Foundations II (Cholley) > HTN > Flashcards

HTN Flashcards

(56 cards)

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1
Q

When does CVD risk double?

A
  • Beginning at 115/75

- For each increment of 20/10

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2
Q

Primary HTN accounts for how many cases?

A

90-95%

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3
Q

What controls BP?

A
  • SNS
  • RAAS
  • Plasma volume
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4
Q

Neural MOA

A

Overactive SNS

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5
Q

Renal MOA

A

Renal sodium retention

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6
Q

Vascular MOA

A
  • Inflammation
  • Oxidative stress
  • Vascular remodeling
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7
Q

Hormonal (RAAS) MOA

A
  • Aldosterone
  • Angiotensin II
  • Renin
  • Prorenin activate pathways damaging vascular health
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8
Q

Secondary HTN indications

A
  • Young age of onset
  • Diastolic HTN at age older than 50
  • Poor response to generally effective therapy
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9
Q

HEENT eval

A
  • Narrowing of arterial diameter
  • Cotton wool spots
  • Hemorrhages
  • Papilledema
  • Exudates (3+)
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10
Q

Abdomen eval

A
  • Renal masses
  • Renal bruits
  • Femoral pulses
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11
Q

Neuro eval

A
  • Visual disturbance
  • Focal weakness
  • Confusion
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12
Q

Cardio eval

A
  • Left ventricular hypertrophy
  • S4 gallop
  • Edema
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13
Q

Screening according to USPSTF?

A

Adults 18+

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14
Q

At what value do we dx HTN?

A

Depends on what guideline we are following

- Based on avg of 2 or more BP readings at 2 or more office visits

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15
Q

JNC 7 BP goal for general population

A

140/90

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16
Q

JNC 7 BP goal for pts w/ diabetes

A

130/80

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17
Q

JNC 8 recommendations

A
  • < 140/90 for ALL adults up to age 59

- < 150/90 for age 60+

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18
Q

ADA recommendations

A
  • < 140/90

- Risk-based individualization

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19
Q

Special considerations

A
  • White coat HTN: 20-25% of stage 1 HTN in office

- Masked HTN: 10%, increased cardiovascular risk

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20
Q

When do you initiate anti-hypertensives according to ACC/AHA?

A
  • Stage 2
  • Stage 1 w/ 1 or more of the following:
    1. Established ASCVD
    2. Type 2 DM
    3. CKD
    4. 10 year calculated ASCVD risk of 10%
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21
Q

What is BP goal according to ACC/AHA?

A
  • < 130/80 if on meds

- < 140/90 for low-risk stage 1 who don’t qualify for meds

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22
Q

What caution should you be aware of in pts > 60 yo?

A

Not to lower DBP < 55-60

*Associated w/ increased risk of MI & stroke

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23
Q

Non-pharmacologic tx

Study These Flashcards
A
  • Salt restriction
  • DASH diet
  • Alcohol reduction
  • Weight loss
  • Exercise
  • Smoking cessation
24
Q

Pharmacologic tx

Study These Flashcards
A
  • Diuretics
  • Calcium channel blockers
  • ACE Inhibitors
  • Beta blockers
  • Direct renin inhibitor
  • Central alpha agonists
  • Alpha blockers
25
What are the types of diuretics?
- Thiazide (ex. hydrochlorothiazide) - Loop (ex. Furosemide) - Potassium sparing (ex. Triamterene) - Aldosterone antagonists (ex. Spironolactone)
26
Diuretics: MOA
Inhibits sodium reabsorption in the nephron, increasing sodium & water excretion
27
Diuretics: Important notes
- Controls BP in 50% - Can be used in combo w/ other agents - More potent in blacks, elderly, obese, smokers
28
Hydrochlorothiazide side effects
- Hypokalemia - Hypomagnesemia - Hypercalcemia - Hyponatremia - Sexual dysfunction - Hyperuricemia (gout) - Glucose disturbance - Dyslipidemia
29
Hydrochlorothiazide contraindications
Hypersensitivity to sulfonamide derived drugs
30
Furosemide (Lasix) side effects
- Hypokalemia* Should supplement potassium - Hyponatremia - Hypomagnesemia - Hypocalcemia - Sexual dysfunction - Hypercholesterolemia - Glucose disturbance
31
Furosemide contraindications
- Poor antihypertensive | - Reserved for pts w/ kidney disease or fluid retention
32
Triamterene (Dyrenium) side effects
- Hyperkalemia (esp w/ CKD, DM) - Nephrolithiasis - Renal dysfunction
33
Triamterene contraindications
- Weak antihypertensives - Caution combining w/ ACE-I, ARB, DRI, K supplements - Hepatic disease - Renal failure - Hyperkalemia
34
Spironolactone (Aldactone, Aldactazide) side effects
- Hyperkalemia | - Gynecomastia
35
Spironolactone contraindications
- Renal impairment - DM w/ proteinuria - Hyperkalemia
36
Calcium channel blockers: MOA
Inhibition of calcium influx into myocardial & vascular smooth muscle cells - Decreased calcium inhibits the contractile process --> vasodilation * Increased efficacy in blacks, elderly
37
Types of calcium channel blockers
- Non-dihydropyridines (verapamil, diltiazem) *Cardiac depressants - Dihydropyridines *Selective vasodilators
38
Calcium channel blocker medication names end w/ what?
- dipine
39
Non-DHP side effects
- Bradycardia - Constipation - Gingival hyperplasia - Worsening HF
40
DHP side effects
- Peripheral edema - Headache - Flushing
41
Non-DHP contraindications
- Acute MI - AV block - Cardiogenic shock - HF - Hypotension - Sick sinus syndrome - Ventricular dysfunction or Vtach - WPW syndrome
42
DHP contraindications
- Acute MI | - In urgent/emergent HTN, immediate release nifedipine is contraindicated
43
ACE inhibitors: MOA
- Inhibit RAAS system - Stimulate bradykinin (vasodilator effect) * Less effective in blacks, elderly, predominant systolic HTN
44
ACE-I medication names end w/ what?
-pril
45
ACE-I side effects
- Cough - Hyperkalemia - Angioedema - Acute renal failure
46
ACE-I contraindications
- Pregnancy - Angioedema - Renal artery stenosis
47
ARBs: MOA
Inhibit RAAS system | *Helpful in pts w/ CKD, diabetes, HF
48
ARBs medication names end w/ what?
-sartan
49
ARBs side effects
- Hyperkalemia - Angioedema - Acute renal failure
50
ARBs contraindications
- Pregnancy | - Renal artery stenosis
51
Direct renin inhibitors MOA
Inhibit enzyme activity of renin, reducing activity of angiotensin I/II & aldosterone
52
Example of DRI
Aliskiren (Tekturna)
53
DRI side effects
- Hyperkalemia - Renal impairment - Hypersensitivity rxns
54
DRI contraindications
- Use w/ ACE-I or ARB | - Pregnancy
55
Beta blockers MOA
Blocks activity of catecholamines at β adrenoreceptors --> decreased CO, some decreased PVR, & decreased renin activity
56
Types of beta blockers
- Cardioselective (β1 receptors) | - Noncardioselective (β1 & β2 receptors)
Foundations II (Cholley)
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