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LS test 2, BP, HTN
Blood Pressure and HTN notes
| Question | Answer |
|---|---|
| What is the BP range for NORMAL classification? | SBP: <120mmHg and DBP: <80mmHg |
| What is the BP range for PREHYPERTENSION classification? | SBP: 120-139mmHg OR DBP: 80-90mmHg |
| What is the BP range for STAGE I HYPERTENSION classification? | SBP: 140-159mmHg and DBP: 90-99MMhG |
| What is the BP range for STAGE II HYPERTENSION classification? | SBP: > OR = 160 and DBP: > OR = 100 |
| The risks of developing this increases with obesity | Hypertension, DMII, Coronary heart disease, Gallbladder disease, Certain cancers, Dyslipidemia, Stroke, Osteoarthritis, Sleep apnea |
| Definition of Obese | BMI>30 |
| Evaluate these things when determining Absolute Risk Status | Disease conditions, Other obesity-associated diseases, Cardiovascular risk factors, other factors |
| How does Physical Activity impact comorbidities? | Enhances cardiorespiratory Fitness, Improves lipid profile, Reduces BP, Increass insulin sensitivity, Improves blood glucose control. |
| What is a realistic Goal for weight loss | Short-term: 5-10% weight loss, 1-2 lbs/week. |
| Which diet has been shown to be most effective?Lowfat/low cal/low carb? | All the same in the long term. Overall: lower calories is key. |
| Sibutramine (Meridia) (PO) | Weight loss drug that works by inhibiting norephinephrine, dopamin and serotonin reuptake. (SE: Increase in heart rate and BP) |
| Orlistat (Xenical) (PO) | Weight loss drug that inhibits pancreatic lipase, decreass fat absorption. SE: decreased vitamin absorption, soft stools, anal leakage) |
| What is JNC7? | Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Created for publication of many new studies, need for a new, clear and concise guideling useful for clinicians. Need to simplify classification of BP. |
| What is the initial drug therapy for most persons with HTN? | Thiazide-type diuretics (HCTZ) |
| If BP is >20/10mmHg above goal, what should you prescribe? | Initiate with two agents, one of which should be Thiazide diuretic. |
| How should you manage a patient with a blood pressure of 125/85? | Patient is PREHYPERTENSIVE. 1) Treat as the signal for need of increased education to reduce BP and prevent HTN. |
| What are the benefits of lowering BP? | Reduces stroke incidence, MI and Heart failure. |
| Name CVD Risk Factors. | HTN, smoking, obesity, physical inactivity, dyslipidemia, DMII, microalbuminuria or estimated GFR <60ml/min, Age (older than 55 for men, 65 for women), Family Hx of premature CVD. |
| What are identifiable causes of HTN? | Sleep apnea, Drug-indused, Chronid kidney disease, primary aldosteronism, Renovascular disease, Chronic steroid therapy, Cushing's syndrome (overproduction of cortisol), Pheochromocytoma, coarctation of the aorta, Thyroid or parathyroid disease. |
| When would you screen for SECONDARY CAUSES of HTN? | With abrupt onset, for a person with family Hx, when BP >210/140, no response to medication, with symtoms. |
| Name symptoms of Cushing's. | truncal obesity, facial plethora, abdominal striae, proximal muscle thinning and weakness, buffalo hump, moon facies |
| Name symptoms of Primary aldosteronism. | Weakness, polyuria, polydipsia and muscle pain. |
| Name symptoms of Pheochromocytoma. | Flushing, diaphoresis, paroxysmal headache, palpatations. |
| Name sympoms of Hyperthyroidism. | Heat intolerance, excessive sweating, increased appetite, weightloss. |
| Name the steps of the HTN work-up. | Rule-out secondary causes, determine severity of pressure elevation, determine degree of target-organ damage, determine presenc eof cardiovascular risk factors. |
| How do you test for Cushing's (secondary cause)? | 24h urine for free cortisol. |
| How do you test for Primary Hyperaldosteronism. | If hypokalemia, get ratio of plasma aldosterone to plasma renin. |
| How do you test for Phochromocytoma? | 24h urine for catecholamines if abnormal CT scan of adrenals. |
| How do you test for Hyperthyroidism? | Thyroid function tests. |
| Name the target organ damage by HTN. | Heart: LVH, angina, MI, coronary revascularization, heart failure. Brain: Stroke or TIA. Chronic kidney disease. Peripheral arterial disease. Retinopathy. |
| Name routine laboratory tests for someone with HTN. | EKG, UA (for protein, glucose), Blood glucose, HCT, serum potassium, creatinine, or GFR, Lipid profile after fast. Urinary ablumin or albumin/creatinine ratio. |
| What are the goals of therapy for HTN? | Reduce CVD and renal morbidity and mortality. Treat to BP<140/90, or BP<130/80 in patients with DM or Chronic kidney disease. Achieve SBP goal especially in persons >50 years. |
| Name lifestyle modifications for controlling HTN in order of effectiveness. | Losing weight, DASH diet, salt reduction, Physical activity, moderation of alcohol intake. |
| Besides Thiazide diuretic, what should be prescribed for a patient with HTN that also has DMII? | ACE-I. |
| What are the Initial Therapy Options for HTN pt with Heart failure? | Thiazide, BB, ACEI, ARB, Aldosterone antagonist |
| What are the Initial Therapy Options for HTN pt with Previous MI? | BB, ACEI, Aldosterone antagonist |
| What are the Initial Therapy Options for HTN pt with High CAD? | Thiazide, BB, ACE, CCB |
| What are the Initial Therapy Options for HTN pt with DM? | Thiazide, BB, ACEI, ARB, CCB |
| What are the Initial Therapy Options for HTN pt with Chronic kidney disease? | ACEI, ARB. |
| What are the Initial Therapy Options for HTN pt with recurrent stroke prevention? | Thiazide, ACEI. |
| What are compelling indications for Beta Blockers? | MI, Angina, Heart failure. *Not as effective as diuretics in lowering BP, but not as well tolerated. Negative effects on glucose and lipid metabolism are amplified when given with diuretic. |
| What are compelling indications for ACEI? | First line for diabetes. Heart failure, MI, CAD, diabetic nephropathy, stroke prevention. |
| What are compelling indications for ARBs? | ACEI intolerance, Type 2 diabetic nephropathy, HTN with LVH. |
| What are compelling indications for CCB? | Elderly patients, Angina, Isolated systolic HTN. |
| Which HTN meds are contraindicated for Asthma/COPD patients? | Betablockers. |
| Thiazide diuretics. | Chlorothiazide (Diuril), Chrolothialidone, Hydrochlorothiazide (Microzide, HydroDiuril), Polythiazide (Renese), Indapamide (Lozol), Metolazone (Mykrox), Metolazon (Zaroxolyn) |
| Loop diuretics. | Bumetanide (Bumex), Furosemide (Lasix), Torsemide (Demadex). |
| Potassium-sparing diuretics. | Amiloride (Midamor), Triamterene (Dyrenium). |
| Aldosterone-receptor blockers. | Eplerenon (Inspra), Spironolactone (Aldactone) |
| Beta blockers. | Atenolol (Tenormin), Betaxolol (Kerlone), Bisoprolol (Zebeta), Metoprolol (Lopressor), Nadolal (Corgard), Propranolol (Inderal), Timolol (Blocadren) |
| ACE-I | Benazepril(Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Prinivil, Zestril), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), etc. |
| Angiotensin II antagonists. | Candesartan (Atacand), Eprosartan (Tevetan), Irbesartan (Avapro), Losartan (Cozaar), Olmesartan (Benicar), Telmisartan (Micardis), Valsartan (Diovan) |
| Calcium channel blockers--non-dihydropyridines | Diltiazem, Verapamil |
| Calcium channel blockers--dihydropyridines | Amlodipine, Felodipine, Isradipine, Nicardipine, Nifedipine, Nisoldipine. |
Created by:
kennjratzer
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