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34 Cards in this Set

  • Front
  • Back
what are 3 things that can cause isolated elevation in triglycerides in patients?
diabetes
hypothyroidism
inherited hypertriglyceridemia
What goal BP do we want to get diabetics under?
130/85 mmHg
what are the 5 main risk factors of metabolic syndrome?
older age
race (Hispanics and Asians)
obesity
history of diabetes
other diseases
The best thing to do in patients with DM and kidney disease is to monitor treatment of ... (less than ...)
hypertension
130/85 mmHg
Criteria for metabolic syndrome:

Abdominal obesity
-Men: > ... in.
-Women: > ... in.

Triglycerides: ... mg/dL or higher, or if taking meds for high triglycerides

HDL:
-Men: < ... mg/dL
-Women: < ... mg/dL
-or taking medicine for low HDL cholesterol

BP: ... mm Hg or higher, or if taking meds for high BP

fasting blood sugar ... mg/dL or higher, or if taking meds for high blood sugar
40
35
150
40
50
130/85
100
Excessive insulin:

The heavier a patient is, the ... their resistance to insulin is. Insulin makes you gain weight. The more weight you have, the ... insulin you make. An example of a drug that will break can help to break this vicious cycle is a ...
more
more
glucophage
... are insulin sensitizers useful in type 2 diabetes and related insulin resistance. They reduce hepatic glucose output and peripheral resistance to insulin action and lowers plasma insulin levels.
Biguanides
...:

These agents are insulin-sensitizing drugs that increase the disposal of glucose in peripheral tissues and act by activating specific nuclear receptors, the PPAR-gamma (peroxisome proliferator-activated receptor gamma). They have a major effect in the stimulation of glucose uptake, skeletal muscle, and adipose tissue. They lower plasma insulin levels and treat type 2 diabetes associated with insulin resistance. They appear to benefit patients with polycystic ovary disease (PCOD).
-include rosiglitazone and pioglitazone
Thiazolidinediones
The goal of treating hypertension is to reduce the risk of ... and its associated morbidity and mortality
cardiovascular disease
The classification of hypertension is based on the mean of ... or more properly measured ... BP readings on each of ... or more office visits.

No recent caffeine or smoking
2
seated
2
How is hypertension defined:

The following definitions have been suggested by the seventh report of Joint National Committee (JNC 7):

Normal blood pressure: systolic<120mmHg and diastolic <80

Prehypertension: systolic ...-... or diastolic ...-...

Hypertension:
-Stage 1: systolic ...-... or diastolic ...-...
-Stage 2: systolic > or = ... or diastolic > or = ...
120-139
80-90
140-159
90-99
160
100
If there is a disparity in category between
the systolic and diastolic pressures, the
... value determines the severity of the
hypertension.
higher
What is the target BP for diabetics?
less than 130/80
What is the usual initial therapy for uncomplicated hypertension?
HCTZ (a diuretic)
HCTZ produces ....

When someone is on a diuretic, measure and watch electrolytes very closely (esp. in elderly patients).
hyponatremia
You have a 26 year old healthy female and a 76 year old male. Both have secondary HTN and renal artery stenosis. But they have different etiologies. Which one is arteriosclerotic and which is fibro-muscular?
female – fibromuscular
male – arteriosclerotic
if a patient presents with HTN and low potassium, think ...
hyperaldosteronism (one of the secondary causes of HTN)
Treating systolic BP and diastolic BP to targets that are less than ... mm Hg is associated with a decrease in CVD complications.

In patients with hypertension with diabetes or renal disease, the BP goal is less than ... mm Hg.
140/90
130/80
There are multiple drugs to treat HTN because of overwhelming indication for one class vs. another class.

Diabetic with hypertension --> drug of choice is ...

HTN patient with history of MI --> ...

For a young female patient --> ... or .... Not ... (kid will be born w/o any kidneys)

Choose drug based on clinical scenario
ACE inhibitor
beta-blocker
calcium channel blocker or a central alpha agonist
ACE inhibitor
There is overwhelming evidence to support certain drug types in certain situations.

... prevents remodeling of myocardium.

COPD patients should not get ... because of bronchoconstriction. Neither should depressed patients.

Look at secondary complications before you give drugs

A patient with gout should not be on ....

... cause cough and congenital malformations.
ACE inhibitor
beta-blockers
HCTZ
ACE inhibitors
Unfavorable effects of some hypertension meds and co-mobidity :

... - worsening asthma, depression possible masking of hypoglycemic reactions, PVD, bradycardia, fetal bradycardia

... - edema

... - worsening DM, hyperlipidemia, gout

... - depression

... - fetal malformation, worsening asthma, cough
Beta-blocker
Calcium channel blockers
Diuretics
Central agonist
ACE/ARB
... should be used as initial therapy for most patients with hypertension, either alone or in combination with 1 of the other classes (ACE inhibitors, ARBs, -blockers, CCBs) demonstrated to be beneficial in randomized controlled outcome trials.
Thiazide-type diuretics
... is the most common form of target-organ damage associated with hypertension. In patients with hypertension and stable angina pectoris, the first drug of choice is usually a ....

In patients with acute coronary syndromes (unstable angina or myocardial infarction), hypertension should be treated initially with ... and ..., with addition of other drugs as needed for BP control.
Ischemic heart disease
beta-blocker
beta-blockers and ACE inhibitors
Heart failure, in the form of systolic or diastolic ventricular dysfunction, results primarily from systolic hypertension and ischemic heart disease. In asymptomatic individuals with demonstrable ventricular dysfunction, ... and ... are recommended.

For those with symptomatic ventricular dysfunction or end-stage heart disease, ACE inhibitors, beta-blockers, ARBs, and aldosterone blockers are recommended along with loop diuretics.
ACE inhibitors and beta-blockers
If a patient is having systolic heart failure, their ... system is extremely high. Block with ..., ... and ...
renin angiotensin
ARBs, renin inhibitors and ace inhibitors
Cerebrovascular Disease:

The risks and benefits of acute lowering of BP during an acute stroke are still unclear; control of BP at intermediate levels (approximately 160/100 mm Hg) is appropriate until the condition has stabilized or improved. Recurrent stroke rates are lowered by the combination of an ... and ....
ACE inhibitor
thiazide-type diuretic
Chronic Kidney Disease:

In patients with chronic kidney disease, defined by either (1) reduced excretory function with an estimated glomerular filtration rate of less than 60 mL/min (2) the presence of albuminuria (>300 mg/d or 200 mg albumin per gram of creatinine), therapeutic goals are to slow deterioration of renal function and prevent CVD.

New class—..., excellent data to support use in proteinuria
Renin inhibitors
Chronic Kidney Disease (continued):

Target BP values of less than ... mm Hg.

The ACE inhibitors and ARBs have demonstrated favorable effects on the progression of diabetic and nondiabetic renal disease. A limited increase in serum ... of as much as 35% above baseline with ACE inhibitors or ARBs is acceptable and not a reason to withhold treatment unless hyperkalemia develops.
130/80
creatinine
Excluding obesity and alcohol abuse, ... hypertension is the most common correctable cause of secondary hypertension.

Stenosis of a renal artery increases renin production from the ischemic kidney. Renin acts on circulating renin substrate to produce angiotensin I, which is converted to angiotensin II by ACE in lung and other tissues.

In addition to vasoconstriction, angiotensin II stimulates aldosterone production, which causes renal sodium retention and volume expansion

... disease is the most common cause of renovascular hypertension in younger persons, mostly thin females

... disease is the most common cause of renovascular hypertension in older persons.
renovascular
Fibromuscular
Atheromatous
Clinical clues for other forms of secondary hypertension:

... - is suggested by an elevated plasma creatinine concentration and/or abnormal urinalysis

... - often raises the blood pressure within the normal range but can induce overt hypertension

... - should be suspected if there are paroxysmal elevations in blood pressure, particularly if associated with the triad of headache, palpitations, and sweating
Primary renal disease
Oral contraceptives
Pheochromocytoma
Clinical clues for other forms of secondary hypertension:

... -the main clinical clue is unexplained hypokalemia due to urinary potassium wasting, however , more than half have a normal potassium concentration. Measurement of the ratio of the plasma aldosterone concentration to plasma renin activity can help identify such patients

... -is usually suggested by the classic physical findings of cushingoid facies, central obesity, proximal muscle weakness, and eccymosis
Primary aldosteronism
Cushing’s syndrome
Clinical clues for other forms of secondary hypertension (continued):

... -in one of the major causes of hypertension in young children and can occur in adults. The classic findings are hypertension in the upper extremities, diminished or delayed femoral pulses, and low or unobtainable arterial blood pressure in the lower extremities.

... -usually occurs in obese men who snore. These patients have repeated apneic episodes at night due to passive collapse of he pharyngeal muscles during inspiration. A variety of symptoms include headache, daytime fatigue, depression, persistent hypertension, and potentially life-threatening arrhythmias
Coarctation of the aorta
Sleep apnea syndrome
Hypertension crisis
Accelerated hypertension:

Elevated B/P reading (.../...) that is high enough to produce target organ damage

Usually refractory to simple treatment
180/110
Drug therapy for hypertensive crisis:

What should you treat a patient with pheochromocytosis with first?
Phentolamine (then, use beta blockers)