Perfusion

Question 1

What is primary hypertension?

Answer 1

No identifiable cause

Question 2

What is an HTN emergency? How do we treat it?

Answer 2

SBP >180 & DBP>120 with organ damage

• decrease BP 25% within 1st hour
  
  • goal 160/100 over 2-6 hours
    
    • decreasing BP too quickly decrease cerebral perfusion

Question 3

Medications for atherosclerosis?

Answer 3

• Lipid Lowering medications 
• Anti-platelet medications 
• Beta blockers
• Angiotensin-converting enzyme (ACE)
inhibitors 
• Calcium channel blockers

Question 4

Important lab assessments for atherosclerosis

Answer 4

Total serum cholesterol < 200mg/dl (considered normal)
– Lipid Profile – Total Cholesterol <200mg/dl
– LDL-C <100 mg/dl (healthy), <70 mg/dl (CAD, DM)
– HDL-C >40 mg/dl exercise

Triglyceride <150 mg/dl
– if > 150 mg/dl hypertriglyceridemia
Women < 135 mg/dl

Question 5

What is white coat HTN?

Answer 5

> 130/90 in healthcare setting & normal outside setting

Question 6

What is atherosclerosis

Answer 6

A type of arteriosclerosis
• Thickening & hardening due to increased cholesterol
development
• Affecting larger arteries i.e. aorta, carotid

Question 7

Side effects of questran? (Bile acid sequestrants)

Answer 7

Side effects: constipation, increase bleeding r/t vit K

malabsorption and vit A,D deficiencies

Question 8

What are risks of HTN?

Answer 8

Race
- Increased incidence in African Americans (30%)
Elderly
obese
Age (30-70years)
< 45 years of age – Males > Females; > 45 years of age - Females = Males
Diet
Alcohol intake
1 out of 3 adults will develop hypertension in their lifetime. (AHA 2010)
Accounts for 50 Million people in the United States
Sleep Apnea
Family History
Smoking
Sedentary Lifestyle
Diabetes mellitus

Question 9

How do we diagnose HTN?

Answer 9

• BP – 2 or more seated BP readings on each of 2 or more office visits
• EKG – measures electrical impulses across the heart
muscle
• Echocardiogram – ultrasonic waves are directed to the
heart. Gives a picture. Detects valve disorders,
congenital disorders, fluid around the heart, heart
tumors
• Cardiac Catheterization – determines BP and blood
flow into the heart chambers

Question 10

Common side effects of fibrates?

Answer 10

Nausea and abdominal pain
Teaching: take 30 mins before morning and evening meal.
May increase effects of anticoagulants and
hypoglycemia

Question 11

What is arteriosclerosis?

Answer 11

A broad term applied to any number of
pathological conditions where there is thickening, hardening, & loss of elasticity of arteries.
Causes: heredity, diet, smoking

Question 12

What is orthostatic hypotension?

Answer 12

Dec BP SBP>20mmHg or DBP >10mmHg with change in position

20 min switch each position

Question 13

What is masked HTN?

Answer 13

Normal in healthcare setting & high @ home/work
• R/T stress, smoking
• Educate: reduce stress, smoking cessation, monitor BP stress

Question 14

What are some antihyperlipidemic meds?

Answer 14

Statins (atorvastatin)
Fibrates (fenofibrate)
Bile Acid Sequestrants (colestipol)
Niacin (niacin)
Cholesterol Absorption Inhibitor (ezetimibe)
Combination Agent (Vytorin: ezetimibe+simvastatin)

Question 15

What are some special considerations for meds involving race?

Answer 15

African Americans respond better to diuretics

Caucasians – ACE inhibitors

Question 16

What is secondary hypertension?

Answer 16

Identifiable cause i.e. med., renal disease, hyperaldosteronism

Question 17

What is an HTN urgency? How do we treat it?

Answer 17

SBP>180/DBP>110 without organ damage, symptoms severe H/A, SOB, anxiety, nose bleeds. Goal is 160/110 BP over several hours.

Treated with oral meds