Nurs 6030 Adult Primary Care Exam 2 Questions With
Complete Solutions
For an adult UNDER 60, at what blood pressure do we begin
pharm management?
Systolic over 140 AND/OR
Diastolic over 90
If you're 60 OR OLDER, at what blood pressure do we begin
pharm management?
Systolic over 150 and/or
Diastolic over 90
(this is a change from > 140/90)
What are the initial pharm options for non-African American
adults with hypertension?
Thiazide diuretic
ACE inhibitor
ARB (angiotensin receptor blocker)
Calcium channel blocker
What are the initial pharm options for African American adults
with hypertension?
Calcium channel blocker
Thiazide diuretic
,...NOT ACE-I or ARBs
If you have chronic kidney disease & hypertension, where do we
want your blood pressure to be?
Systolic under 140
Diastolic under 90
What are the initial pharm options for adults with CKD and
hypertension? How does this change for African Americans?
Diabetes status?
ARB or ACE inhibitor
REGARDLESS of race or diabetes status - same for African
Americans & diabetics
How often after starting HTN meds do you want to follow up &
recheck blood pressure?
Within 1 month.
May want to up-titrate the dose if goal BP has not been reached
and/or add another med class
Who gets beta blockers as an initial HTN treatment of choice?
No one - no longer recommended as a first-line agent for
primary treatment of HTN
When do you use ACE inhibitors and ARBs together?
You DON'T - they should not be used in combination therapy
,What is the basic pathophysiologic process involved in essential
HTN?
Arterial endothelial dysfunction.
Normally, the arterial endothelium regulates vascular tone,
structure, thrombosis, & inflammation. In HTN, here is an
imbalance in the vasodilator & vasoconstrictive substances
secreted by the endothelium.
What are the local effects of high BP on blood vessels?
Creates a shearing force against arterial wall -> injures
endotheilum.
Accelerates development of atherosclerosis by initiating a
localized reaction of vasoconstriction, inflammation, platelet
aggregation, and fibrin & lipid deposits --> Atherosclerotic
plaque
What target organs are damaged by HTN?
Heart (L ventricle hypertrophy, CAD -> angina, MI)
Kidneys (chronic renal insufficiency)
Brain (TIAs, CVAs, increased dementia risk)
Eyes (retinal hemorrhages, hypertensive retinopathy)
Peripheral arteries (Peripheral artery disease)
What are the most common causes of secondary HTN?
, Combo of book & lecture:
Obesity
Obstructive sleep apnea
Renovascular disease / Renal artery stenosis
Renal parenchymal disease
Chronic steroid therapy
Cushing's
Primary hyperaldosterism
Pheochromocytoma
Coarctation of the aorta
Thyroid disease
Parathyroid disease
Excess alcohol intake
Drug-induced
What lifestyle behaviors can cause secondary HTN?
Licorice!
smoking, chewing tobacco (raises BP)
Alchohol intake
Drugs
What are common drugs that cause secondary HTN?
NSAIDs,
COX-2 inhibitors
Sympathomimetics - eg deongestants & diet pills
TCIs & MAOIs
OTC cold medicine
Complete Solutions
For an adult UNDER 60, at what blood pressure do we begin
pharm management?
Systolic over 140 AND/OR
Diastolic over 90
If you're 60 OR OLDER, at what blood pressure do we begin
pharm management?
Systolic over 150 and/or
Diastolic over 90
(this is a change from > 140/90)
What are the initial pharm options for non-African American
adults with hypertension?
Thiazide diuretic
ACE inhibitor
ARB (angiotensin receptor blocker)
Calcium channel blocker
What are the initial pharm options for African American adults
with hypertension?
Calcium channel blocker
Thiazide diuretic
,...NOT ACE-I or ARBs
If you have chronic kidney disease & hypertension, where do we
want your blood pressure to be?
Systolic under 140
Diastolic under 90
What are the initial pharm options for adults with CKD and
hypertension? How does this change for African Americans?
Diabetes status?
ARB or ACE inhibitor
REGARDLESS of race or diabetes status - same for African
Americans & diabetics
How often after starting HTN meds do you want to follow up &
recheck blood pressure?
Within 1 month.
May want to up-titrate the dose if goal BP has not been reached
and/or add another med class
Who gets beta blockers as an initial HTN treatment of choice?
No one - no longer recommended as a first-line agent for
primary treatment of HTN
When do you use ACE inhibitors and ARBs together?
You DON'T - they should not be used in combination therapy
,What is the basic pathophysiologic process involved in essential
HTN?
Arterial endothelial dysfunction.
Normally, the arterial endothelium regulates vascular tone,
structure, thrombosis, & inflammation. In HTN, here is an
imbalance in the vasodilator & vasoconstrictive substances
secreted by the endothelium.
What are the local effects of high BP on blood vessels?
Creates a shearing force against arterial wall -> injures
endotheilum.
Accelerates development of atherosclerosis by initiating a
localized reaction of vasoconstriction, inflammation, platelet
aggregation, and fibrin & lipid deposits --> Atherosclerotic
plaque
What target organs are damaged by HTN?
Heart (L ventricle hypertrophy, CAD -> angina, MI)
Kidneys (chronic renal insufficiency)
Brain (TIAs, CVAs, increased dementia risk)
Eyes (retinal hemorrhages, hypertensive retinopathy)
Peripheral arteries (Peripheral artery disease)
What are the most common causes of secondary HTN?
, Combo of book & lecture:
Obesity
Obstructive sleep apnea
Renovascular disease / Renal artery stenosis
Renal parenchymal disease
Chronic steroid therapy
Cushing's
Primary hyperaldosterism
Pheochromocytoma
Coarctation of the aorta
Thyroid disease
Parathyroid disease
Excess alcohol intake
Drug-induced
What lifestyle behaviors can cause secondary HTN?
Licorice!
smoking, chewing tobacco (raises BP)
Alchohol intake
Drugs
What are common drugs that cause secondary HTN?
NSAIDs,
COX-2 inhibitors
Sympathomimetics - eg deongestants & diet pills
TCIs & MAOIs
OTC cold medicine
