP
Prior antibiotic use within the past 90 days
Sepsis
ARDS
>5 days hospital stay prior to VAP
Acute renal replacement therapy prior to VAP
Risk factor for MDR Pathogens in general
Prior antibiotic use within the past 90 days
Triple antibiotic regimen for patients with risk of having MDR pathogen
1. Beta-lactam Ceftazidime 2 mg IV q8 Cefepime 2 mg IV q8-12 Pip-Tazo 4.5 mg IV q6 Imipenem 1 g IV q8 Meropenem 1 g IV q8 Aztreonam 2 g IV q8
- Against G(-)
Aminoglycosides:
Gentamicin 7 mg/kg IV q24
Amikacin 20 mg/kg IV q24
OR Respiratory Fluoroquinolones:
Ciprofloxacin 400 mg IV q8
Levofloxacin 750 mg IV q24
- Against MRSA/G(+)
Vancomycin 15 mg/kg IV q 12
Linezolid 600 mg IV q 12