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42 Cards in this Set

  • Front
  • Back
21. Tx for Prehypertension?
a. Lifestyle
22. Tx for stage I HTN?
a. Lifestyle modification, drug therapy.
23. Tx for stage II HTN? >160 or >100.
a. Lifestyle modification and drug therapy (2-drug combo for most).
24. Goals for evaluating a pt w/HTN?
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
25. Lifestyle changes for BP reduction?
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.
26. In whom is wt. loss especially important for HTN?
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.
27. Best initial anti-hypertensive med for African-American pts?
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.
28. Why should serum potassium be checked regularly in hypertensive?
a. Bc hypokalemia can be exacerbated by high salt intake.
29. Action of Beta-blockers?
a. Decrease HR and CO
b. Decrease Renin Release
30. MOA of ACE inhibitors?
1. MOA of ACE inhibitors?
30. MOA of ACE inhibitors?
a. Inhibit the rennin-angiotensin-aldosterone system
b. Inhibit bradykinin degradation.
c. Preferred in all diabetic pts bc of their protective effect on kidneys.
31. Angiotensin II receptor Blockers (ARBs)?
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.
32. Action of Calcium channel blockers?
a. Cause vasodilation of the arteriolar vasculature.
33. Effect of Beta blockers on arteries?
a. They work by decreasing arteriolar resistance.
34. With what comorbid condition may beta blockers be additionally helpful in an older man?
a. May also help BPH.
35. Utility of Vasodilator (hydralazine and minoxidil)?
a. Not commonly used.
b. Typically given in combination w/beta-blockers and diuretics to pts w/refractory HTN.
36. General principals of BP tx?
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.
37. What two BP drugs have been shown to reduce morbidity and mortality and are the most common initial choices?
a. Beta blockers and thiazides.
b. Ace inhibitors are also a good choice, especially in diabetics.
38. What should you do if the pt’s response to one agent is not adequate?
a. Change to another first-line agent of a different class before adding a second agent.
39. Why should you choose thiazide diuretics as either the first or second drug?
a. Because they enhance the effectiveness of all other antihypertensive drugs.
40. When should you start pharmacologic tx for HTN?
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.
41. What beneficial risk reduction is tx w/ACE inhibitors and ARBs associated with in pts w/HTN?
a. Decreased risk of new-onset diabetes.
42. Which anti-hypertensives are contraindicated in pregnancy?!?!?!?!?
1. Thiazides
2. Ace inhibitors
3. Calcium channel blockers
4. ARBs
43. What two classes of anti-hypertensives are safe in pregnancy?
1. Beta blockers
2. Hydralazine
44. Thiazide SE?
1. Hypokalemia!!!!!!!!
2. Hyperuricemia
3. Hyperglycemia
4. Elevation of cholesterol and triglyceride level
5. Metabolic alkalosis
6. Hypomagnesemia
45. SE of Beta Blockers?
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.
46. SE of ACE inhibitors?
a. Acute Renal failure
b. Hyperkalemia
c. Dry cough angioedema
d. Skin rash
e. Altered sense of taste
f. Contraindicated in pregnancy.
47. Risk of hyperlipidemia?
a. Causes accelerated atherosclerosis.
48. Which 3 dyslipidemia syndromes account for over 80% of all familial dyslipidemias?
1. IIa
2. IIb
3. IV.
49. 3 Endocrine causes of hyperlipidemia (secondary)?
a. Hypothyroidism
b. DM
c. Cushing’s.
50. 2 Renal causes of hyperlipidemia?
a. Nephrotic syndrome
b. Uraemia
51. 4 Medication causes of hyperlipidemia?
1. Glucocorticoids
2. Oestrogen
3. Thiazides
4. Beta blockers
52. 2 other causes of hyperlipidemia?
1. Chronic liver disease
2. Pregnancy.
53. Do High-calorie diet increase LDL, cholesterol, or triglycerides?
a. Triglycerides only.
54. How does alcohol affect levels?
a. It increase TG and HDL levels but does not affect total cholesterol levels.
55. How is cholesterol affected by age?
a. Cholesterol levels increase w/age until approximately age 65.
b. The increase is greatest during early adulthood-about 2 mg/dl per yr.
56. Other risk factors for Hyperlipidemias?
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).
57. Effect of thiazides on lipids?
a. Increase LDL, total cholesterol, TG (VLDL) levels.
58. Effect of Beta-blockers on lipids?
a. Increase TGs (VLDL)
b. Lower HDL
59. Affect of Oestrogens on lipids?
a. TG levels may further increase in pts w/hypertriglyceridemia.
59. Effect of Oestrogens on lipids?
a. TG levels may further increase in pts w/hypertriglyceridemia.
60. Effect of Steroids and HIV protease inhibitors on lipids?
a. May elevate serum lipids.