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77 Cards in this Set

  • Front
  • Back
state the classsifications of hypertension
normal below 120/80
pre below 140/90
stage 1: below 160/100
stage 2 above 160/100
list the risk factors for cardiovascular disease as stated by the JNC7
(9)
HTN, BMI >30, dyslipidemia, DM, physical inactivity, Age (M>55, F>65), Family Hx of premature CVD (same ages as above), gfr <60, smoking
JNC & says to rule out other causes of HTN. What are some
sleep apnea, pheochromo, cushings/steroid therapy, drug related (think long term Birth control), primary aldosteronism, thyroid/para disease, coarctation of the aorta, renovascular disease/kidney disease
what do you treat BP to?
140/90
130/80 if diabetic or chronic kidney
distinguish Tx between stage 1 and stage 2 HTN
Stage 1, start w/ one med. Probably HCTZ
Stage 2 probably require two to start, HCTZ and ACE most often
Drug classes for HTN and HF
Thiaz, BB, ACE/ARb, ALDO (for heart only)
Drug classes for HTN and Post MI
BB ACE (not ARB) Aldo (for heart only)
Drug classes for HTN and high CVD risk
thiaz, BB, ACE (not ARB), CCB
Drug classes for HTN and kidney disease
ACE/ARB
Drug classes for HTN and stroke prevention
thiaz and ACE
list some causes of resistant hypertension
excess NA, medications (NSAIDS, BC, coke) alcohol, inadequate Tx, imporper measurement, and primary identifiable causes
list some lifestyle mods for HTN
weight, DASH, d/c sodium, aerobic activity, moderate alcohol
list cholesterol goals
LDL optimal <100
40<HDL<60
Totoal cholesterol <200
list risk factors beside LDL that affect goals
smoking, HTN, low HDL (<40), Fam Hx of CHD, AGE (M>45, F>55), C reactive protein
* HDL >60 negates one risk factor
* diabetes is CHD equivalent
What are your LDL Goals?
CHD or CHD risk equiv <100
2+ risk factors <130
0-1 risk factor <160
parasympathetic control of the heart occurs through the
vagus nerve
sympathetic control of the heart occurs through
SA/AC node from the reticular formation
where does most of our peripheral resistance come from
arterioles
histamine is present in what cells
basophils, mast cells, and platelets
which tissure factors vasodilate
the kinins, histamine, Prostoglandin E
list what drug may cause ___ when used to treat hyperlidemia
myophathy
many GI side effects
flushing
gallstones
statins
bile acids
niacin
fibric acids
list some herbal remedies for cholesterol
red yeast rice, plant sterols, garlic, omega 3's, soy proteina
metabolc syndrome can be diagnosed by presence of 3 or more factors, list them:
abdominal obesity (M>40, F>35)
triglycerides >150
HDL (M<40 F<50)
BP >130/85
FBG >110
the most common site for atherosclerosis
coronary arteries
list complications of atherosclerosis
MI, IHD, stroke, CHD, PVD
congenital, seccular enlargements of cerebral arteries, of the circle of willis
berry aneurysm
most common place for aneurysm
infrarenal
the "worst headache I've ever had"
photophobia, visual changes, N/V
subarachnoid hemorrhage
painful nodules affecting small and medium sized arteries, often described as a funny feeling in the hands and legs, immune complexes in lesions, infarctions in infected organs.
DX and TX
classic polyarteritis nodosa (PAN)

corticosteroids and immunosuppressants
most common cause of aquired heart disease in children in the us
Kawasaki disease
a vasculitis that orginates in small vessels progressing to larger, causes acute febrile illness, distinguished by rash ad red oral mucosa
Kawasaki disease
vasculiltis affecting meduim and large muscular arteries, unilateral amaurosis fugax is a classic symptom.
Giant cell arteritis
Vasculitis that typically leads to visual disturbances in elderly ladies due to involvement of the temporal artery
giant cell arteritis
typically involves large vessels causing stenosis of the aortic arch. AKA pulseless disease
Takyasu's Arteritis
TX glucocorticoids
thrombus formation affecting medioum arteries, specifically digital vessels. most often seen in middle aged male smokers
DX and TX
thromboangitis Obliterans
smoking cessation
medications that may worsen Raynauds
Ergot, B-blockers, amphetamines, chemo
disease characterized by color progression from palor->cyanosis->hyperemia
Raynauds phenomenon
ischemic pain following exertion. caused by limited blood flow in arteries, most commonly in the legs, alleviated by rest
claudication
list tx of varicose veins
frequent rest, elevated legs, support stockings, surgery, laser therapy, sclerotherapy
*avoid girdles and tight pants
list the four common causes of lower leg ulcers
venous (80%) and arterial insufficiency, neuropathy (diabetes), and pressure ulcers
Verchows triad, venous thrombosis
blood stasis, vessel wall injury, INCREASED blood coag
risk factors for venous stasis
immobility, acute MI, CHF, shock, venous obstruction
risk factors for hypercoag of blood
stress and trauma (including preg and childbirth), BC, cancer, dehydration, familial
tests used to Dx deep vein thrombosis
Homan sign, d-dimer, physical exam, compression ultrasound
pt complains of swelling and tenderness is Left leg, exam shows "red hot cord"
thrombophlebitis
tx for septic thrombophelbitis
aseptic
inpatient IV antibiotics

outpatient NSAIDS and anticoagulants
apply heat, elevate,

*avoid plastic cannula over 2 days
three complications from DVT
pulmonary emboli, varicose veins, chronic venous insufficiency
causes of decreased compartment size, leading to compartment syndrome
constrictive dressings and casts, IV fluids, Thermal injury and frostbite, surgical closure of fascial defects
causes of increased compartment volume
fractures, orthopedic surgery, trauma and bleeding, thermal injury and frostbite
risk factors for pressure ulcers
altered sensory perception, altered skin moisture, incontinence, altered circulation, altered hydration status
how can you prevent pressure ulcers
move, change bed linens, skin care, observation
hospitalized pt has persistant redness on rump
stage I ulcer
hospitalized pt has what appears to be a blister on back, part of the dermis is lost
stage II pressure ulcer
renin is produced where and what does it do?
liver, converts angiotensinogen to angio I
where is angio I converted to angio II
lungs by ACE
what does angio II do?
causes adrenal cortex to secrete aldosterone, stimulates hypothalamus to stimulate thirst and ADH, vasoconstriction of arteries
elevation of blood pressure resulting from some other disorder
secondary hypertension
list medications that may cause secondary hypertension
Stimulants, NSAIDS, BC, ST johns wart, ginger
pt presents with hypertension. Upon further exam you note postural hypotension, characteristics of anxiety, diaphoresis. Your order a complete lab panel. What do you expect
elevated catecholamines due to a tumor on the adrenal gland
(pheochromocytoma)
teenager presents with hyperetension and hypokalemia. You order a PRA and PAC. What might you find througout the endocrine system
multiple neoplasms
renal ischemia or stenosis of the renal arteries may lead to
abrupt onset of renal hypertension
hypertension in children is decribed as
average of atleast 3 measurements BP >95th percentile
a possible cause of childhood hypertension characterized by a femoral pulse lag, decreased pulse pressure in the right arm, and an abnormal contour of the aorta onx ray
coarctation of the aorta
the gold standard of invasive studies for hypertension
digital subtraction angiography
list some changes in pregnancy affecting blood pressure
increased fluid volume, increased stroke volume, hr, co, reduced vascular tone
describe the timeline of bp changes in pregnancy
bp drops until 16-20 weeks, maintains, then starts to rise after 28 weeks
diagnosis of hypertension during pregnancy doesn't completely follow the JNC 7. What are the differences
increase in SBP >30
increase in DBP> 15
and the normal bp>140/90
when should gestational HTN resolve itself
12 weeks
what can you use to treat chronic HTN in pregnancy
Hydralazine and lebatolol, if necessary add nifedipine
Preeclampsia is defined as
HTN during pregnancy + Proteinuria
list risk factors for preeclampsia
age extremes, is happened in 1st pregnancy, >10 yrs between pregnancies, new partner, pre-existing disorders
HELLP Syndrome in pregnancy
for preeclampsia- hemolysis, elevated liver enzymes, low platelets
differentiate between mild and severe preeclampsia
severe >160/110 and evidence of other organ involvement
you can deliver a baby as early as ___ weeks if severe preeclampsia
34 weeks
what determines how agressive treament should be in a hypertensive crisis
degree of target organ damage
when is rapid bp reduction called for in a hypertensive emergency (bp >225/125)
acute MI, CHF with pumonary edema, aortic dissection, hypertensive encephlaopathy, pheo, acute renal failure, HTN from MAO, eclampsia
when is rapid BP reduction not called for (bp >225/125)
cerebral vascular accident
intercranial hemorrhage