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21 Cards in this Set
- Front
- Back
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hypertension /LVH
preferred agents |
ACEI/ARBS, ca ch blockers, sympatholytics cause regression LVH
best is diuretic +ACEI significance of LVH regression uncertain |
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severe LVh/stiff ventricle/diastolic dysfunction
avoid which type of med in these pts? |
preload reduction ie nitrates, and use diuretics w care
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gout pts
avoid which meds? |
diuretics
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ischemic stroke
avoid which meds? |
centrally acting agents such as clonidine and
nitroprusside "steals blood from the brain" |
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Malignant htn what is it
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severe htn w papilledema or retinal hemorrhages or exudates can also cause malignant nephrolsclerosis
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hypertensive encephalopathy
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htn + cerebral edema
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hypertensive crises
meds to tx oral |
loop diuretics beta blockers, alpha 2 antagonists, and ca ch blockers
AVOID SUBLINGUAL OR ORAL NIFEDIPINE AND SUBLINGUAL CAPTOPRIL |
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hypertensive crises
IV meds |
nipride, labetalol, nicardipine, fenoldopam (dopamine receptor agonist)
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hypertensive crises --end organ damage
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malig htn, hypertensive encepholathy, angina, dissection
use IV agents |
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causes of renovascular htn
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renal artery nephrosclerosis
usu men >50 fibromuscular dysplasia--usu females <40 other causes: vasculitis, scleroderma |
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what type of bruit do you see w renovascular htn?
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continuous
if continuous bruit + low K(hyperreninemic hyperaldo) is very suggestive of renovascular htn |
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screen for renovascular htn
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captopril renogram or doppler ultrasound
gold std angiography if angio + must do renal v renin if involved/uninvolved renin ratio >1.5 then this is significant! |
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when will you see prerenal azotemia and renal failure w ACEI/ARB use
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bilat renal artery stenosis, decreases GFR in involved kidney,but if both involved get RF
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Primary hyperaldosteronism
suspect in what kind of pt? what are 2 main causes? |
pt w hypokalemia of unknown etiol
1. adrenal adenomas 70% (conn syn) 2. idiopathic bilat adrenal hypoplasia |
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How do you screen for primary hyperaldo?
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ck stim plasma renin activity
if low or undetectable, to confirm diagnosis give 2L NS IV over 3-4 hrs and then ck aldo level (after this salt load) aldo level should be low, but if not suppressed has primary aldosteronism alt: if pt on acei or arb ck renin and aldo levels --should be suppressed, if not pt has primary aldo |
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initial tx of primary hyperaldo
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salt/water restriction
K+ sparing diuretics +/- thiazide diuretics |
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HELLP syn
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severe pregnancy induced hypertension
low platelets microangiopathic hemolytic anemia |
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treatment of HELLP
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hospitalization, bedrest
mehyldopa is drug of choice and hydralazine also labetalol has been used |
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Prerenal ARF
FeNa urine osmolal Urine Na urine sediment |
FeNa <1%
urine osmolal >400 urine Na <20 urine sediment normal or granular or hyaline casts |
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Postrenal ARF
FeNa urine osmolal Urine Na urine sediment |
FeNa normal
urine osmolal normal urine Na normal urine sediment blood is common |
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Intrarenal ARF (ATN)
FeNa urine osmolal urine Na urine sediment |
FeNa >>1%
urine osmolal 300-350 urine Na>20 urine sediment LARGE muddy brown granular casts |
