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Flashcards in Step Up-Ambulatory Medicine Deck (311)
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1

What are the two most common causes of hypertension?

1) Essential HTN (95%) 2) OCPs are the most common secondary cause of HTN. Other secondary causes include renovascular disease, endocrine disorders, medications, coarctation and OSA.

2

Why are patients with HTN at increased risk of CAD, PVD and CVA?

HTN accelerates atherosclerosis

3

4 non-modifiable risk factors for HTN

1) Age > 60 2) Male 3) African-American 4) FHx

4

3 modifiable risk factors for HTN

1) Obesity 2) Sodium intake 3) Alcohol intake > 2 oz.

5

Complications of uncontrolled HTN

1) Cardiovascular: MI, CHF due to LVH, PVD, aortic dissection 2) Retinopathy: AV nicking, cotton wool spots, scotomata, hemorrhages, exudates and papilledema 3) CNS: hemorrhage, TIA, CVA and lacunar stroke 4) Renal: nephrosclerosis (atherosclerosis of afferent AND efferent arterioles), decreased GFR and ESRD

6

Diabetic & renal disease definition of HTN

> 130/80

7

A patient comes in for a BP check, how long should you wait if they just drank coffee or had a cigarette?

30 minutes

8

A patient comes to clinic and has blood pressure elevations on two separate visits over a span > 4 weeks. You diagnose him with HTN and assess for target organ damage. What labs do you want to order at this time?

1) UA (proteinuria) 2) BMP (K, BUN, Cr) 3) FBG (r/o DM) 4) Lipid panel (minimize atherosclerosis) 5) ECG (check for LVH)

9

When will most newly diagnosed patients with HTN get 2-drug tx from the start?

Stage II (> 160/100)

10

What lifestyle modifications have the most profound effect on dropping BP?

DASH diet (8-14), q10kg wt. loss (5-20), 30 min exercise q5-6x/week (4-9), Na

11

Best anti-HTN med for AAs? What if they have DM?

AAs = HCTZ. AA + DM = ACE-I is 1st line in all patients with DM due to its renal protective effect

12

Lifestyle modification necessary for HCTZ to work?

Na restriction, otherwise hypokalemia will be exacerbated 

13

Best anti-HTN med for old men with BPH?

Alpha-blockers

14

Meds usually tried in patients with HTN refractory to 1st and 2nd line therapy?

Vasodilators (hydralazine and minoxidil) in combination w/beta-blockers and diuretics

15

Anti-HTN medications contraindicated in pregnancy?

ACE-I, ARBs, CCBs and thiazides. Beta-blockers and hydralazine are safe.

16

Which anti-HTN is the best 1st line medication?

Unless there is a compelling reason HCTZ, dihydropyridine (CCB), ACE-I and ARBs are all commonly used as initial monotherapy.

17

ACCOMPLISH trial findings regarding effectiveness of combination therapy

Benazepril + amlodipine was more effective than and ACE-I or CCB alone.

18

A patient presents with HTN non-responsive to lifestyle modifications and 6 weeks of HCTZ. What is your next step?

Change to a different type of monotherapy before adding on a second medication. 

19

Who gets screening lipid testing?

All adults > 20 yrs q5 years

20

What are the causes of primary dyslipidemia syndromes? How are they treated?

I) Exogenous HLD = chylomicrons, tx’d w/diet modification. IIa) Familial hypercholesterolemia = LDL, tx’d w/statins, niacin, cholestyramine. IIb) Combined hyperlipoproteinemia = LDL + VLDL, tx’d w/statins, niacin, gemfibrozil. III) Familial dysbetalipoproteinemia = IDL, tx’d w/gemfibrozil, niacin. IV) Endogenous HLD = VLDL, tx’d w/niacin, gemfibrozil, statins. V) Familial hypertriglyceridemia = VLDL + chylomicrons tx’d w/niacin, gemfibrozil

21

Causes of secondary dyslipidemia?

Endocrine (hypothyroidism, DM, Cushing’s), Renal (nephrotic syndrome), ESLD, Meds (propranolol, HCTZ, estrogen, prednisone) and Pregnancy.

22

Foods that will elevate LDL

Saturated fatty acids and cholesterol

23

Foods that will elevate triglycerides (VLDL)?

High calorie diets and alcohol

24

At what age do cholesterol levels stop increasing?

65

25

When do both genders have equal risk for HLD?

After menopause

26

How is LDL measured?

Total cholesterol - HDL - TG/5

27

LDL levels associated with significant increase in CAD risk

160

28

Total cholesterol levels associated with significant increase in CAD risk?

160-200, > 240 is really bad

29

Why is HDL so good?

Every 10mg/dL increase = 50% decrease CAD risk. HDL 60 subtracts 1 point from risk.

30

Risk associated with total cholesterol to HDL ratio