special considerations of htn

Question 1

what is the BP goal for pt’s with diabetes

Answer 1

140/90

Question 2

what is the treatment for nonblack population for HTN with DM in JNC8?

Answer 2

1. ACEI/ ARB
2. Thiazides
3. CCB’s
4. Beta-Blockers

Question 3

what is the general treatment for the black population for HTN with DM

Answer 3

thiazides

CCB’s

Question 4

for every 10 ml you decreases diastolic bp what happens for DM pt’s

Answer 4

decrease mortality by 50%

Question 5

what is the JNC 8 BP goal with CKD?

Answer 5

140/90

Question 6

anyone with HTN and CKD should have what medications started?

Answer 6

ACEI/ARB for renal

Question 7

what is the most common cause of death with pt’s with CKD?

Answer 7

cardiovascular disease

Question 8

what are for criteria for patients at risk of HTN crisis?

Answer 8

1. men
2. elederly
3. African americans
4. low SES

Question 9

what percent of patients with HTN experience HTN crisis?

Answer 9

1-2%

Question 10

the majority of HTN crisis’ are caused by what

Answer 10

idiopathic causes

Question 11

what is a hypertensive crisis?

what level BP is considered this?

Answer 11

acutely elevated BP
either systolic over 180 or diastolic over 120
>180/120

Question 12

what is the term for elevated BP without acute end organ damage in HTN Crisis?

Answer 12

hypertensive urgency

Question 13

what is the term for HTN crisis with acute end-organ damage?

Answer 13

hypertensive emergency

Question 14

what is the difference in HTN urgency vs. emergency?

Answer 14

urgency doesn’t have acute end organ damage

emergency has acute end organ damage

Question 15

what are the target organs in a hypertensive emergency?

Answer 15

1. Brain
2. eyes
3. peripheral vasculature
4. heart
5. kidney

Question 16

what are 3 types of eye damage seen in a HTN emergency

Answer 16

1. narrowing of retinal arteries
2. flame shaped hemorrhage
3. cotton wool spots (not unique to HTN crisis)

Question 17

how is mena arterial pressure calculated?

Answer 17

MAP= CO x SVR

Question 18

what is the cerebral venous pressure (CVP) generally seen in HTN crisis

Answer 18

0-1

Question 19

what levels should MAP be above to keep blood flow to vital organs?
what is the normal range of MAP

Answer 19

above 60
(normal = 60-120)

Question 20

in clinical practive how is MAP calculated?

Answer 20

((2 x diastolic pressure) + systolic)/3

Question 21

why is diastolic multiplied by 2 when calculating MAP

Answer 21

diastolic lasts twice as long as systolic

Question 22

why does MAP stay high overtime in unmanaged patients?

Answer 22

MAP will autoregulate to a higher level, possibly leading to end organ damage

Question 23

what happens to vascular resistance in HTN crisis?

What causes this

Answer 23

abrupt increase in vascular resistance

do to an increase in vasoconstrictors

Question 24

what happens in response to vascular resistance?

Answer 24

endothelial cells release vasodilatiors

Question 25

overtime, what happens with response to increased vascular resistance

Answer 25

endothelial cells become damaged and cant release vasodilators causes loss of normal autoregulatory function

Question 26

what can occur with increased vasoconstriction without opposition

Answer 26

ischemia and infarction

Question 27

endothelial damage causes what 4 specific, negative things leading to vasoconstriction

Answer 27

increased permability increased nitric oxide activates coagulation cascade fibrin deposits

Question 28

if a patient has BP that is greater than 180/120 what should be done to confirm it clinically?

Answer 28

confirm it in both arms

Question 29

what are 3 clinical presentations common in emergency HTN?

Answer 29

1. chest pain 2. dyspnea 3. neurological deficits

Question 30

what are the physical exams needed to identify end organ damage for an emergency HTN pt.

Answer 30

1. pulse evaluation 2. auscultation of ungs, heart and renal arteries 3. neurological exam 4. eye exam 5. CV exam

Question 31

what labs should be evaluated during HTN emergency

Answer 31

1. SCr 2. BUN 3. urinary analysis (UA) 4. electrolytes 5. CBC

Question 32

encephalopathy, and eclampsia indicate what HTN urgency or emergency?

Answer 32

HTN emergency

Question 33

as a pharmacist what should be evaluated with a HTN emergency

Answer 33

medication history and compliance

Question 34

what is the mortality rate for HTN crisis left untreated?

Answer 34

79%

Question 35

what are 4 common most common causes of death with HTN crisis

Answer 35

1. renal failure (40% 2. stroke (23%) 3. MI (11%) 4. heart failure (10%)