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83 Cards in this Set

  • Front
  • Back
Is the most common cause of HTN primary or secondary?
Primary (95%)
What is considered a normal BP?
Under 120 systolic AND
Under 80 diastolic
What is pre-HTN?
Systolic 120-139 OR
Diastolic 80-89
What is Stage I HTN?
Systolic 140-159 OR
Diastolic 90-99
What is Stage II HTN?
Systolic 160+ OR
Diastolic 100+
What is HTN urgency?

What is HTN emergency?
Urgency: Diastolic 130+ and no target organ damage

Emergency: Diastolic 130+ and target organ damage
What organs are affected by hypertensive emergencies (target organ damage) (5)?
Eyes
Heart
Kidney
Brain
Peripheral vascular
What will be seen on physical exam in the case of hypertensive retinopathy (5)?
A/V nicking (arteriole causes crossing venule to bulge -- hourglass)

Papilledema (optic disc margin blurring)

Cotton wool spots (white spots on retina)

Hemorrhages (red spots on retina)

Exudates (yellow spots on retina)
Non-pharm treatment for HTN (5)?
Physical activity
DASH diet
Low sodium diet
Weight reduction
Alcohol in moderation
What is the BP goal in uncomplicated HTN?
Systolic <140 AND
Diastolic <90

(get back to pre-HTN)
What is the pharm treatment for uncomplicated Stage I HTN?

What is the pharm treatment for uncomplicated Stage II HTN?
Diuretic or (ACEI or ARB or CCB)

Diuretic + (ACEI or ARB or CCB)
What pharm HTN treatment should be avoided in African Americans? Why?

Which pharm HTN treatments have been shown to be more effective in African Americans (2)?
Avoid ACEI in African Americans due to angioedema

Diuretics and CCBs have been shown to be effective in African Americans
What is the BP goal for HTN with compelling indications?
< 130/80
Consider < 120/80 in CHF

Compelling indications:
DM
Renal ds
CAD/PAD
AAA
Framingham > 10%
CHF
What is the pharm treatment for HTN with DM or chronic kidney ds (CKD)?
ACEI
What is the pharm treatment for HTN with CAD or history of MI?
Start with BB
What is the pharm treatment for HTN with recurrent stroke or left ventricular dysfunction?
Diuretic + ACEI
How do you treat HTN urgency?

How do you treat HTN emergency?
Reduce BP to < 100 systolic within 24 hours using po agents

Reduce BP < 110 systolic within 30 minutes and to < 100 systolic within 24 hours using IV agents
What drug class ends with -dipine?

Name some adverse effects
CCBs

AE: HA, edema, dizziness
Two CCBs that affect heart rate

What are some adverse effects?
Diltiazem
Verapamil

Bradycardia, HOTN, HA, edema, HA
What drug class ends with -sartan?

Name some adverse effects
ARB

AE: Hyperkalemia, HOTN, angioedema

Titrate up

CI in 2nd/3rd trimester pg
What drug class ends with -pril?

Name some adverse effects
ACEI

AE: Hyperkalemia, cough, HOTN, angioedema, rash

Titrate up

CI in 2nd/3rd trimester pg
What drug class ends with -olol?

Name some adverse effects
BB

AE: Depression, bradycardia, ED

Need to taper

Avoid using non-selective BB in asthma
Which BBs are cardioselective?
Atenolol
Metoprolol
What are three classes of diuretics?

Name one drug from each class

Name some adverse effects
Thiazide, K+ sparing, loop

HCTZ, spiranolactone, furosemide

AE: hypokalemia, hypomagnesemia, hyperglycemia, hyperuricemia
What is the most common cause of death in the United States?
CAD
What are the risk factors for CAD (6)?
Smoking
HTN or taking HTN meds
HDL < 40
Family hx (M < 55, F < 65)
Age (M > 45, F > 55)
HDL > 60 (neg risk)

Some Hippos Have Families At Home
What are the CAD risk equivalents (5)?
Framingham > 20%
Symptomatic CAD
AAA
DM
PAD

Fucking Sad About Dead Puppies
Normal values for:

Total cholesterol
Triglycerides
HDL
LDL
TC: < 200
Tri: < 150
HDL: 40 - 60
LDL: < 100
What constitutes a high risk of CHD?
CHD or risk equivalent
For a high risk of CHD:

LDL Goal?
Start TLC at what LDL?
Consider pharm at what LDL?
LDL Goal: < 100
TLC at 100+ LDL
Pharm at 100+ LDL
For a moderate-high risk of CHD:

LDL Goal?
Start TLC at what LDL?
Consider pharm at what LDL?
LDL Goal: < 130
TLC at 130+ LDL
Pharm at 130+ LDL
For a moderate risk of CHD:

LDL Goal?
Start TLC at what LDL?
Consider pharm at what LDL?
LDL Goal: < 130
TLC at 130+ LDL
Pharm at 160+ LDL
For a low risk of CHD:

LDL Goal?
Start TLC at what LDL?
Consider pharm at what LDL?
LDL Goal: < 160
TLC at 160+ LDL
Pharm at 190+ LDL
What constitutes a moderate-high risk of CHD?
At least two risks or a Framingham score of 10%-20%
What constitutes a moderate risk of CHD?
At least 2 risks and less than 10% Framingham score
What constitutes a low risk of CHD?
0 - 1 risks
What is the non-pharm treatment for CAD (3)?

How long should this be done before starting pharm tx?
TLC:

Good diet
Exercise
Decrease weight

This should be done of six weeks prior to pharm treatment unless pharm is indicated immediately
What do statins do?

What do fibric acids do?

What does nicotinic acid do?

What do bile acid resins do?

What does 2-azetidione do?
Statins: Decrease LDL (gold standard, inhibits enzyme that makes cholesterol [HmgCoA)

FA: Decrease triglycerides (secrete cholesterol in bile)

NA: Increase HDL (block VLDL --> LDL)

BAR: Good for young people, bind bile acids to excrete in stool and prevents fat absorption

2AZ: Inhibits absorption of cholesterol, usually added to statin
What drug class ends with -statin?

Name some adverse effects (3)
Statins

AE: hepatotoxicity, myopathy, neuropathy

Don't use in pg, lots of drug interactions.
What drug class is gemfibrozil (Lopid) in?

Name some adverse effects (2)
Fibric acid

AE: GI complaints, bile stones

Avoid statins
Name some adverse effects of nicotinic acid (Niacor
Niaspan) (3)
What drug class is cholestyramine (Questran)?

Name some adverse effects (3)
Bile acid resin

AE: GI complaints, increase triglycerides, constipation
Name some adverse effects of ezetimibe (Zetia) (4)?
Fatigue, abd pain, diarrhea, joint pain

Do not use in conjunction with statins in liver ds
Chest pain that comes on with stress or exercise.

What relieves it?

What will cardiac enzymes show?

What will EKG show?

What is the treatment?
Stable angina

Rest or nitro

Normal enzymes

ST depression

Correct risk factors, nitrates, BB, CCB (dilt/verapamil), ASA
Chest pain that comes on at the same time everyday, regardless of stress or exercise.

What relieves it?

What will cardiac enzymes show?

What will EKG show?

What is the treatment?
Prinzmetal's angina

Nitro

Normal enzymes

ST elevation

CCB prophylaxis
Chest pain that comes on with stress or exercise, worsening over time. May eventually come on at rest.

What relieves it?

What will cardiac enzymes show?

What will EKG show?

What is the treatment?
Unstable angina

Nitro (increasing doses)

Enzymes normal to mildly elevated

ST depression persists for hours

Admit to hospital
MONAHB + clopidogrel, glycoprotein 2b/3a
(morphine, oxygen, nitro, aspirin, heparin, bb)
What are the criteria needed for an MI diagnosis?
EKG (ST elevation >= 1 small box in 2 contiguous leads) or new Q-wave formation or LBBB

Cardiac enzymes (serial troponin, CK-MB, myoglobin)

H&P consistent with MI

(Need two of the above three to dx)
What is the gold standard for diagnosing MI?
Angiogram
Which artery is occluded in an anterior MI?

Which leads would this appear on?
Left anterior descending (LAD)

V1-V4
Which artery is occluded in an lateral MI?

Which leads would this appear on?
Left circumflex

I, aVL, V5-V6
Which artery is occluded in an inferior MI?

Which leads would this appear on?
Right coronary artery

II, III, aVF
Which artery is occluded in an posterior MI?

Which leads would this appear on?
Right coronary artery

V1-V3 depression
What is the treatment for an acute MI?
MONAHB
(w/ glycoprotein 2b/3a for PCI)
Thrombolytics within 3 hours if no cath lab available

Morphine
Oxygen
Nitrates
Aspirin (324mg crushed/chewed)
Heparin
BB
Primary cause of death resulting from an MI
Arrhythmia
1. What are the sx of CHF?
2. What system is activated in CHF?
1. dyspnea/fatigue
2. RAAS (renin/angiotensin = vasoconstrict, aldosterone = Na retention)
1. Pathophysiology of CHF? 2. How does CHF change cardiac output?
1. myocardial damage 2. preload (fill of ventricles), afterload (tension/stress in LV during ejection), contractility, ↓ HR
1. Where does R sided HF back up to? 2. Left sided heart failure?
1. backs up to periphery (distensed neck veins, hepatomegaly, edema) 2. lungs (rales/crackles)
1. Signs of CHF
1. cyanosis, tachycardia, JVD, S3/4, edema, ascites, ↓urine, BNP >100 (left ventriculal EDV)
1. Causative agents of CHF
1. negative inotropes (BB, CCB, anti-arrhythmics), cardiotoxic (EtOH, amphetamines, chemo), Na/H2O retainers (NSAIDs, estrogens, glucocoricoids)
What are the AHA Stages of HF
A = @ risk; B = asymptomatic; C = mild-mod dz; D = severe dz
What are the NYHA Functional Classes of CHF?
I = no sx, II = slight limitation, III = marked limitation, IV = no activity
What does a chest XR show with CHF?
Kerly B lines (short, parallel linear opacities), cardiomegaly, interstitial/pulmonary edema
Tx Options of CHF
1. BB = reverse remodel (cardioprotective) 2. Diuretic (↓ preload) 3. ACEi = prevents remodeling (↓ afterload) 4. Digitalis (↑ contractility)
1. What are the types of cardiomyopathies? 2. MC?
1. dilated, hypertrophic, restrictive 2. dilated = MC
Dilated Cardiomypathy 1. Causes 2. Features 3. Labs 4. Tx
1. ↓ strength of contraction dt idiopathic, EtOH, chemo, endocrine 2. signs of CHF 3. CXR like CHF, Echo (dilation, ↓CO), EKG 4. no EtOH, tx underlying dz
Hypertrophic Cardiomyopathy 1. Causes 2. Features 3. Labs 4. Tx
1. hypertrophy of septum/LV - can't fill = GENETIC (athletes) 2. dyspnea/angina/syncope w/ exercise, S4 gallop, stong PMI 3. CXR (prominent LV), EKG = LVH, Echo = hypertrophy 4. BB or CCB
Restrictive Cardiomyopathy 1. Causes 2. Features 3. Labs 4. Tx
1. LV small/nl w/ ↓ fx dt Fibrosis/Collagen defect dz 2.↓ exercise tolerance - R sided HF 3. CXR (cardiomegaly), EKG (A. fib), Echo (↓ LV fx) 4. diuretics, steroids, antiarrhythmics
Types of Carditis (3)
Pericarditis, Myocarditis, Endocarditis
Pericarditis 1. Describe/Cause 2. S/S 3. Labs 4. Tx
1. inflammed pericardium dt virus (MC), bacteria, tumor, post-MI 2. sharp CP, positional (:( laying),pleuritic, FRICTION RUB (heard best leaning forward) 3. diffuse ST elevation, all other tests nl (Echo, cardiac enzymes, CXR) 4. NSAIDS
Endocarditis
1. Describe/cause
2. S/S
3. Labs
4. Tx
1. infection of valve leaflets, MCC = RHD, MC valve = mitral
2. anemia, fever, new murmur
3. CXR (P-edema/cardiomegaly), EKG = tachycardia, Echo = use TTE, enzymes = nl
4. IV Abx
MC type of Murmur?

Is it Systolic/Diastolic?
Aortic Stenosis

systolic
Aortic Stenosis
1. Cause
2. Heard
3. Labs
4. Tx
1. degenerative (MCC)
2. systole, @ R 2nd ICS, radiates to neck/LSB, heard best sitting/squatting/leaning forward
3. EKG = LVH, left axis dev, atrial hypertrophy
4. Tx = sx - replace
What occurs during the following:
S1 sound?
S2 Sound?
Systole?
Diastole?
Stenosis?
Regurg?
S1 = mitral/tri closing, S2 = aortic/pulm closing, systole = b/t S1 & S2, diastole = after S2 before S1; Stenosis = can't open; Regurg/Insufficiency = can't close
Mitral Stenosis 1. Cause 2. Heard 3. Labs/Tx
1. 2nd MC type, MCC = rheumatic fever 2. diastole (opening snap), @ apex, little/no radiation, heard best left lateral position 3. Dx w/ A. fib in elderly (severe cases)
Mitral Valve Prolapse 1. Cause 2. Heard
1. young/healthy 2. systolic, SYSTOLIC CLICK, @ mitral valve area (apex), heard best w/ valsalva, whoop/honk = pathognomonic
Peripheral Arterial Disease (PAD) 1. Info 2. S/S 3. Dx 4. Tx
1. chronic = atherosclerosis; acute = thrombus/embolus; usu LE (MC: femoral), ↑ risk MI (7x) 2. asx, pain, cludication, hair loss, dec. pulses/color/cap refill 3. Allen's ABI (close to 0 = bad), US, CT, angiography 4. Surgery, decrease risk factors
AAA 1. Info 2. S/S 3. Dx 4. Tx
1. usu below renal arteries, MCC = degenerative, Risks: male, HTN, smoke, age, Marfan's 2. back pain (deep/boring) 3. PE = pulsatile mass in abdomen, Dx = spiral CT 4. screen male >65 qyr, surgery >4-5cm
Temporal Arteritis 1. Info 2. S/S 3. Dx 4. Tx
1. inflammatory dz of large bvessels, MC = cranial 2, unilateral, HA, change in vision, pain 3, ESR/CRP, temporal artery biopsy 4. Tx = prednisone
Raynaud's Dz/Phenomenon 1. info 2, S/S 3. Dx 4. Tx
1. vasospastic, MC = F, phenomenon = secondary to other dz 2. red, white, blue, numbness 3. Allens = (-) in dz, (+) in phenomenon 4. CCB (avoid smoke, ergots, BB)
DVT 1. info 2. S/S 3. Dx 4. Tx
1. clot in legs, Risks = >40, smoke, Wells Score (CA, immobile, PMHx…) 2. none, tender, skin color change, warmth 3. Homan's sign (+), US 4 anticoagulate, compression socks, caval filter, surgery
What makes up the 3 parts of Virchow's Triad?
venous stasis, tissue injury, increased coagulopathy
Superficial Venous Thrombosis 1. Info 2. S/S 3. Dx 4. Tx
1. same as DVT in superficial sx 2. pain, tender, warm 3. Pexam = palpate cord, leg = pain, pulses in foot = nl 4. self-limiting (1-2wks), NSAIDs, warm compress
Varicose Veins 1. Info 2. S/S 3. Dx 4. Tx
1. dilated veins in legs, Risk Factors = FHx, Female, obese, caucasian 2. worse w/ menstruation, achy, fatigue, better w/ rest 3. palpate on exam 4. incurable, compression socks, severe = injection therapy