FNP2 Quiz 5- HTN

  1. What is considered prehypertension for teens?
    • > or = 120/80
    • 90th to < 95th %
  2. What are some s/s that should alert you to the possibility of HTN in older kids?
    • ha
    • fatigue
    • blurred vision
    • epistaxis
    • Bell's palsy
  3. All kids at what age should have BP measured?
    >3 yrs
  4. Red flags for HTN in neonates
    • irritability or lethargy
    • CHF
    • resp distress
    • failure to thrive
    • seizure
  5. In ped pts with comorbid RF & BP 90-94% and ALL with BP 95% or higher, what should you do?
    • evaluate for tgt organ damage:
    • ECG
    • retinal exam
  6. Plasma renin determination identifes low renin, suggesting ________ - related disease.
    mineralocorticoid
  7. Use plasma renin determination for young child with ___________, any child with ______, or positive family h/o __________.
    • stage 1 HTN
    • stage 2 HTN
    • severe HTN
  8. In treating HTN, do not use _______ and _______ together. Instead, use ______ plus _______.
    • ACEI
    • ARBs
    • ACEI or ARB + thiazide + CCB
  9. FIrst line tx for HTN.
    • Thiazides
    • ACEI
    • ARBs
    • CCB
    • **NOT BB**
  10. At what BP do you start med?
    • SBP 140 or higher
    • DBP 90 or higher (more important in younger)
  11. At what BP do you start meds for 60 yrs and older?
    • SBP 150 or higher
    • DBP 90 or higher
  12. If DM or CKD and > 18 yrs old, when do you start BP meds?
    • SBP 140 or higher
    • DBP 90 or higher
  13. If BP goal is not reached within ONE month of initiating tx, what should you do?
    • increase dose of first drug, OR
    • start a second drug
  14. General tx for blacks for HTN
    • Thiazide OR
    • CCB
    • (not ACEI or ARB)
  15. What should you check for if you have an infant with HTN?
    coarctation of aorta
  16. Drugs that can contribute to HTN
    • NSAIDs
    • Steroids
    • OCs
    • Decongestants
    • Antidepressants (Wellbutrin, Effexor)
    • Methylxanthines (caffeine, theophiline)
    • Nicotine replacement therapy
  17. If > 60 yrs old, when do you treat for HTN?
    • SBP 150 or higher
    • DBP 90 or higher
  18. Careful with pts on _______ or _______ when prescribing thiazides because the thiazide can cause toxicity with these other drugs.
    • digoxin
    • lithium
  19. A potential life-threatening AE of ACEI.
    • angioedema! 
    • If this happens, do NOT give pt ACEIs OR ARBs
  20. When are ACEIs & ARBs absolutely contraindicated?
    • pregnancy, esp 2nd & 3rd trimester (cat D)
    • (caution in women of child-bearing age)
  21. Which BP drugs should you NOT combine with a beta blocker?
    CCBs: NONdihydropyridines (verapamil, diltiazem)
  22. __________ can cause reflex tachycardia.
    CCBs: dihydropyridines
  23. Relative CIs with BBs
    • DM
    • hyperlipidemia
  24. CIs with BBs
    • asthma
    • COPD
    • PVDz w/ ischemia
  25. What drug would you likely see prescribed to a male with BPH and HTN?
    alpha blocker (doxazosin)
  26. Drugs used for pregnant women with HTN (typically they would be with OB).
    • Methyldopa (most common)
    • Hydrazine (IV)
    • beta blockers
  27. HTN drug that comes in a patch and has 24 hour coverage; also used to lower severe HTN in office.
    Clonidine
  28. What HTN drug would you give if unsure about or difficulty with metabolizing drugs?
    clonidine patch
  29. HTN drug that causes sleepiness.
    • Clonidine
    • BB
  30. HTN drug that you should give at bedtime because can cause first dose hypOtension.
    alpha1 blocker (doxazosin)
  31. What is the problem with bringing BP down too fast?
    risk of MI or stroke
  32. Which HTN drugs are CI in pregnancy?
    • ACEIs
    • ARBs
    • direct renin inhibitors
  33. When is BP notmally slightly higher in girls than boys?
    6 yoa through puberty
  34. When is BP normally higher in males than in females?
    puberty through adulthood
  35. Obese children have a ____ times higher risk for HTN.
    three
  36. Primary cause of secondary severe HTN in kids is ___________ or __________ disease.
    • renovascular
    • parenchymal renal
  37. When should kids < 3 yoa have BP checked?
    • prematurity or very low birth wt
    • congenital heart dz
    • recurrent UTIs, hematuria, proteinuria
    • known renal dz or urologic malformations
    • fam hx or congenital renal dz
    • solid organ transplant
    • increased ICP
  38. Why should you always measure BP in right arm of kids?
    Could get falsely low reading in left arm if they have undiagnosed coarctation of aorta
  39. The _______ Korotkoff sound defines systolic pressure; the _______ sound defines diastolic.
    • first
    • fifth
  40. What is considered prehypertension and when should you recheck?
    • 90th to 95th% OR >120/80
    • 6 months
  41. If HTN is dx, when should you recheck?
    • 1-2 weeks or sooner if symptomatic
    • If still elevated on 2 additional occasions, re-eval or refer w/in 1 month
  42. What is stage 1 and stage 2 HTN?
    • 1 = 95th to 99%
    • 2 = >99%
  43. When should you recheck VP if stage 2?
    within one week or refer immediately if symptomatic
  44. When should you evaluate for target organ damage?
    • all pts with comorbid RF and BP 90-94%
    • all pts VP 95% or higher
  45. To diagnose HTN, at least three abnormal BP readings, unless what?
    greater than or equal to 180/110
  46. Relative CIs for BBs.
    • Asthma, COPD
    • DM, hyperlipidemia
    • PVD w/ ischemia
  47. SE of BB.
    fatigue
  48. SE of alpha1 blockers.
    • dizzy
    • orthostatic hypotension
    • ha
    • first dose hypotension
    • (give at bedtime, titrate slowly)
  49. What drug class is doxazosin and when would you give it?
    • alpha1 blocker
    • HTN with BPH
  50. What is considered resistant HTN and what is your plan?
    • above goal w/ at least 3 meds
    • refer to cardiology; reconsider secondary cause
  51. Which drugs can you use for HTN in a pregnant woman?
    • methyldopa
    • BB
    • hydralazine
  52. DBP control is likely more important in _______ populations than SBP.
    younger
  53. IN gen population of 60+ yrs, pharm tx should begin when?
    • SBP 150 or higher OR
    • DBP 90 or higher
  54. If DM OR CKD and 18+ you, when do you start pharm tx?
    • SBP 140 or higher OR 
    • DBP 90 or higher
    • (same as in gen population younger than 60)
  55. If CKD & HTN & 18+ you, what pharm tx do you start with?
    • ACE or ARB
    • regardless of race or DM
  56. If kidney dysfxn and 75+ you, what pharm tx do you start with?
    • CCBs or thiazides
    • *AVOID ACE or ARB to decrease risk of hyperkalemia or increased Cr
  57. If goal is not reached within _______ of initial tx for HTN, increase dose or add another drug.
    one month
Author
MeganM
ID
321041
Card Set
FNP2 Quiz 5- HTN
Description
FNP2
Updated