Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
62 Cards in this Set
- Front
- Back
definition of hypertension
|
multiple readings with systolic >140mmHg or diastolic >90mmHg in the absence of specific identifiable underlying cause
|
|
hypertension in those with diabetes or renal disease
|
defined as pressure > 130/80
|
|
hypertension stages
|
preHTN --> systolic 120-129, diastolic 80-89
stage I --> systolic 140-159, diastolic 90-99 stage II --> systolic >160, diastolic > 100 |
|
long term cardiac complications of hypertension
|
myocardial ischemia or infarction
CHF left ventricular hypertrophy aortic aneurysm dissection |
|
long term cerebrovascular complications of hypertension
|
transient ischemic atack or stroke
|
|
long term renal complications of hypertension
|
microscopic hematuria, elevation of BUN/creatinine which may need dialysis
|
|
long term eye complications of hypertension
|
retinopathy
hemorrhages exudates arteriolar narrowing papilledema results in blurred vision, scotomata, sometimes blindness |
|
hypertension diagnosis
|
allow patient to sit quietly for 5 minutes before pressure is measured
repeat reading 3-6 times over several months before labeling as hypertensive and giving treatment |
|
hypertension routine laboratory analysis
|
urinalysis for protein, glucose or red blood cells
cretinine/BUN hematocrit glucose and lipids (for athersoclerosis risk) serum potassium (exclude hyperaldosteronism) ECG for LVH |
|
who to treat
|
diastolic >90 after 3-6 months of nonpharmacologic therapy
|
|
what to use for hypertension
|
best initial treatment is diuretic such as hydroclorothiazide; stage III add ACEI, ARB, CCB or beta blocker; if not enough add another drug
|
|
specific antihypertensives for diabetics
|
ACEIs
goal is <130/80 (as in renal insufficiency, CHF, retinopathy or stroke) |
|
specific antihypertensives for post MI
|
beta blockers
|
|
specific antihypertensives for CHF or left ventricle dysfunction post MI
|
ACEIs and/or betablocker
|
|
specific antihypertensives for pregnant
|
alpha methyldopa, labetalol, hydralazine or CCB
ACEIs and ARB are absolutely contraindicated diuretics relatively contraindicated |
|
hypertensive emergency definition
|
diastolic >120 with end-organ damage
|
|
malignant hypertension definition
|
has encephalopathy or nephropathy with accompanying papilledema
|
|
hypertensive emergency neurologic presentation
|
encephalopathy
headache confusion seizures subarachnoid or intracerebral hemorrhage |
|
hypertensive emergency cardiac presentation
|
chest pain
MI palpitations dyspnea pulmonary edema jugular venous distention gallops |
|
hypertensive emergency nephropathy presentation
|
acutely progressive hematuria, proteinuria, renal dysfunction
|
|
hypertensive emergency retinopathy presentation
|
papilledema, hemorrhages, blurred vision
|
|
hypertensive emergency diagnosis
|
no concern for white coat artifact; EKG is first initial test to exclude MI; head CT to exclude hemorrhage
|
|
hypertensive emergency treatment
|
IV nitroprusside and labetalol
if MI, nitroglycerin is preferred IV enalaprilat is also being used do not reduce pressure more than 25% in 1-2 hours to not compromise cerebral or myocardial perfusion (keep it above 95-100 diastolic) |
|
causes of secondary hypertension
|
renal artery stenosis
Conn pheochromocytoma Cushing also oral contraceptives, acromegaly, glomerulonephritis |
|
renal artery stenosis
|
2dary hypertension
presents with upper abdominal bruit radiating laterally best initial screen is abdominal ultrasound captopril renogram is noninvasive to confirm best confirmation is arteriogram treat with percutaneous transluminal angioplasty or surgical resection |
|
secondary hypertension due to Conn syndrome
|
presents with hypertension + hypokalemia
muscular weakness nephrogenic diabetes insipidus diagnosis --> high aldosterone levels in blood and urine surgical resection of adenoma or spironolactone if hyperplasia |
|
secondary hypertension in pheochromocytoma
|
episodic hypertension with headaches, sweating, palpitations and tachycardia
best initial test is VMA, metanephrines and free urine catecholamines then do CT or MRI to locate tumor treat with alpha adrenergics blockers followed by surgery |
|
secondary hypertension in Cushing
|
present with hypertension, truncal obesity, buffalo hump, menstrual abnormalities, striae, etc… best initial tests are dexamethasone suppression test and 24-hour urine cortisol; treat with surgery
|
|
thiazide drugs
|
hydrochlorothiazide, chlortalidone, metolazone, indapamide
|
|
loop diuretic drugs
|
furosemide, bumetanide, torsemide
|
|
potassium sparing diuretics
|
spironolactone, amiloride, triamterene
|
|
specific indications of diuretics
|
CHF, edematous states, african-american patients, least expensive
|
|
side effects of diuretics
|
↓potassium
↓ magnesium ↑calcium ↑uric acid hyperglycemia ↑LDL gynecomasia |
|
relative contraindications of diuretics
|
diabetes, gout, hyperlipidemia
|
|
specific indications of beta blockers
|
myocardial infarction or ischemic heart disease
supraventricular arrhythmias migraines glaucoma anxiety diastolic heart failure |
|
side effects of beta blockers
|
bronchospasm
heart block, bradycardia, conduction defects depression impotence fatigue ↓HDL, ↑triglycerides masking of hypoglycemia |
|
relative contraindications of beta blockers
|
asthma or COPD
conduction defects systolic heart failure diabetes |
|
specific indications of ACEIs
|
diabetics (prevents neuropathy)
CHF (decreases afterload) postmyocardial infarction with systolic failure |
|
side effects of ACEIs
|
cough, angioedema, neutropenia, hyperkalemia, taste disturbance, anaphylactoid reaction
|
|
relative contraindications of ACEIs
|
less effective in african americans
|
|
absolute contraindications of ACEIs
|
bilateral renal artery stenosis, pregnancy
|
|
specific indications of calcium channel blockers
|
angina
supraventricular arrhythmia migraines Raynaud esophageal spasm |
|
side effects of calcium channel blockers
|
peripheral edema
constipation heart block reflex tachycardia |
|
relative contraindications of calcium channel blockers
|
AV conduction defects, CHF from systolic dysfunction
|
|
angiotensin receptor blocker specific indications
|
those intolerant to ACEIs (specially due to cough)
|
|
angiotensin receptor blockers side effects
|
fewer than ACEIs
|
|
angiotensin receptor blockers absolute contraindications
|
pregnancy
|
|
first-line drugs for hypertension
|
diuretics, betablockers, ACEIs, ARBs
|
|
second-line drugs for hypertension
|
central acting sympatholytics
direct vasodilators alpha adrenergic blockers |
|
central-acting sympatholytics drugs
|
clonidine, guanabenz, guanfacine, methyldopa
|
|
specific indications of central-acting sympatholytics
|
clonidine in opiate detox
|
|
central-acting sympatholytics side effects
|
depression
fatigue dry mouth impotence bradycardia heart block memory loss |
|
methyldopa specific side effects
|
hepatitis, Coombs+ hemolytic anemia
|
|
relative contraindications of central-acting sympatholytics
|
elderly or depressed patients
|
|
direct vasodilator drugs
|
hydralazine, minoxidil
|
|
specific indications of direct vasodilators
|
hydralazine in eclampsia; minoxidil in baldness
|
|
minoxidil specific side effects
|
fluid retention, pericardial effussion, hirsutism
|
|
hydralazine specific side effects
|
lupus-like syndrome
|
|
direct vasodilator relative contraindications
|
angina
|
|
alpha adrenergic blocker drugs
|
doxazosin, prazosin, terazosin
|
|
specific indications of alpha adrenergic blockers
|
lipid disorders (they ↓LDL and ↑HDL)
prostatic hypertrophy |
|
side effects of alpha adrenergic blockers
|
first-dose syncope, dizziness, headache
|