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83 Cards in this Set
- Front
- Back
what does the JNC do?
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issues guidelines etc re HTN
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definition of HTN
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systolic >140 or diastolic >90
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how many measurements for diagnosing HTN
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at least 2, one in each arm, on 2 or more visits
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for how long does patient need to be seated before measuring BP
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5
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should you ask about the following in a HTN interview: past HTN diagnosis and how long?
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yes
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should you ask about the following in a HTN interview: CHF symptoms
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yes
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should you ask about the following in a HTN interview: peripheral vascular disease
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yes
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should you ask about the following in a HTN interview: cancer history?
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no
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should you ask about the following in a HTN interview: diabetes
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yes
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should you ask about the following in a HTN interview: cardiovascular disease
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yes
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should you ask about the following in a HTN interview: cholesterol issues
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yes
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should you ask about the following in a HTN interview: glaucoma
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no
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should you ask about the following in a HTN interview: premature heart attack or stroke?
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yes
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should you ask about the following in a HTN interview: diabetes family history
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yes
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should you ask about the following in a HTN interview: hypercholesterolemia
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yes
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should you ask about the following in a HTN interview: colon cancer
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no
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should you ask about the following in a HTN interview: OTC and complementary meds
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yes
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should you ask about the following in a HTN interview: weight change
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yes
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should you ask about the following in a HTN interview: smoking history
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yes
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should you ask about the following in a HTN interview: diet history
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yes
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should you ask about the following in a HTN interview: psychosocial stressors
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yes
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should you assess the following on physical exam? 2 blood presure measurements 2 minutes apart on each arm
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yes
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should you assess the following on physical exam? BMI
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yes
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should you assess the following on physical exam? fundiscopic exam
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yes
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should you assess the following on physical exam? tympanic membranes
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no
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should you assess the following on physical exam? thyroid
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yes
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should you assess the following on physical exam? neck bruits
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yes
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should you assess the following on physical exam? PMI
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yes
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should you assess the following on physical exam? abdominal bruits
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yes
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should you assess the following on physical exam? hepatosplenomegaly
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yes
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should you assess the following on physical exam? genital exam
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yes
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should you assess the following on physical exam? peripheral vein assessment
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yes
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should you assess the following on physical exam? lower extremity edema
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yes
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should you assess the following on physical exam? neurological evaluation
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yes
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should you assess the following on physical exam? skin
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yes
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lifetime risk of getting HTN
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90%
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high BP increases risk of
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heart attack
CHF stroke renal disease |
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what % of arm circumference should the bladder of the cuff be?
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80%
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measurement for stage 2 HTN
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>160 or >100
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to evaluate essential HTN should you order? - EKG
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yes
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to evaluate essential HTN should you order? - TFTs
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no
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to evaluate essential HTN should you order? - hematocrit
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yes because anemia makes a CV event more likely
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to evaluate essential HTN should you order? - K, Cr, Ca, Cl, Na
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K, Cr, Ca (not CL or Na)
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to evaluate essential HTN should you order? - urinary albumin excretion or alb/crit ration
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yes
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what BMI increases CVD risk
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>=30
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CVD risk factors
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HTN
smoking BMI over 30 physical inactivity dyslipidemia DM Microalbuminuria or GFR <60 men >55, women >65 famHx of men under 55 or women under 65 |
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components of metabolic syndrome
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htn
obesity dyslipidemia DM |
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heart evidence of HTN end organ damage
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LVH (2nd best prognosticator of death)
angina or prior MI prior cath CHF |
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target organ damage indicators outside of heart
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stroke/tia
CKD PAD retinopathy |
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secondary HTN cuases
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sleep apnea
drug induced CKD primary aldosteronism renovascular disease chronic steroid therapy pheo coartcation of aorta thyroid/parathyroid disease |
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initial drug therapy for prehypertension
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non indicated unless compelling indications (CKD, DM if over 130/80)
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initial drug therapy for Stage 1 HTN
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thiazide
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initial drug therapy for stage 2 HTN
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two drug cobo, usually thiazide and ACEI or
ARB, BB, CCB |
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BP reduction from? - weight reduction
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5-20 per 10 Kg
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BP reduction from? - DASH plan
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8-14
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BP reduction from? - sodium restriction
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2-8
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BP reduction from? - physical activity
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4-9
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BP reduction from? - moderation of alcohol
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2-4
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normal BMI
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18.5-24.9
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what's in DASH diet
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fruits
vegies lowfat dairy reducted saturated and total fat |
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what is meant by physical activity
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30 minutes aerobic most day sof week
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moderate alcohol consumption:
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2 or fewer drinks per day for men, 1 for women or light men
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what are compelling indications for starting drug therapy for stage 1 HTN at 130/80
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CHF
post MI high CAD risk DM CKD recurrent stroke prevention |
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drugs for HTN in CHF
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thiazides
bb acei arb aldo ant |
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drugs for HTN in post MI
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bb
acei aldo ant |
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drug therapy for HTN in high CAD risk
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thiazide
bb acei ccb |
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drug therapy for HTN in dM
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thiazide
bb acei arb CCb |
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drug therapy for HTN in CDK
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ACEI
ARB |
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drug therapy for HTN in recurrent stroke
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thiazide
ACEI |
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which HTN meds reduce afterload
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ACEI
ARBs |
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which HTN meds reduce morbidity and mortality in CHF but should not be titrated to higher levels
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aldosterone antagonists
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do beta blockers mask hypoglycemia in diabetics?
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no -- and they are excellent reducers of morbidity and mortality
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after what age do you really need to care about BP goal
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50
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when do you add additional agents in attaining BP control
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when you max out on the first one
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which is better BID or daily rx
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daily, because it usually gvies more constant coverage
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why does smoking interfere with BP treatment
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nicotine increases blood pressure
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what needs to be monitored for patients in BP tx
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K and creatinine 1-2 times per year
follow-up visits every month until goal reached, 3-6 months therafter no rules, but periodic checking of fasting chol, fasting glucose and microalbumin might be helpful |
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definition of resistant hypertenison
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failure on a three drug regimen wthat includes a diuretic
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what are bad BP meds for pregnant women
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ACEIs, ARBs
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what HTN med reaction are AAs more vulnerable to?
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angiodema
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what meds are AAs less responsive to
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monotherapy with
BB ACEI ARBs |
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what group has lowest rate of BP control
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elderly
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do older patients get same BP med dosing?
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yes, but usually start out lower
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