Term
|
Definition
- HTN
- Smoking
- Obesity
- Physical inactivity
- Dyslipidemia
- Elevated glucose levels/DM
- Microalbuminuria or estimated GFR less than 60 ml/min
- men over 55, women over 65
- FHx of premature CVD |
|
|
Term
| Cardiovascular disease still the number 1 killer. Over past 10 years cardiovascular disease has gone down by 30%. |
|
Definition
|
|
Term
| Most common cause of young people having cardiovascular events: |
|
Definition
|
|
Term
| Most common cause of secondary HTN: |
|
Definition
| - renal disease (like renal artery stenosis due to fibroblastic changes in artery- type of peripheral artery disease) |
|
|
Term
| _ to __% of pts with HTN have secondary HTN. |
|
Definition
|
|
Term
| Symptoms of HTN can be indicative of __ _ ___. |
|
Definition
|
|
Term
| After menopause, women's CVD risk increases and exceeds men's risk. |
|
Definition
|
|
Term
| __, __, and __ __ __ all lead to endothelial dysfucntion, which in turn encourages __ leading to ____ ___. |
|
Definition
- Hypertension, dylipidemia, and impaired glucose tolerance
- atherosclerosis
- cardiovascular disease |
|
|
Term
| Most common reason for MIs: |
|
Definition
| - HTN creating unstable plaques that break off |
|
|
Term
| 4 characteristics of endothelial dysfucntion that encourage atherosclerosis: |
|
Definition
- decreased NO synthesis
- increased COX activity
- inflammation
- increased endothelin |
|
|
Term
| what %age of pts with HTN are treated to target: |
|
Definition
|
|
Term
| Is HTN more common in AA or Caucausians? |
|
Definition
|
|
Term
| Leading cause of stroke and MI: |
|
Definition
|
|
Term
| HTN increases your risk for all of the following conditions: |
|
Definition
- Coronary Artery Disease
- Heart Failure
- Cerebrovascular Disease
- Renal disease and failure
- Aortic dissection
- Peripheral neuropathies
- Insulin resistance> Diabetes |
|
|
Term
| Hypertensive heart disease is changes in the __ due to long standing hypertension. This increases risk of __, __, and __ __ __. |
|
Definition
- myocardium
- stroke
- MI
- sudden cardiac death |
|
|
Term
| If you have a HTNisve pt, one of the first tests you should do is checking their blood sugar, b/c there is a chance that a HTN pt may be hiding Diabetes or a high risk for Diabets. If you’re gonna check bs, might as well check lipids too to understand all pt risks. |
|
Definition
|
|
Term
|
Definition
| systolic <120 AND diastolic <80 |
|
|
Term
|
Definition
| systolic 120-139 OR diastolic 80-89 |
|
|
Term
|
Definition
| systolic 140-159 OR diastolic 90-99 |
|
|
Term
|
Definition
| systolic greater than or equal to 160 OR diastolic greater than or equal to 100 |
|
|
Term
| Even in preHTN, have increased risk for strokes, MI, and other cardiovascular events. |
|
Definition
|
|
Term
NSAIDS (OTC AND PRESCRIBED) chronic use pts are at increased risk for high blood pressure.
ARTERIOSCLEROSIS- CALCIFIC CHANGES IN ARTERIOLES BOTH IN SMALL AND LARGE VESSELS, LOOSE ELASTICITY AND BP GOES UP.
ATHEROSCLEROSIS IS DIFFERENT THAN ARTERIOSCLEROSIS, KNOW THE DIFFERENCE. |
|
Definition
|
|
Term
| Primary/essential HTN accounts for 90-95% of HTNs. It is idiopathic, but what are some of the proposed causes: |
|
Definition
- sympathetic hyperactivity
- renin-angiotension
- natriuresis defect
- intracellular Na or K
- exacerbating factors: obesity, sodium or potassium intake, alcohol or tobacco, NSAIDs
- arteriosclerosis |
|
|
Term
|
Definition
- renal disease (most common)
- estrogen use
- sleep apnea
- renal vascular disease
- primary hyperaldosteronism
- pheochromocytoma
- aorta coarction
- thyroid disease
- pregnancy |
|
|
Term
| What pts are you likely to see secondary causes of HTN in? |
|
Definition
|
|
Term
| If you are dealing with drug resistant HTN, consider __ __. |
|
Definition
|
|
Term
| SLEEP APNEA CREATES AN ENVIRONMENT FOR HIGH BP. This is b/c normally when we sleep our bp should drop, if it stays the same or it goes up> increased risk for cardiovascular events. |
|
Definition
|
|
Term
| Aorta Coarction symptoms: |
|
Definition
- Abdominal discomfort
- Vague Pain
- high arm blood pressures
- low feet blood pressures
possible cause of secondary HTN |
|
|
Term
| Thyroid disease: if thyroid is out of wack, bp and cholesterol is out of wack |
|
Definition
|
|
Term
| For pts over the age of 50, __ blood pressure is more important than __blood pressure as CVD risk factor. |
|
Definition
- systolic
- diastolic
(JNC VII) |
|
|
Term
| According to JNC VII, starting at 115/75 mmHg, CVD risk ___ with each increment of __ throughout the BP range. |
|
Definition
- doubles
- 20/10
(JNC VII) |
|
|
Term
| Persons who are normotensive at age 55 have a 90% lifetime risk for developing HTN (JNC VII) |
|
Definition
|
|
Term
| Those with SBP 120–139 mmHg or DBP 80–89 mmHg should be considered pre hypertensive who require health-promoting lifestyle modifications to prevent CVD. |
|
Definition
|
|
Term
Thiazide-type diuretics should be initial drug therapy for most, either alone or combined with other drug classes.
Certain high-risk conditions are compelling indications for other drug classes.
Most patients will require two or more antihypertensive drugs to achieve goal BP.
If BP is >20/10 mmHg above goal, initiate therapy with two agents, one usually should be a thiazide-type diuretic. |
|
Definition
|
|
Term
| There is systolic and diastolic HTN. In younger pts you see both of them elevated. After age 60 you see systolic bp continuing to risk and diastolic normal or low (isolated systolic HTN- not uncommon in older patients). Treatment approach still the same for these pts. |
|
Definition
|
|
Term
| Pulse pressure: diff between systolic and diastolic blood pressure, the wider the pulse pressure the greater the risk for cardiovascular events |
|
Definition
| With treating bp, might be a necessary evil to widen pulse pressure in order to get bp down. |
|
|
Term
| A narrowed pulse pressure suggests ___, __ __, or __ __. This commonly causes tachycardia. |
|
Definition
- pericarditis
- pericardial effusion
- pericardial tamponade |
|
|
Term
| what does a widened pulse pressure mean? |
|
Definition
| - increased risk for CVD events |
|
|
Term
The most effective therapy prescribed by the careful clinician will control HTN only if patients are motivated.
Motivation improves when patients have positive experiences with, and trust in, the clinician.
Empathy builds trust and is a potent motivator.
The responsible physician’s/PA’s judgment remains paramount. |
|
Definition
|
|
Term
| Isolated Systolic Hypertension (ISH) is a __ __ greater than __ and a __ __ less than __. This is common in the __, but increasing in occurence in younger pts. |
|
Definition
- systolic pressure greater than 140
- diastolic pressure less than 85
- elderly |
|
|
Term
| A widened pulse pressure is greater than __. This is common in __ __ __, __, __ __ __, __, and __. |
|
Definition
- 40 mmHg
- Isolated systolic HTN (ISH)
- AR
- Patent ductus arteriosis (PDA)
- Coarction
- Thyrotoxicosis |
|
|
Term
| The concern with a widened pulse pressure is __ diasotlic blood pressure. |
|
Definition
|
|
Term
| widened pulse pressure is an __ cardiovascular disease risk factor. |
|
Definition
|
|
Term
| A narrowed pulse pressure is less than __, this is common in __, __, and __. |
|
Definition
- 30 mmHg
- tachycardia
- pericardial disease
- AS |
|
|
Term
| Hypertensive Heart Disease is a term for pts with HTN that also have __ __ __ like __ __ __. |
|
Definition
- structural heart changes
- hypertensive heart disease |
|
|
Term
| Malignant HTN is __ __ blood pressure readings with apparent __ __ __ especially with the __. ___ is a required finding for this dx. This often presents with hypertensive emergency blood pressure levels. |
|
Definition
- very high
- end-organ damage
- eyes
- Papilledema |
|
|
Term
So pt with HTN and LVH or systolic/diastolic dysfunction> HTNSive heart disease
Sometimes with aging normal to have a little LVH and diastolic dysfunction- can be normal in pts without HTN just from aging |
|
Definition
|
|
Term
| Clinical evaluation of HTN, symptoms: |
|
Definition
- COMMONLY ASYMPTOMATIC
- suboccipital headache
- visual disturbances
- nausea
- anxiety
- palpitations
- flushing
- weakness/fatigue
- paresthesias
- chest pain
- dizziness |
|
|
Term
| NSAIDS AND DECONGESTANTS (CHRONIC USE USUALLY) ARE ASSOCIATED WITH HIGH BLOOD PRESSURE. |
|
Definition
|
|
Term
Physical Exam
> 140/90 X 3-5 (both arms)
Displaced PMI/S4
Retinal hemorrhage
Carotid bruit
LVH
Coarctation
AAA
< Peripheral pulse |
|
Definition
|
|
Term
| 2 common causes of peripheral arterial disease: |
|
Definition
|
|
Term
| 3 blood pressure measuring techniques according to JNC VII: |
|
Definition
- In-office
- Ambulatory BP monitoring
- Self-measurement |
|
|
Term
| In-office bp measuring is ___ __, __ minutes apart, __. Confirm elevated reading in __ arm. |
|
Definition
- two readings
- 5 minutes apart
- contralateral |
|
|
Term
| Ambulatory blood pressure measuring is indicated for evaulation of __ __ HTN. The absence of __ to __% decrease in blood pressure during __ may indicated increased __ risk. |
|
Definition
- white coat
- 10-20%
- sleep
- CVD |
|
|
Term
| BP self measurement provides information in response to __. May improve __ and evaluate ___ HTN. |
|
Definition
therapy
adherence
white coat |
|
|
Term
| If coming in for the first time, want to check bp in __ __. If they are not the same you are concerned about __ __ __ (doesn't mean thats what is happening, but its possible). |
|
Definition
- both arms
- aortic aneurysmal changes |
|
|
Term
|
Definition
Use auscultatory method with a properly calibrated and validated instrument.
Patient should be seated quietly for 5 minutes in a chair (not on an exam table), feet on the floor, and arm supported at heart level.
Appropriate-sized cuff should be used to ensure accuracy.
At least two measurements should be made.
Clinicians should provide to patients, verbally and in writing, specific BP numbers and BP goals. |
|
|
Term
| If the blood pressure cuff is too small, you will get __ blood pressure readings. |
|
Definition
|
|
Term
| If the blood pressure cuff is too big, you will get __ blood pressure readings. |
|
Definition
|
|
Term
| Lead I in an EKG should be __ and aVr should be __. If this is not so, the leads must be flipped. |
|
Definition
|
|
Term
| Ambulatory blood pressure readings are usually ___ than clinic readings. Awake HTNsive individuals usually have average bp of > ___ and during sleep greater than ___. |
|
Definition
|
|
Term
| With self monitoring BP measurement a home reading of >___ is generally considered HTNsive. |
|
Definition
|
|
Term
| Initial Dx Evaluation should include: |
|
Definition
- CBC
- Chemistry profile: Glucose, Na, K, Ca, BUN, creatinine, lipid panel
- Urinalysis: Glucose, Protein, Hemoglobin
- 12-lead EKG: ischemic disease, rhythm disturbances, LVH
- Chest X-ray: cardiomegaly
- Echocardiogram (if concerned about cardiomyopathy or LV dysfunction) LV mass, LV chamber, ejection fraction |
|
|
Term
| __ is the best way to screen patients for renal disease. KNOW THIS. |
|
Definition
|
|
Term
Other lab as indicated
Plasma renin
24 hour urine catecholamine
Renal function testing
GFR
Blood flow
Note:
Diagnostic testing is often performed to differentiate between 1o & 2o hypertension or target organ involvement of the disease.
More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved |
|
Definition
|
|
Term
| Evidence of heart damage due to HTN: |
|
Definition
- LVH
- Angina
- Prior MI
- Prior coronary revascularization
- Heart failure |
|
|
Term
| Evidence of brain damage from HTN: |
|
Definition
|
|
Term
| Other indicators of organ damage from HTN: |
|
Definition
- chronic kidney disease
- peripheral arterial disease
- retinopathy |
|
|
Term
| Normal GFR is __ or above. |
|
Definition
|
|
Term
| Tachycardia is defined as over 100 bpm, but in the world of CVD risk factors over __ bpm is a risk factor. |
|
Definition
|
|
Term
|
Definition
| treat to less than 140/90 mmHg |
|
|
Term
| Goal bp in HTNsive pts with diabetes or chronic kidney disease? |
|
Definition
|
|
Term
Therapeutic Lifestyle Modification
Diet, Exercise, Weight Loss and Maintenance
Diet - Low Fat and Low Sodium, include oatmeal*
Weight loss
Exercise (30-45 mins x 3-5 days weekly at conversation pace/ at least 150 minutes weekly)
No more than 2 oz. ETOH / day (Total cessation if difficult BP)
No more than 2.0 gm Na+ / day
Smoking cessation |
|
Definition
|
|
Term
| Eating red meat more than __ times/week is too often unless they are cooking it right. |
|
Definition
|
|
Term
| Oatmeal has been shown to lower __ and __ __. |
|
Definition
cholesterol
blood pressure |
|
|
Term
| 2 oz of EtOH (hard liqour), no more than 1-2 glasses of wine |
|
Definition
|
|
Term
| Per 10 kg of weight loss, systolic blood pressure can decrease __ to __ mmHg. |
|
Definition
|
|
Term
| By adopting the DASH diet, systolic blood pressure can drop __ to __mmHg. |
|
Definition
|
|
Term
| Decreasing dietary sodium can drop systolic blood pressure by : |
|
Definition
|
|
Term
| Physical activity can decrease systolic pressure by: |
|
Definition
|
|
Term
| Moderation of alcohol consumption can decrease systolic pressure by: |
|
Definition
|
|
Term
| When would you start a pt on 2 antiHTNsive drugs right away? |
|
Definition
|
|
Term
Followup and monitoring
Once or twice yearly for STG I/Controlled
More frequent visits for STG II or complications
Liver enzymes, lipid levels, electrolytes, BUN/CR should be measured at least once or twice yearly |
|
Definition
|
|
Term
| You will see HCTZ used the most, but actually ___ is more effective. |
|
Definition
|
|
Term
| Diuretics inhibit __, __, and __ reabsorption, cause __ __, and reduce plasma volume. |
|
Definition
sodium, chloride, and water
arteriolar vasodilation |
|
|
Term
| Thiazides are most effective at __ doses. |
|
Definition
|
|
Term
Lasix (fursosemide) one of the strongest diuretics you can give, but weak antihypertensive (KNOW THIS contrast)
HCTZ and chlorthiazone= weak diuretics
Keep eye on potassium with diuretics. |
|
Definition
|
|
Term
| Spiranolacton- potassium sparing, using with heart failure, but not used primarily with HTN, check potassium at least every 4 montsh to make sure potassium isn’t too high. |
|
Definition
|
|
Term
| name 3 thiazide diuretics: |
|
Definition
HCTZ
chlorthalidone
Indapamide |
|
|
Term
| Central acting alpha adrenergic agonsists work by __ sympathetic activity via __ NE. This leads to a modest decrease in __ levels,__, and __ __. |
|
Definition
- decreasing
- decreasing
- renin
- SVR (resistance?)
- cardiac output |
|
|
Term
| Side effects of central acting alpha agonists (clonidine): |
|
Definition
- sedation
- dry mouth
- bradycardia |
|
|
Term
| Must slowly decrease central alpha agonists to prevent __ __. |
|
Definition
|
|
Term
| Central acting alpha agonists: |
|
Definition
- Methyldopa (Aldomet)
- Clonidine (Catapres)> fast acting, have to take it 2-3 times/day or via patch |
|
|
Term
| Clonidine (central acting alpha agonist) is not first line for HTN tmt, but when may you start out pt on it? |
|
Definition
|
|
Term
| Specifica alpha 1 adrenegic blockers (antagonists) block __ __ alpha adrenergic receptors leading to decreased __ and __ activity. __ with decreased __. These are commonly used with ___. |
|
Definition
- post synaptic
- decreased catecholamines and sympathetic
- vasodilation with decreased SVR (resistance)
- pheochromocytoma |
|
|
Term
| specific alpha 1 blockers: |
|
Definition
- Prazosin
- Terazosin
- Doxazosin |
|
|
Term
| Pt has pheochromocytoma, what bp med will you likely use? |
|
Definition
| specific alpha 1 blocker (Prazosin) |
|
|
Term
| Beta blockers inhibit __ release leading to decreased __ with some agents.These also diminish __ secretion. These have a negative __ and __ effect. |
|
Definition
- catecholamine
- resistance
- renin
- negative chronotropic and inotropic effect |
|
|
Term
| what does it mean that beta blockers have a negative chronotropic and inotropic effect? |
|
Definition
- negative chronotropic: decrease heart rate
- negative inotropoic: decrease contractility |
|
|
Term
| When discontinuing __ __ must always wean to prevent reflex tachycardia |
|
Definition
beta blockers
also true for when d/c central alpha agonists like clonidine |
|
|
Term
| Beta blockers are recommended in the following situations: |
|
Definition
- Ischemic disease
- Arrhythmia
- Tachycardia
- Diastolic dysfunction
- Migraine
- Heart Failure |
|
|
Term
| What are the only 2 beta blockers approved for left ventricular dysfunction? |
|
Definition
- Carvedilol
- Metropolol long acting |
|
|
Term
| Cardioprotective medication b/c decreases oxygen demand in heart. Commonl yused for tachy disrhythmias. |
|
Definition
|
|
Term
Dose beta blockers in the evening b/c side effects of tiredness and fatigue.
Don’t withold beta blocker b/c COPD or asthma, be careful and cn try it, but if have reaction> stop it.
Short term memory loss can be a side effect of this medication- not common.
SEXUAL DYSFUNCTION |
|
Definition
|
|
Term
|
Definition
All agents are essentially non-selective but may have mixed
Cardioselective (B1 Receptors)
Vasculature and Bronchi (B2 Receptors)
Relax vascular smooth muscle and decrease SVR (Alpha Receptor blocking)
Intrinsic Sympathomimetic Activity (ISA)
Less bradycardia, less bronchospasm, less lipid concerns |
|
|
Term
| advantages of Instrinsic Sympathomimetic Activity Beta blockers: |
|
Definition
- less bradycardia
- less bronchospasm
- less effect on lipids |
|
|
Term
| Beta blocker side effects: |
|
Definition
- decreased exercise tolerance
- aggravated bronchospasmic disease
- short term memory loss
- SEXUAL DYSFUNCTION
- HYPOGLYCEMIA
- ELEVATED LIPIDS
- careful use in pts with PVD |
|
|
Term
|
Definition
Atenolol
Metoprolol
Carvediolol
Labetolol
Propranolol
Bisoprolol
Timolol
Nebivilol |
|
|
Term
| Renin is a very strong __. |
|
Definition
|
|
Term
| ACE inhibitors prevent conversion of __ to ___. |
|
Definition
| angiotensin I to angiotensin II |
|
|
Term
| ARBs block angiotensin II type 1 recptors. |
|
Definition
|
|
Term
|
Definition
Decrease angiotensin II production
Decreases Na & H2O retention
Decreases aldosterone production
Inhibit bradykinin degradation
Stimulate synthesis of vasodilating prostaglandins
May reduce sympathetic nervous system activity
Very synergistic with diuretics |
|
|
Term
| ACE-I are most effective in what 4 types of pple? |
|
Definition
- Caucasians
- LV dysfunction
- Prior MI
- DM |
|
|
Term
| Adverse effects of ACE-I: |
|
Definition
- hypotension (elderly)
- cough
- angioedema |
|
|
Term
|
Definition
Captopril
Lisinopril
Moexipril
Benazapril
Fosinopril
Ramipril
Quinapri |
|
|
Term
|
Definition
Similar pharmocokinetics as ACEI
Inhibit coupling of A-II to angiotensin receptor
Equivalency of potency for HTN control as ACEI
Has shown to have positive effects in HF and T2DM
Recommended in patients with renal disease
Alternative for ACE inhibitor intolerance
May use with ACEI; Also synergistic with diuretic
Less side effects than ACEI
Should not cause cough
Angioedema |
|
|
Term
|
Definition
Losartan
Olmesartan
Telmisartan
Valsartan
Candesartan
Ibesartan
Azilsartan
Eprosartan |
|
|
Term
| Direct renin inhibitors block the conversion of ___ to ____ leading to decreased ___ resulting in __. |
|
Definition
- angiotensinogen to angiotensin I
- decreased angiotensin II
- vasodilation
Most commonly used in combination with ACE or ARB but now can be considered for first line therapy |
|
|
Term
| Direct Renin Inhibitor Side Effects: |
|
Definition
- Diarrhea
- Angioedema
- Hyperkalemia |
|
|
Term
|
Definition
|
|
Term
| Calcium channels decrease __ meaning they have a negative __ effect. |
|
Definition
- contractility
- inotropic |
|
|
Term
|
Definition
- reduce contractilty
- vasodilation
- synnergistic in combination with ACE-I |
|
|
Term
|
Definition
- African Americans
- B-blocker intolerance
- Diastolic dysfunction (not first line)
- Ischemic heart disease (not first line) |
|
|
Term
| With diastolic dysfunction, first try a __ __. If this doesn't work then try __ __ __. |
|
Definition
- beta blocker
- calcium channel blocker |
|
|
Term
| Calcium channel blocker adverse effects: |
|
Definition
- peripheral edema
- headache
- dizziness
- flushing
- may aggravate heart failure |
|
|
Term
| Dihydropyridine CCBs are primarily __. Name these meds. |
|
Definition
- vasodilators
- Nifedipine
- Amlodipine
- Felodipine |
|
|
Term
| Non-dihydropyridine CCB vasodilate but also are __ __. These are good ___. Name the drugs. |
|
Definition
- rate slowing
- tachydysrhythmias
- Diltiazem
- Verapimil |
|
|
Term
| __ CCB have less effect on heart and more on vasculature, thus these are the CCB best for HTN. |
|
Definition
- Dihydropyridine
Amlodipine most commonly used |
|
|
Term
| 2 classes of drugs that decrease heart rate: |
|
Definition
- Beta blockers
- Non-dihydropyridine CCBs |
|
|
Term
|
Definition
- Hydralazine (Apresoline)
- Minoxidil (Loniten) |
|
|
Term
| Direct Vasodilator side effects: |
|
Definition
- reflex sympathetic activity
- lupus symptoms
- tachycardia
- headache
- flushing
- nausea |
|
|
Term
| Direct vasodilators should be avoided in pts with __ __ __. |
|
Definition
|
|
Term
| 3 classes of cardioprotective agents: |
|
Definition
- Beta blockers
- ACE-I
- ARBs |
|
|
Term
Oral contraceptives may increase BP, and BP should be checked regularly. In contrast, HRT does not raise BP.
Development of HTN—consider other forms of contraception.
Pregnant women with HTN should be followed carefully. Methyldopa, BBs, and vasodilators, preferred for the safety of the fetus. ACEI and ARBs contraindicated in pregnancy. |
|
Definition
|
|
Term
| In children/adolescents, HTN is defined as a bp in the ___ percentile or greater, adjusted for __, __, and __. |
|
Definition
- 95th
- age
- height
- gender
Use lifestyle interventions first, then drug therapy for higher levels of BP or if insufficient response to lifestyle modifications.
Drug choices similar in children and adults, but effective doses are often smaller.
Uncomplicated HTN not a reason to restrict physical activity.
Consider secondary causes |
|
|
Term
| A 65 year old African – American male follows up after 6 months of TLM’s with a 5 day BP average of 150/90. Which of the following medications would be most appropriate to initiate? |
|
Definition
Amlodipine
(AA don't respond as well to ACE-I or Beta Blockers) |
|
|
Term
| An asymptomatic 65 year old African-American male with a 5 day BP average of 170/102. Which of the following tests is least appropriate to order at this time? |
|
Definition
exercise stress test
(could order: chest xray, echo, and CMP) |
|
|
Term
| Resistant HTN is continued HTN after at least __ medications. |
|
Definition
|
|
Term
|
Definition
Secondary Causes
Improper BP measurement
Excess sodium intake
Inadequate diuretic therapy
Medication
Inadequate doses
Drug actions and interactions (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit drugs, sympathomimetics, oral contraceptives)
Over-the-counter (OTC) drugs and herbal supplements
Consider aldosterone antagonists (MRAs)
Consider renal denervation
Timing of drugs
Excess alcohol intake
Patient non-compliance |
|
|
Term
| Hypertensive CRISIS patients have __ and __. |
|
Definition
|
|
Term
| Hypertensive URGENCY patients do __ have __ and __. |
|
Definition
| - NOT have signs or symptoms |
|
|
Term
| Criteria for Hypertensive Crisis: |
|
Definition
- sustained elevated bp greater than or equal to 180/ greater than or equal to 120
- symptomatic
- pre-peri operative
- malignant |
|
|
Term
| Symptoms of hypertensive crisis: |
|
Definition
- HTNSive encephalopathy (headache, irritability, confusion, altered mental status due to cerebrovascular spasm, optic disc edema)
- HTNsive nephropathy(hematuria, proteinuria, progressive renal dysfunction due to arteriolar necrosis and intimal hyperplasia of interlobular arteries)
- intrancranial hemorrhage
- aortic dissection
- preeclampsia-eeclampsia
- pulmonary edema
- unstable angina/MI |
|
|
Term
| Hypertensive crisis treatment must be slow and deliberate, no more than __ reduction in the first hour. The target within the first few hours is ___. Requires IV meds. |
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Definition
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Term
| Possible IV meds for hypertensive crisis: |
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Definition
Nitroprusside sodium
Nitroglycerin, IV
Labetalol
Esmolol
Nicardipine
Enalaprilat
Diazoxide
Hydralazine
Fenoldopam
Trimethaphan
Diuretics |
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Term
| Nitroprusside sodium is given to __ ___ pts via IV and gradually titrated. It lowers the bp in __ by __ ___ __. Monitoring with an __ __ __ prevents hypotension. |
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Definition
- hypertensive crisis
- seconds
- direct arteriolar and venous dilation
- intra-arterial line |
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Term
| ___ __ combined with a __ __ are particulary good for pts with aortic dissection. |
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Definition
Nitroprusside sodium
beta blocker |
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Term
| ___, IV is a less potent antihypertensive than nitroprusside sodium and should be reserved for pts with accompanying __ __ __ . |
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Definition
Nitroglycerin
acute ischemic syndromes |
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Term
| Labetalol is a combined __ and __ blocking agent and is the most potent adrenergic blocker for rapid bp reduction. Other beta blockers are not near as potent. Can be used during pregnancy. |
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Definition
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Term
| Esmolol is a rapid acting __ blocker approved only for the tmt of __ __, but it is often also used for lowering bp. It is less potent that labetalol and should be reserved for pts in whom there is a concern about serious adverse events related to beta blockers. |
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Definition
- beta
- supraventricular tachycardia |
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Term
| Nicardipine IV is the __ __ __ __ and the __ acting parenteral calcium channel blocker. It is primarily an __ __, thus it can cause __ __. It should NOT be used without a __ __ in patients with coronary artery disease. |
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Definition
- most potent antihypertensive drug
- longest
- arterial vasodilator
- reflex tachycardia
- beta blocker |
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Term
| If a pt has CAD, and you put them on Nicardipine to lower bp, you must also put them on a __ __ to prevent __ __. |
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Definition
- beta blocker
- reflex tachycardia |
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Term
| Supraventricular tahchycardia IV drug: |
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Definition
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Term
| Fenoldopam is a __ __ __ __ that causes a __ __ reduction in __ __ without evidence of __, __, or __ or __ of renal function. In higher dose ranges, __ may occur. |
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Definition
- peripheral dopamine 1 receptor agonist
- dose-dependent reduction in arterial pressure
- without evidence of tolerance, rebound, withdrawal, or deterioration of renal function
- high doses> tachycardia |
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Term
| dopamine 1 receptor agonist that shows dose dependent reduction in arterial pressure? |
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Definition
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Term
| Enalaprilat is the active form of the __ __ __. The onset of action is usually within __ __, but the peak effect may take __ __. It is used mostly as an __ agent to lower bp. |
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Definition
- oral ACE-I Enalapril
- 15 minutes
- 6 hours
- adjunctive |
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Term
| Diazoxide IV acts promptly as a __ without decreasing __ ___ __. It should be given in __ __ or as an __ rather than as a large bolus, to prevent hypotension. This has been used in __ and __ . Side effects include __ and __/__ retention. It should only be used for a short time and should be combined with a __ __. |
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Definition
- vasodilator
- without decreasing renal blood flow
- small boluses or as an infusion
- pre-eclampsia and eclampsia
- hyperglycemia and salt/water retention
- loop diuretic |
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Term
| Vasodilator that has been given for preeclampsia/eclampsia? How should it be administered? What are its SE? What other drug should be given with it? |
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Definition
- Diazoxide
- IV small boluses
- hyperglycemia, salt/water retention
- loop diuretic |
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Term
| Hydralazine can be given __ or __, but its effect is less predictable. It produces __ __ and should be given with __ __ in pts with possible coronary disease or aortic dissection. It can be used in __ and __. |
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Definition
- IV or IM
- reflex tachycardia
- be given with beta blockers
- pregnancy and children |
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Term
| Trimethaphan is a __ __ __ that is titrated with the patient __. Its activity depends on the patient __. The pt can be __ if hypotensive effect is excessive. The effects occur in a few minutes and persist for the duration of the infusion. This agent has mostly been replaced with __. |
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Definition
- ganglionic blocking agent
- sitting
- sitting
- supine
- Nitroprusside |
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Term
| Diuretics—Intravenous loop diuretics can be very helpful when the patient has signs of heart failure or fluid retention, but the onset of their hypotensive response is slow, making them an adjunct rather than a primary agent for hypertensive emergencies. Low dosages should be used initially (furosemide, 20 mg; or bumetanide, 0.5 mg). They facilitate the response to vasodilators, which often stimulate fluid retention. |
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Definition
| diuretics are good to use with vasodilators |
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Term
| IV agents for lowering BP: |
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Definition
| 1. Nitroprusside sodium—This agent is given by controlled intravenous infusion gradually titrated to the desired effect. It lowers the blood pressure within seconds by direct arteriolar and venous dilatation. Monitoring with an intra-arterial line avoids hypotension. Nitroprusside—in combination with a beta-blocker—is especially useful in patients with aortic dissection. 2. Nitroglycerin, intravenous—This agent is a less potent antihypertensive than nitroprusside and should be reserved for patients with accompanying acute ischemic syndromes. 3. Labetalol—This combined beta- and alpha-blocking agent is the most potent adrenergic blocker for rapid blood pressure reduction. Other beta-blockers are far less potent. Excessive blood pressure drops are unusual. Experience with this agent in hypertensive syndromes associated with pregnancy has been favorable. 4. Esmolol—This rapidly acting beta-blocker is approved only for treatment of supraventricular tachycardia but is often used for lowering blood pressure. It is less potent than labetalol and should be reserved for patients in whom there is particular concern about serious adverse events related to beta-blockers. 5. Nicardipine—Intravenous nicardipine is the most potent antihypertensive agent and the longest-acting of the parenteral calcium channel blockers. As a primarily arterial vasodilator, it has the potential to precipitate reflex tachycardia, and for that reason it should be used with a beta-blocker in patients with coronary artery disease. 6. Fenoldopam—Fenoldopam is a new peripheral dopamine-1 (DA1) receptor agonist that causes a dose-dependent reduction in arterial pressure without evidence of tolerance, rebound, or withdrawal or deterioration of renal function. In higher dosage ranges, tachycardia may occur. 7. Enalaprilat—This is the active form of the oral ACE inhibitor enalapril. The onset of action is usually within 15 minutes, but the peak effect may be delayed for up to 6 hours. Thus, enalaprilat is used primarily as an adjunctive agent. 8. Diazoxide—Diazoxide acts promptly as a vasodilator without decreasing renal blood flow. To avoid hypotension, it should be given in small boluses or as an infusion rather than as the previously recommended large bolus. One use of diazoxide has been in preeclampsia-eclampsia. Hyperglycemia and sodium and water retention may occur. The drug should be used only for short periods and is best combined with a loop diuretic. 9. Hydralazine—Hydralazine can be given intravenously or intramuscularly, but its effect is less predictable than that of other drugs in this group. It produces reflex tachycardia and should not be given without beta-blockers in patients with possible coronary disease or aortic dissection. Hydralazine is now used primarily in pregnancy and in children, but even in these situations, newer agents are supplanting it. 10. Trimethaphan—The ganglionic blocking agent trimethaphan is titrated with the patient sitting; its activity depends upon this. The patient can be placed supine if the hypotensive effect is excessive. The effect occurs within a few minutes and persists for the duration of the infusion. This agent has largely been replaced by nitroprusside and newer medications. 11. Diuretics—Intravenous loop diuretics can be very helpful when the patient has signs of heart failure or fluid retention, but the onset of their hypotensive response is slow, making them an adjunct rather than a primary agent for hypertensive emergencies. Low dosages should be used initially (furosemide, 20 mg; or bumetanide, 0.5 mg). They facilitate the response to vasodilators, which often stimulate fluid retention. |
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Term
| Oral agents for lowering BP |
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Definition
| B. Oral Agents Patients with less severe acute hypertensive syndromes can often be treated with oral therapy. Abrupt blood pressure lowering is not usually necessary in asymptomatic individuals, and the use of agents such as rapid-acting nifedipine probably causes more adverse effects than benefits. 1. Clonidine—Clonidine, 0.2 mg orally initially, followed by 0.1 mg every hour to a total of 0.8 mg, will usually lower blood pressure over a period of several hours. Sedation is frequent, and rebound hypertension may occur if the drug is stopped. 2. Captopril—Captopril, 12.5-25 mg orally, will also lower blood pressure in 15-30 minutes. The response is variable and may be excessive. 3. Nifedipine—Fast-acting nifedipine capsules are commonly employed in the emergency room or urgent care setting because they usually provide a rapid reduction in blood pressure. However, the nifedipine effect is unpredictable and may be excessive, resulting in hypotension and reflex tachycardia. Because myocardial infarction and stroke have been reported in this setting, the use of nifedipine without concomitant beta-blocker therapy is not advised. |
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Term
| 3 oral agents that can be used to get bp down relatively quickly: |
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Definition
1. Clonidine
2. Captopril
3. Nifedipine |
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Term
| DOC FOR HYPERTENSIVE CRISIS: |
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Definition
Nitroprusside (IV)probably this
or Clonidine (oral) |
|
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Term
Therapeutic Lifestyle Modification
Diet, Exercise, Weight Loss and Maintenance
Diet - Low Fat and Low Sodium
Expect mean reduction of 9-10 mmHg
Weight loss (10 lbs ~ 10 mmHg)
Exercise (30-45 x 3-5 at conversation pace)
No more than 2 oz. ETOH / day
No more than 2.0 gm Na / day
Smoking cessation |
|
Definition
|
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Term
|
Definition
Inhibit 1 receptors on veins & arteries
Peripheral dilatation
Recommended in:
Prostatic disease
Dyslipidemia (uncomplicated) |
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|
