Ou Tulsa Pa Htn

Front 1

Normal BP

Back 1

<120/ <80

Front 2

Pre-HTN

Back 2

120-139/ 80-89

Front 3

HTN Stage I

Back 3

140-159/ 90-99

Front 4

HTN Stage II

Back 4

160>/ 100>

Front 5

What determine HTN classification?

Back 5

BP classification and treatment is determine by the highest BP category of either the DBP or the SBP. Example: 142/102 = stage II; 120/60 = pre-HTN

Front 6

List the information that should be obtained in the medical history in the evaluation of a patient with hypertension.

Back 6

Three objectives: Assess lifestyle/ identify other Cardiovascular risk factors, Identifiable causes of high BP, Target organ Damage/CVD

Front 7

List the routine laboratory tests that should be performed before initiating specific therapy for hypertension and be able to explain why the tests are performed.

Back 7

ECG
Blood Glucose
Urinalysis
Hematocrit
Serum Potassium
Creatinine, Calcium
Lipid Profile
and Optional tests: measurement of Urinary Albumin excretion or Albumin/Creatinine ratio

Front 8

Identify the major risk factors for cardiovascular disease

Back 8

HTN, Cigarette Smoking, obesity (BMI >30), physical inactivity, dyslipidemia, diabetes mellitus, Microalbuminuria, age (M >55, F > 65), Family hx of CVD

Front 9

Identify target organ damage

Back 9

L ventricular failure, angina or prior MI, prior coronary revascularization, heart failure, stroke or transient ischemic attack, chronic kidney disease, peripheral arterial disease, retinopathy

Front 10

Recommend appropriate therapy, either lifestyle modification or drug therapy, currently recommended by the JNC VII when provided a patient’s blood pressure classification is Normal

Back 10

Support lifestyle
PT w/o compelling indication = No antihypertensive drug indicated
PT w/ compelling indication = Drug(s) for compelling indications only

Front 11

Recommend appropriate therapy, either lifestyle modification or drug therapy, currently recommended by the JNC VII when provided a patient’s blood pressure classification is PreHTN

Back 11

Lifestyle modification
PT w/o compelling indication = No antihypertensive drug indicated
PT w/ compelling indication = Drug(s) for compelling indications only

Front 12

Recommend appropriate therapy, either lifestyle modification or drug therapy, currently recommended by the JNC VII when provided a patient’s blood pressure classification is HTN SI

Back 12

Lifestyle Modification
PT w/o compelling indication = Thiazide diuretic, ACEi, ARB, CCB
PT w/ compelling indication = Drug(s) for compelling indication or combination, and Other antihypertensive drugs (ACEi, ARB, CCB) as needed

Front 13

Recommend appropriate therapy, either lifestyle modification or drug therapy, currently recommended by the JNC VII when provided a patient’s blood pressure classification is HTN-SII

Back 13

Lifestyle modification
Two Drug combination for most (Usually Thiazide diuretic + ACEi, ARB, CCB)
PT w/ compelling indication = Drug(s) for compelling indication Other antihypertensive drugs (ACEi, ARB, CCB) as needed

Front 14

Why use Antihypertensive therapy?

Back 14

Antihypertensive drug therapy substantially reduces the risks of cardiovascular events and death.

Antihypertensive therapy has been associated with a reduction in stroke, myocardial infarction, and heart failure.

Front 15

State the specific blood pressure goals recommended by the JNC VII.

Back 15

Uncomplicated Hypertension: <140/ <90

Hypertension w/ diabetes/renal disease: <130/<80

Front 16

List and describe the details of the lifestyle changes recommended by the JNC VII for the prevention and management of hypertension.

Back 16

Lose weight, Dash Diet, Reduce Dietary Sodium, Increase physical activity, moderate alcohol consumption

Front 17

State the known benefits of using drug therapy in the management of hypertension.

Back 17

Reducing blood pressure with drugs decreases cardiovascular morbidity and mortality

Front 18

Thiazide Diuretics

Back 18

Hydrochlorothiazide (HCTZ) Chlorthalidone (Hygroton)

Front 19

Loop Diuretics

Back 19

Furosemide (Lasix)

Front 20

Potassium-sparing diuretic

Back 20

Triamterene (Dyrenium or Maxzide) * contains HCTZ *

Front 21

Aldosterone Antagonist

Back 21

Spironolactone (Aldactone)

Front 22

Adrenergic Inhibitors Peripheral Agents

Back 22

Reserpine (Serpasil)

Front 23

Adrenergic Inhibitors Central Alpha Agonist

Back 23

Clonidine (Catapres)

Front 24

Alpha-1 Blockers

Back 24

Doxazosin (Cardura)

Front 25

Cardioselective beta-blocker

Back 25

atenolol (Tenormin)

Front 26

Non-specific beta-blocker

Back 26

propranolol (Inderal)

Front 27

Combined Alpha-Beta blocker

Back 27

Carvedilol (Coreg)

Front 28

Direct vasodilators

Back 28

Minoxidil (Loniten)

Front 29

Calcium Channel Blockers Non-Dihydropyridines

Back 29

Verapamil long-acting (Calan SR, Isoptin SR), Diltiazem extended release (Cardizem CD, Dilacor XR, Tiazac)

Front 30

Calcium Channel Blockers Dihydropyridines

Back 30

Amlodipine (Norvasc)

Front 31

ACE inhibitors

Back 31

Lisinopril (Prinivil, Zestril)

Front 32

Angiotensin II Receptor Blockers

Back 32

Valsartan (Diovan)

Front 33

Adverse side effects of Thiazide Diuretics

Back 33

short-term increase in cholesterol and glucose levels, decreased serum levels of K+, Na+, Cl-, Mg2+, increased serum levels of uric acid and Ca2+

Front 34

Adverse side effects of Loop Diuretics

Back 34

short-term increase in cholesterol and glucose levels, decreased serum levels of K+, Na+, Cl-, Mg2+, increased serum levels of uric acid, EXCEPT furosemide decreases serum Ca2+

Front 35

Adverse side effects of Potassium-sparing diuretic

Back 35

Hyperkalemia, especially w/ impaired renal fxn

Front 36

Adverse side effects of Aldosterone Receptor Blockers

Back 36

hyperkalemia, gynecomastia

Front 37

Adverse side effects of Adrenergic Inhibitors Peripheral Agents (reserpine)

Back 37

nasal congestion, sedation

Front 38

Adverse side effects of Adrenergic Inhibitors Central Alpha Agonist (clonidine)

Back 38

sedation, dry mouth, lethargy, bradycardia,
withdrawl rebound HTN (always tapper this drug, DO NOT stop abruptly)
impaired cognitive fxn in elderly PT

Front 39

Adverse side effects of Alpha-1 Blockers

Back 39

Postural HTN, especially after the first dose and in the elderly or diabetic PT due to impaired autonomic nervous system fxn

Front 40

Adverse side effects of Beta-Blockers


(Even cardioselective beta-blockers can cause problems resulting from blocking beta-2 receptors at higher doses)

Back 40

Bronchospasm
Bradycardia
Heart failure
May Masked insulin-induced hypoglycemia and delay recovery time
Impaired peripheral ciruclation
insomnia, fatigue
impaired cognitive fxn in elderly PT
decreased exercise tolerance
sexual dysfunction

Front 41

Adverse side effects of Combined Alpha-Beta blocker

Back 41

posterual hypotension, same as beta-blockers and alpha-blockers

Front 42

Adverse side effects of Direct vasodilators

Back 42

orthostatic hypotension (elderly PT), headaches, fluid retention, tachycardia, hirsutism (used in tx for baldness)

Front 43

Adverse side effects of Calcium Channel Blockers Non-Dihydropyridines

Back 43

Verapamil long-acting: slowed cardiac conduction, worsening of systolic fxn in heart failure, constipation

Diltiazem extended release: slowed cardiac conduction, worsening of systolic fxn in heart failure

Front 44

Adverse side effects of Calcium Channel Blockers Dihydropyridines

Back 44

Amlodipine: ankle edema, flushing, headache

Front 45

Adverse side effects of ACE inhibitors

Back 45

cough, hyperkalemia, angioedema, rash, loss of taste;

Contraindicated: pregnancy (may cause teratogenesis)

Front 46

Adverse side effects of Angiotensin II Receptor Blockers

Back 46

hyperkalemia; Contraindicated: pregnancy (may cause teratogenesis)

Front 47

appropriate monitoring parameters for Diuretics

Back 47

Chem-7, BP

Front 48

appropriate monitoring parameters for Aldosterone Receptor Blockers

Back 48

Chem-7, BP

Front 49

appropriate monitoring parameters for Adrenergic Inhibitors Peripheral Agents

Back 49

BP, question PT about adverse effects

Front 50

appropriate monitoring parameters for Adrenergic Inhibitors Central Alpha Agonist

Back 50

BP, ECG, question PT about adverse effects

Front 51

appropriate monitoring parameters for Alpha-1 Blockers

Back 51

BP (sitting and standing), question PT about adverse effects

Front 52

appropriate monitoring parameters for Beta-Blockers

Back 52

BP, ECG, question PT about adverse effects

Front 53

appropriate monitoring parameters for Combined Alpha-Beta blocker

Back 53

BP, ECG, question PT about adverse effects

Front 54

appropriate monitoring parameters for Direct vasodilators

Back 54

BP, question PT about adverse effects, physical assessment

Front 55

appropriate monitoring parameters for Calcium Channel Blockers Non-Dihydropyridines

Back 55

BP, ECG, question PT about adverse effects

Front 56

appropriate monitoring parameters for Calcium Channel Blockers Dihydropyridines

Back 56

Amlodipine: BP, question PT about adverse effects, physical assessment

Front 57

appropriate monitoring parameters for ACE inhibitors

Back 57

Chem-7, BP, question PT about adverse effects, physical assessment

Front 58

appropriate monitoring parameters for Angiotensin II Receptor Blockers

Back 58

Chem-7, BP

Front 59

Initial Drug therapy required for Heart Failure

Back 59

Diuretics, Beta Blocker, Angiotensin Converting Enzyme Inhibitors, Angiotensin receptor blockers, aldosterone antagonists

Front 60

Initial Drug therapy required for Post-myocardial infarction

Back 60

BB, ACEi, Aldosterone antagonists

Front 61

Initial Drug therapy required for High coronary disease risk

Back 61

diuretics, BB, ACEi, Calcium Chanel blockers

Front 62

Initial Drug therapy required for Diabetes

Back 62

Diuretics, BB, ACEi, ARB, CCB

Front 63

Initial Drug therapy required for Chronic Kidney Disease

Back 63

ACEi, ARB

Front 64

Initial Drug therapy required for Recurrent Stroke prevention

Back 64

Diuretics, ACEi

Front 65

Identify appropriate treatment considerations for Minorities

Back 65

differential responses are largely ELIMINATED by drug combinations that include adequate doses of a diuretic

Front 66

Identify appropriate treatment considerations for Elderly

Back 66

initiate drugs at lower doses (to avoid symptoms); however, standard doses and multiple drugs are needed in the majority of elderly people to achieve goal BP

Front 67

Identify appropriate treatment considerations for Postural HTN

Back 67

BP should be monitored sitting and standing; caution to avoid volume depletion and excessively rapid dose titration

Front 68

Identify appropriate treatment considerations for Hypertensive urgency

Back 68

ideally managed by adjusting maintenance therapy (adding new antihypertensive or increasing dose of present medication) → gradual reductions of BP are preferred to reduce risk of Cerebrovascular Accident, MI, acute kidney failure

Front 69

Identify appropriate treatment considerations for Hypertensive Emergency

Back 69

initial target is a reduction in Mean Arterial Pressure of up to 25% w/in minutes to hours → if then stable, BP can be reduced towards 160/110-100 within next 2-6 hours. If tolerated well reduction toward goal BP can be initiated over 24-48 hours
IV agents used to manage a hypertensive emergency: nitroprusside (agent of choice in most w/ chronic kidney disease), nitroglycerin, and nicardipine.

Front 70

Select appropriate antihypertensive therapy for PT with Ischemic Heart Disease w/ HTN and Stable Angina

Back 70

the first drug of choice is usually Beta Blocker, alternatively, long acting CCBs can be used

Front 71

Select appropriate antihypertensive therapy for PT with acute coronary syndromes (unstable angina)

Back 71

HTN should be treated initially w/ Beta Blockers and Angiotensin Converting Enzyme Inhibitors

Front 72

Select appropriate antihypertensive therapy for PT with Post-myocardial infarction

Back 72

ACEIs, BBs, and aldosterone antagonists have proven to be most beneficial

Front 73

Select appropriate antihypertensive therapy for Asymptomatic PT with demonstrable ventricular dysfunction

Back 73

ACEIs and BBs are recommended

Front 74

Select appropriate antihypertensive therapy for Symptomatic PT with ventricular dysfunction or end-stage heart disease

Back 74

ACEIs, BBs, ARBs and aldosterone blockers are recommended along with loop diuretics

Front 75

Select appropriate antihypertensive therapy for PT with Diabetic HTN

Back 75

ACEIs and ARBs have demonstrated favorable effects on the progression of diabetic and non-diabetic renal disease

Front 76

Select appropriate antihypertensive therapy for PT with Advanced renal disease

Back 76

increasing doses of loop diuretics are usually needed in combination with other drug classes. A loop diuretic should be selected instead of a Thiazide.