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Flashcards in special considerations of htn Deck (35):
1

what is the BP goal for pt's with diabetes

140/90

2

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

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

3

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

thiazides
CCB's

4

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

decrease mortality by 50%

5

what is the JNC 8 BP goal with CKD?

140/90

6

anyone with HTN and CKD should have what medications started?

ACEI/ARB for renal

7

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

cardiovascular disease

8

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

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

9

what percent of patients with HTN experience HTN crisis?

1-2%

10

the majority of HTN crisis' are caused by what

idiopathic causes

11

what is a hypertensive crisis?
what level BP is considered this?

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

12

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

hypertensive urgency

13

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

hypertensive emergency

14

what is the difference in HTN urgency vs. emergency?

urgency doesn't have acute end organ damage
emergency has acute end organ damage

15

what are the target organs in a hypertensive emergency?

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

16

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

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

17

how is mena arterial pressure calculated?

MAP= CO x SVR

18

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

0-1

19

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

above 60
(normal = 60-120)

20

in clinical practive how is MAP calculated?

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

21

why is diastolic multiplied by 2 when calculating MAP

diastolic lasts twice as long as systolic

22

why does MAP stay high overtime in unmanaged patients?

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

23

what happens to vascular resistance in HTN crisis?
What causes this

abrupt increase in vascular resistance
do to an increase in vasoconstrictors

24

what happens in response to vascular resistance?

endothelial cells release vasodilatiors

25

overtime, what happens with response to increased vascular resistance

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

26

what can occur with increased vasoconstriction without opposition

ischemia and infarction

27

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

increased permability
increased nitric oxide
activates coagulation cascade
fibrin deposits

28

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

confirm it in both arms

29

what are 3 clinical presentations common in emergency HTN?

1. chest pain
2. dyspnea
3. neurological deficits

30

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

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

31

what labs should be evaluated during HTN emergency

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

32

encephalopathy, and eclampsia indicate what HTN urgency or emergency?

HTN emergency

33

as a pharmacist what should be evaluated with a HTN emergency

medication history and compliance

34

what is the mortality rate for HTN crisis left untreated?

79%

35

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

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