CMN 572 - Exam 2 (book) with correct answers 100%2026

CMN 572 - Exam 2 (book) with correct answers 100%2026 Chemoprevention (p.10) - Correct Answer Low dose (81mg) ASA reduces CV events but increases GI bleeding. Also reduces colorectal, esophageal, gastric, breast, prostate, and possible lung cancer. Benefits Risks in middle age adult who are at inc risk for CV disease (10%) - and do not have risk of bleeding. Older adults: risksbenefits = should not be initiated in adults 70yo Chemoprevention with nonsteroidal antiinflammatory (NSAIDs) - Correct Answer MAY reduce risk of colorectal adenomas and polyps but inc risk of heart dx and GIB = not recommended for colon cancer prevention in average risk patients Chemoprevention with antioxidant vitamin (E, C and beta carotene) - Correct Answer No significant refuction in 5 year incident of mortality from vascular, cancer, or other major outcomes in high risk patients with CAD or other arterial disease or DM. Osteoporosis chemoprevention (p. 11) - Correct Answer Screening for women 65yo or younger at inc risk for fx Low adherence to biphosphonate tx (femoral fx, jaw osteonecrosis) HTN stats - Correct Answer 45% os US adults have BP 140/90 or are being tx for htn - only controlled in 52% of ppl. SBP and PP better predictors 50yo. More blacks than whites. Measuring BP - Correct Answer Cuff encircle 80% of the arm circumference, pt resting for at least 5 min or at least 30 min after smoking or coffee. Ambulatory pressures are better (white coat) One single elevated BP not sufficient for tx. Normal in office 120/80, elevate 120-129/80, st 1 130-139/80-89, stage 2 140/90 HTN exacerbating factors (primary HTN) - Correct Answer Obesity, OSA(CPAP improves BP), inc salt intake, alcohol, smoking, polycythemia, NSAIDs(avoid if high BP), low potassium intake Metabolic syndrome - waist, insulin resistance, triglycerimia) - high c reactive protein and low hdl Genetics and HTN - Correct Answer Glucocorticoid aldoteronism - autosomal dominant - early onset Mineralocorticoid excess - autosomal recessive Licorice causes high BP Pregnancy HTN - autosomal dominant Gordon syndrome - autosomal dominant - thiazide diuretic Fibromuscular dysplasia - Correct Answer Most commonly affects renal artery and carotid artery in women 50yo - HTN! Renal causes - onset before 20 or after 50, resistant to drugs, no atherosclerosis, no aorta problems, no pad, presence of pulm htn Primary hyperaldosteronism - Correct Answer Adenoma of adrenal cortex (aldesterone elevated16ng); take plasma aldosterone/renin ratio, hold BP meds for 2-4 weeks, replace with verapimil) Resistant HTN Cushing syndrome and htn Pheochromocytoma and htn - Correct Answer cushing: Excess glucocorticoid - salt and water retention pheo: cathecolamine excess - crisis precipitated by TCA, antidopaminergics, naloxone, metoclopramine Drugs that can cause inc in BP - Correct Answer Cyclosporine, tacrolumys, angiogenesis inhibitors, and erythropoetin NSAIDs, cocaine, alcohol Yohimbine - libido - severe rebound with clonidine Most adverse events associated with HTN are seen with ___________ rather than ___________. - Correct Answer Thrombosis; rather than bleeding! Remember that home and ambulatory BPs are superior to office readings (major predisposing factor in all types of stroke - SBP) Labs for HTN - Correct Answer Hemoglobin; serum electrolytes and serum creatinine; fasting blood sugar level (hypertension is a risk factor for the development of diabetes, and hyperglycemia can be a presenting feature of pheochromocytoma); plasma lipids (necessary to calculate cardiovascular risk and as a modifiable risk factor); serum uric acid (hyperuricemia is a relative contraindication to diuretic therapy); and urinalysis. Lifestyle modifications for HTN - Correct Answer diet rich in fruits, vegetables, and low-fat dairy foods and low in saturated and total fats (DASH diet) has been shown to lower blood pressure. Increased dietary fiber lowers blood pressure. For every 7 g of dietary fiber ingested, cardiovascular risk could be lowered by 9%. HTN risk factors - Correct Answer Hypertension1 Cigarette smoking Obesity (BMI ≥ 30)1 Physical inactivity Dyslipidemia1 Diabetes mellitus1 Microalbuminuria or estimated GFR 60 mL/min Age ( 55 years for men, 65 years for women) Family history of premature cardiovascular disease ( 55 years for men, 65 years for women) USE ASCVD ESTIMATOR! ACC uses meds if BP 140/90 to target BP 130/80, elderly 65yo 130/80 ACEi (prils) - Correct Answer Usual initial med for mild to mod htn - more effective in younger white pts - less effective in blacks and older ppl (ACEi with ccb or diuretic is potent) ACEi is choice for pts with T1D (and some t2d) and frank proteinuria Need baseline BMP, and repeat 1-2 weeks after starting ACEi to eval creatinine and K SE: sever hypotension with kidney sclerosis, hyperkalemia, chronic dry cough, skin rash, angioedema dangerous (stop), teratogenic ARBs (angiotensin II receptor blockers) - Correct Answer For pts with HF and T2D ARBs not preferred for blacks Do not add ARB with ACEi, not advised SE: rarely cause cough or skin rash or angioedema. Hyperkalemia,, sprue syndrome, nausea, weight loss, less depression than BB and CCBs Renin Inhibitors - Correct Answer Aliskiren - lowers bp, dec albuminuria, limits LVHF, do not mix with ACEi and ARBs CCBs (mils, nicardipine, amlodipine, nifedipine) - Correct Answer Preferred in blacks over ACEi and BBs Equivalent to ACEi and diuretics in prevention of CAD SE: HA, peripheral edema, bradycardia, constipation Edema minimized by adding ACEi or ARB Amlodipine is good for severe HF, and SAFE Thiazide diuretics (HCTZ) and loop diuretics (lasix) - Correct Answer Reduces peripheral vascular resistance Loops lead to electrolyte and volume depletion (shorter duration - for pts with kidney dysfunction) MORE POTENT in blacks, older pts, and obese pts More effective in smokers Causes osteoporosis in women OK to use with other BP meds SE: ED, skin rash, photosensitivity, hypokalemia (inc dietary) Precipitates gout, causes diabetes, inc LDL, TG Aldosterone receptor antagonists - - Correct Answer Spironolactone and Eplerenone - weak for htn Effective in blacks Prevents organ damage SE: breast pain and gynecomastia, hyperkalemia Beta blockers - lols - Correct Answer Dec. HR. and CO. Metoprolol good for HFeEF Not used as first line agents for HTN (ACEi or ARBs are.) SE: bronchospasms, arrhythmias, nasal congestion, raynauds, CNS s/s, nightmares, depression, confusion, fatigue, lethargy, ED Mask hypoglycemia s/s use with caution for PAD Do not give BB with phentolamine Do not give BB for cocaine use alpha adrenoreceptor antagonists - Correct Answer Prazosin, terazosin, etc Unlike BBs and diuretics, no effect on TGs, it can actually increase HDL SE: hypotension, palpitation, hd, not for pts that had cataract surgery Clonidine, methyldopa (pregnant), guanabenz, granfacine - Correct Answer Lowers bp, secondary or third agents! SE: sedation, fatigue, dry mouth, postural hypotension, ED, rebound HTN methyldopa causes hepatitis and hemolytic anemia Reserpine, guanethidine and guanadrel to lower BP - Correct Answer Causes depression, sedation, nasal stuffiness, sleep disturbances, peptic ulcers Granathidine and guanadrel - diarrhea, hypotension, fluid retention Hydralazine and Minoxidil - Correct Answer Arterial vasodilators - reflex tachy - HA, palpitation and fluid retention Combine it with diuretic or BBs Hydralazine can cause lupus like syndrome Hypertensive meds and cancer - Correct Answer ACEi and lung cancer CCBs and breast cancer ???? Initial tx for HTN: - Correct Answer ACEi, ARBs or CCBs Thiazides: older pts Blacks: THIAZIDES