Su 12 Ambulatory Medicine 1-1

Front 1

21. Tx for Prehypertension?

Back 1

a. Lifestyle

Front 2

22. Tx for stage I HTN?

Back 2

a. Lifestyle modification, drug therapy.

Front 3

23. Tx for stage II HTN? >160 or >100.

Back 3

a. Lifestyle modification and drug therapy (2-drug combo for most).

Front 4

24. Goals for evaluating a pt w/HTN?

Back 4

a. Look for secondary causes (may be treatable)
b. Assess damage to target organs (heart, kidneys, eyes, CNS).
c. Assess overall CV risk
d. Make therapeutic decisions

Front 5

25. Lifestyle changes for BP reduction?

Back 5

a. Reduce salt intake. Reduction in salt intake has been shown to reduce BP. Recommend either a no-added-salt diet (4g sodium/day) or a low-sodium diet (2 g/day).
b. Lose weight. Wt. loss lowers BP significantly.
c. Avoid excessive alcohol consumption. Alcohol has a presser action, and excessive use can increase BP.
d. Exercise regularly. Regular aerobic exercise can lower BP (and reduce overall CV risk).
e. Follow a low-saturated-fat diet rich in fruits, vegetables, and low-fat dairy products. Such a diet has been shown to lower BP.
f. Stop unnecessary meds that may contribute to HTN.
g. Engage in appropriate stress management practices.

Front 6

26. In whom is wt. loss especially important for HTN?

Back 6

a. Pts w/central obesity (who often have coexisting diabetes, hyperlipidemia, and other risk factors.
b. It is especially important bc multiple risk factors can be reduced concomitantly.

Front 7

27. Best initial anti-hypertensive med for African-American pts?

Back 7

a. Thiazides (or other diuretics) because “salt-sensitive” HTN is more common in these pts.
b. However, if they also have DM, an ACE inhibitor is still the initial agent of choice.

Front 8

28. Why should serum potassium be checked regularly in hypertensive?

Back 8

a. Bc hypokalemia can be exacerbated by high salt intake.

Front 9

29. Action of Beta-blockers?

Back 9

a. Decrease HR and CO
b. Decrease Renin Release

Front 10

30. MOA of ACE inhibitors?

Back 10

1. MOA of ACE inhibitors?

Front 11

30. MOA of ACE inhibitors?

Back 11

a. Inhibit the rennin-angiotensin-aldosterone system
b. Inhibit bradykinin degradation.
c. Preferred in all diabetic pts bc of their protective effect on kidneys.

Front 12

31. Angiotensin II receptor Blockers (ARBs)?

Back 12

a. Also inhibit rennin-angiotensin-aldosterone system.
b. Recent studies suggest that ARBs have the same beneficial effects on the kidney in diabetic pts as ACE inhibitors.

Front 13

32. Action of Calcium channel blockers?

Back 13

a. Cause vasodilation of the arteriolar vasculature.

Front 14

33. Effect of Beta blockers on arteries?

Back 14

a. They work by decreasing arteriolar resistance.

Front 15

34. With what comorbid condition may beta blockers be additionally helpful in an older man?

Back 15

a. May also help BPH.

Front 16

35. Utility of Vasodilator (hydralazine and minoxidil)?

Back 16

a. Not commonly used.
b. Typically given in combination w/beta-blockers and diuretics to pts w/refractory HTN.

Front 17

36. General principals of BP tx?

Back 17

a. BP should be lowered to <140/90, w/135/85 as the MINIMUM goal in people w/diabetes or renal insufficiency.
b. The ideal goal is to lower the BP to <120/80, but this is not always practical or well tolerated by the pt.

Front 18

37. What two BP drugs have been shown to reduce morbidity and mortality and are the most common initial choices?

Back 18

a. Beta blockers and thiazides.
b. Ace inhibitors are also a good choice, especially in diabetics.

Front 19

38. What should you do if the pt’s response to one agent is not adequate?

Back 19

a. Change to another first-line agent of a different class before adding a second agent.

Front 20

39. Why should you choose thiazide diuretics as either the first or second drug?

Back 20

a. Because they enhance the effectiveness of all other antihypertensive drugs.

Front 21

40. When should you start pharmacologic tx for HTN?

Back 21

a. Should not just be based on BP but on the pt’s total CV risk.
b. For any BP elevation, the presence of CV risk factors and/or comorbid conditions dramatically accelerates the risk from HTN, and therefore modifies the tx plan.

Front 22

41. What beneficial risk reduction is tx w/ACE inhibitors and ARBs associated with in pts w/HTN?

Back 22

a. Decreased risk of new-onset diabetes.

Front 23

42. Which anti-hypertensives are contraindicated in pregnancy?!?!?!?!?

Back 23

1. Thiazides
2. Ace inhibitors
3. Calcium channel blockers
4. ARBs

Front 24

43. What two classes of anti-hypertensives are safe in pregnancy?

Back 24

1. Beta blockers
2. Hydralazine

Front 25

44. Thiazide SE?

Back 25

1. Hypokalemia!!!!!!!!
2. Hyperuricemia
3. Hyperglycemia
4. Elevation of cholesterol and triglyceride level
5. Metabolic alkalosis
6. Hypomagnesemia

Front 26

45. SE of Beta Blockers?

Back 26

1. Bradycardia
2. Bronchospasm
3. Sleep disturbances (insomnia)
4. Fatigue
5. May increase TGs and decrease HDL
6. Depression
7. Sedation
8. May mask hypoglycemic symptoms in diabetic pts on insulin.

Front 27

46. SE of ACE inhibitors?

Back 27

a. Acute Renal failure
b. Hyperkalemia
c. Dry cough angioedema
d. Skin rash
e. Altered sense of taste
f. Contraindicated in pregnancy.

Front 28

47. Risk of hyperlipidemia?

Back 28

a. Causes accelerated atherosclerosis.

Front 29

48. Which 3 dyslipidemia syndromes account for over 80% of all familial dyslipidemias?

Back 29

1. IIa
2. IIb
3. IV.

Front 30

49. 3 Endocrine causes of hyperlipidemia (secondary)?

Back 30

a. Hypothyroidism
b. DM
c. Cushing’s.

Front 31

50. 2 Renal causes of hyperlipidemia?

Back 31

a. Nephrotic syndrome
b. Uraemia

Front 32

51. 4 Medication causes of hyperlipidemia?

Back 32

1. Glucocorticoids
2. Oestrogen
3. Thiazides
4. Beta blockers

Front 33

52. 2 other causes of hyperlipidemia?

Back 33

1. Chronic liver disease
2. Pregnancy.

Front 34

53. Do High-calorie diet increase LDL, cholesterol, or triglycerides?

Back 34

a. Triglycerides only.

Front 35

54. How does alcohol affect levels?

Back 35

a. It increase TG and HDL levels but does not affect total cholesterol levels.

Front 36

55. How is cholesterol affected by age?

Back 36

a. Cholesterol levels increase w/age until approximately age 65.
b. The increase is greatest during early adulthood-about 2 mg/dl per yr.

Front 37

56. Other risk factors for Hyperlipidemias?

Back 37

a. Inactive lifestyle, abdominal obesity.
b. Family hx
c. Gender- Men generally have higher cholesterol levels than women until women reach menopause (they may then be equal or even greater).

Front 38

57. Effect of thiazides on lipids?

Back 38

a. Increase LDL, total cholesterol, TG (VLDL) levels.

Front 39

58. Effect of Beta-blockers on lipids?

Back 39

a. Increase TGs (VLDL)
b. Lower HDL

Front 40

59. Affect of Oestrogens on lipids?

Back 40

a. TG levels may further increase in pts w/hypertriglyceridemia.

Front 41

59. Effect of Oestrogens on lipids?

Back 41

a. TG levels may further increase in pts w/hypertriglyceridemia.

Front 42

60. Effect of Steroids and HIV protease inhibitors on lipids?

Back 42

a. May elevate serum lipids.