Printable Flash Cards
Hypertension template



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QuestionsAnswers
Diagnostic Studies for HypertensionHematocrit Urinalysis - May reveal protinuria Electrolytes, Creatinine, Calcium Fasting Lipid Profile Fasting Blood Glucose ECG Measure BP twice: 5 minutes apart, always assess contralateral arm to confirm elevated reading
Goal of Diagnostic Studies for HypertensionTo identify target organ damage, an underlying cause, and/or additional risk factors
Prevention of HypertensionMaintain healthy weight and BMI Smoking cessation Regular aerobic exercise Alcohol in moderation Stress management Compliance with regimen
Nonpharmacological Management of HypertensionLifestyle Modifications DASH diet Compliance with Regimen Management of stress Counseling on elimination of cardiovascular risks (ex. smoking) Treat underlying disease Twice weekly BP checks during pregnancy Patient education
Pharmacological Management of HypertensionDiuretics ACE Inhibitors ARBs Beta blockers Calcium Channel Blockers Vasodilators Combination of above
Pharmacological Management of Hypertension in PregnancyBeta Blockers Methyldopa Vasodilators AVOID ARB and ACE inhibitors
Diuretics in HypertensionIncrease excretion of Na and Cl and thus H2O Decreases circulating plasma volume Considered FIRST LINE for most pts Monitor for hypokalemia (check k level 2 weeks after start and with increase) May worsen gout and elevate glucose and lipid levels
Loop diuretics in HypertensionInhibit absorption of Na, Cl in proximal/distal tubules, and loop of Henle Monitor for dehydration, electrolyte imbalances, and hypotension. May be used for pts who develop fluid overload
K-Sparring Diuretics in HypertensionEnhance action of thiazide & loop diuretics and counteract K loss by these agents Monitor for hyperkalemia and hypotension May be used in pts who develop hypokalemia
ACE InhibitorsInhibit action of ACE which converts Angio I to Angio II; Angio II causes vasoconstriction & Na retention. Prevents breakdown of bradykinin SE: Dry cough (Common), Angioedema (Rare) Monitor for first dose hypotension, hyperkalemia, acute renal failure PREFERRED in pts with Diabetes and CHF AVOID in pts with bilateral renal artery stenosis and sexually active women
ARBs in HypertensionBlock vasoconstriction and Na retention affects of AT II found in many tissues Good alternative in diabetics who cannot tolerate ACE inhibitors Monitor for hypotension and possible renal failure Do NOT use in sexually active females
Cardioselective Beta Blockers in HypertensionBlock stimulation of beta1 receptors in heart causing decreased HR, decreased BP, and cardiac output SE: bradycardia, exercise intolerance, and fatigue May mask s/s of hypoglycemia (tachycardia, BP changes) Monitor for reflex tachycardia if discontinued too quickly
Non-Cardioselective Beta BlockersBlock stimulation of beta1 (heart) and beta2 (lung) receptors causing decreased HR, BP, and cardiac output Contraindicated in bronchoconstrictive disease (asthma, COPD, etc) Caution in Diabetics due to ability to mask hypoglycemia Helpful in pts with tremors, anxiety, and migraine HAs
Dihydropyridine (CCBs) in HypertensionInhibit movement of Ca ions across the cell membrane and vascular smooth muscle which depresses myocardial contractility and increases cardiac blood flow. Monitor for hypotension, worsening CHF, ankle edema. Good for diabetics with proteinuria, pts with ISH, migraine prophylaxis, and pts with stable angina Serious interaction with Grapefruit Juice
Non-Dihydropyridine (CCBs) in HypertensionInhibit movement of calcium ions across cell membrane which depresses myocardial contractility, impulse formation and conduction velocity Monitor for conduction defects, worsening CHF, hypotension, bradycardia, and constipation. CAUTIOUS or AVOID with beta blockers Consider in pts with a fib with RVR, pts with angina, and diabetics with proteinuria SERIOUS interaction with grapefruit juice
Special Pharmacological Considerations in HypertensionIf pt has Stage II HTN, consider initiating therapy with 2 meds
Follow-Up for pts with HypertensionMonthly until pt reaches goal and then every 3-6 months



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