Exam 2 NU 561 UPDATED ACTUAL Questions and CORRECT
Answers
Why do we tx hyperetension linear increased risk for CHD, CHF, CKD/renal failure, stroke and vascular
dementia
Hypertension is generally asymptomatic
Age related changes to BP DBP decreases with age
SBP increases w/ age d/t atherosclerosis
HTN guideline recommendations: < 130/80= goal
Stages:
< 120 and < 80= normal
120-129 and < 80= elevated
130-139 and 80-89(HTN stage 1)
>140 or > 90 (HTN stage 2)
Hypertension dx: -should be based on the highest # in their BP
-need to separate readings on 2 different days BUT you can dx with 1 reading if
you have identifiable end organ damage
Complications of htn: retina Grade 1: silver wiring, no vision changes, reversible
Grade 2: arteriovenous nipping, no vision changes, reversible
Grade 3: retinal ischemia, "cotton wool", vision changes, EMERGENCY
Grade 4: papilledema, vision changes, irreversible, EMERGENCY
The most common type of htn primary htn d/t a combo of genetic and environmental factors
worsened by: obesity, sleep apnea, high sodium, low K, NSAIDS, polycythemia,
excessive ETOH, smoking and metabolic syndrome
Secondary causes of htn: -renal disease (most common cause -renal artery stenosis)
-coaraction of the aortia
Primary hyperaldosteronism
Cushing syndrome
Pheochromocytoma
Hyperthyroidism
Pregnancy
Estrogen use (COCPs)
Genetic causes → autosomal dominant conditions
Others: cocaine, NSAIDs, decongestants, sleep apnea
3 purposes for lab testing in newly dx htn patient: End organ damage
ID pt w/ other high RF for CV complications
Screening for secondary and poss reversible forms of dx
, Non pharm htn measures: Exercise- aerobic 4-9 mm Hg isometric resist 5 mm Hg
salt restriction - 2-8 mm Hg
weight reduction - 5-20 mm Hg/10kg wt loss
DASH - 8-14 mm Hg
decrease ETOH consumption - 2-4 mm Hg
behavioral therapies
Pharm managment htn: Initiate if >140/90 or earlier with 1 ASCVD risk, evidence of target organ
damage, DM, multiple CV RF, and when lifestyle mod is ineffective
1st line → no DM or CKD
-NonAA - thiazide type diuretic, ACEI, ARB, or CCB, alone in combo
-AA - thiazide type diuretic or CCB, alone or in combination
CKD - include ACEI or ARB
1st line if CKW or NO DM (all age and race)
ACEI or ARB, alone/in combination w/ other drug classes
2nd line → loop and K+ sparing diuretics, alpha blockers, BB, centrally acting
sympatholytic, older arterial vasodilators, newer agents, aldosterone agents
HTN compelling indications
HF → thiaz, BB, ACEI, ARB, ALDO ANT
Post MI → BB, ACEI, ALDO ANT
High CVD risk → THIAZ, BB, ACEI, ARB, CCB
CKD → ACEI, ARB
Recurrent stroke prevention → THIAZ, ACEI
When to initation pharm tx of htn: Initiate if >140/90 or earlier with 1 ASCVD risk, evidence of target organ
damage, DM, multiple CV RF, and when lifestyle mod is ineffective
Management of hyperetension in pt with CKD ACE
ARB if ACE is no tolerated
Thiazide diuretics: decrease PVR
Enhance NA excretion to reduce IV volume and PVR
Takes 4-6 weeks to work
Sodium depletion can occur with elderly pt/cognitive changes
Can cause transient increase in LDL
NOT used in GFR < 30, must see nephrology
ACEI Decrease PVR, used in type 1/type 2 DM, may cause transient rise in CC
(check baseline CC and recheck in 4 weeks)
Can cause hyperkalemia
always used in HF and post MI
SE: angioedema, cough→ switch to an ARB
Pregnancy category X= should be on BC, come off meds before attempting
to conceive
ARB No impact on K
Do NOT use an ACE and ARB in the same patient= risk for stroke increases
Lower risk of uric acid level= good for gout
Answers
Why do we tx hyperetension linear increased risk for CHD, CHF, CKD/renal failure, stroke and vascular
dementia
Hypertension is generally asymptomatic
Age related changes to BP DBP decreases with age
SBP increases w/ age d/t atherosclerosis
HTN guideline recommendations: < 130/80= goal
Stages:
< 120 and < 80= normal
120-129 and < 80= elevated
130-139 and 80-89(HTN stage 1)
>140 or > 90 (HTN stage 2)
Hypertension dx: -should be based on the highest # in their BP
-need to separate readings on 2 different days BUT you can dx with 1 reading if
you have identifiable end organ damage
Complications of htn: retina Grade 1: silver wiring, no vision changes, reversible
Grade 2: arteriovenous nipping, no vision changes, reversible
Grade 3: retinal ischemia, "cotton wool", vision changes, EMERGENCY
Grade 4: papilledema, vision changes, irreversible, EMERGENCY
The most common type of htn primary htn d/t a combo of genetic and environmental factors
worsened by: obesity, sleep apnea, high sodium, low K, NSAIDS, polycythemia,
excessive ETOH, smoking and metabolic syndrome
Secondary causes of htn: -renal disease (most common cause -renal artery stenosis)
-coaraction of the aortia
Primary hyperaldosteronism
Cushing syndrome
Pheochromocytoma
Hyperthyroidism
Pregnancy
Estrogen use (COCPs)
Genetic causes → autosomal dominant conditions
Others: cocaine, NSAIDs, decongestants, sleep apnea
3 purposes for lab testing in newly dx htn patient: End organ damage
ID pt w/ other high RF for CV complications
Screening for secondary and poss reversible forms of dx
, Non pharm htn measures: Exercise- aerobic 4-9 mm Hg isometric resist 5 mm Hg
salt restriction - 2-8 mm Hg
weight reduction - 5-20 mm Hg/10kg wt loss
DASH - 8-14 mm Hg
decrease ETOH consumption - 2-4 mm Hg
behavioral therapies
Pharm managment htn: Initiate if >140/90 or earlier with 1 ASCVD risk, evidence of target organ
damage, DM, multiple CV RF, and when lifestyle mod is ineffective
1st line → no DM or CKD
-NonAA - thiazide type diuretic, ACEI, ARB, or CCB, alone in combo
-AA - thiazide type diuretic or CCB, alone or in combination
CKD - include ACEI or ARB
1st line if CKW or NO DM (all age and race)
ACEI or ARB, alone/in combination w/ other drug classes
2nd line → loop and K+ sparing diuretics, alpha blockers, BB, centrally acting
sympatholytic, older arterial vasodilators, newer agents, aldosterone agents
HTN compelling indications
HF → thiaz, BB, ACEI, ARB, ALDO ANT
Post MI → BB, ACEI, ALDO ANT
High CVD risk → THIAZ, BB, ACEI, ARB, CCB
CKD → ACEI, ARB
Recurrent stroke prevention → THIAZ, ACEI
When to initation pharm tx of htn: Initiate if >140/90 or earlier with 1 ASCVD risk, evidence of target organ
damage, DM, multiple CV RF, and when lifestyle mod is ineffective
Management of hyperetension in pt with CKD ACE
ARB if ACE is no tolerated
Thiazide diuretics: decrease PVR
Enhance NA excretion to reduce IV volume and PVR
Takes 4-6 weeks to work
Sodium depletion can occur with elderly pt/cognitive changes
Can cause transient increase in LDL
NOT used in GFR < 30, must see nephrology
ACEI Decrease PVR, used in type 1/type 2 DM, may cause transient rise in CC
(check baseline CC and recheck in 4 weeks)
Can cause hyperkalemia
always used in HF and post MI
SE: angioedema, cough→ switch to an ARB
Pregnancy category X= should be on BC, come off meds before attempting
to conceive
ARB No impact on K
Do NOT use an ACE and ARB in the same patient= risk for stroke increases
Lower risk of uric acid level= good for gout
