Happy
What is the MOA of labetalol and what are some side effects?
Vasodilator and decrease heart contractility via B2 antagonism, and B1, also works on a1
What happens to cardiac output and function as we age? Why?
The contractility decreases leading to less efficiency in pumping out blood
Why is sodium nitroprusside dangerous?
Adverse effects of sodium nitroprusside include cyanide and thiocyanate toxicities, rebound hypertension, inhibition of platelet function, and increased intrapulmonary shunting
How does Renal blood flow change with aging?
Decrease
How do you evaluate if a patient has hypertension (criteria)? What are risk factors of hypertension?
two or more reading of high BP, risk factors like T2D, dyslipidemia, lifestyle, family history, age
What do you give a person with stable angina? and what is the MOA
Nitroglycerin, vasodilator that works by increase in cGMP levels
What are some rare side effects of labetolol?
Prickling feeling, burning sensation, pins and needles feeling
In simple terms, how does aging increase the likelihood of hypertension?
Vascular structures get stiffer! leads to increase endothelial disregulation and damage which releases nitric oxide which are vasodilators (this doesn't happen now)
Is there much of an effect on V/Q mismatch and aging?
Not really since both V and Q slightly decrease with aging
How can you evaluate end organ damage?
ECG, EKG, X-ray to check fluids, CT scan
Describe Hypertensive emergency versus hypertensive urgency
Both are greater than or equal to 180/120mmHG but emergency involves end organ damage
What are natural expected changes in the heart as we with an older population with hypertension? Why would you expect this?
Increased fibrosis and sarcomeres organized in parallel, there is increased vasoconstriction and after load that and leads to the sheer force of blood damaging the heart
How can aging potentially contribute to metabolic acidosis?
Chest wall is stiffer with aging, can't really properly breath out leading to increase in CO2 trapping
Why are drug adverse affects much more common in older patients?
Elderly patients generally take multiple medications with multiple interactions of drugs. Additionally, filtration of the drug decrease with age and liver metabolism
What is the name of the creature guarding the trapdoor in Harry Potter and the Sorcerer's Stone?
Fluffy
What happens to GFR as we age and why does creatinine overestimate GFR as we age?
GFR decreases with age, and our ability to actively filtrate substances, as we age the decrease in creatinine from muscle destruction leads to overstimulation of GFR
What is the most important medication in treating long term hypertension and why? How does this drug assist in cardiovascular health?
Does GFR increase of decrease with exercise?
It depends on the the hydration level
Which of the following is most likely is increased in patients with a hypertension induce MI and why?
A. Kallikrein D. Thromboxane A2
B. Hageman Factor E. Prostacyclin
C. Protein C F. Serotonin
E, endothelial damage leads to damage that increase thromboxane A2 to form platelet plug, nitric product help stop clotting as a counter measure
Act out a motivation interviewing for a patient who is hesitant to make changes in lifestyle and is unsure about what hypertension is/can lead too
Answers will vary
How does hypertensive emergency lead to heart damage?
Hypertension leads to concentric heart failure with left ventricular heart modeling that leads to eventual diastolic failure (stiff wall)
What do happens to renin and aldosterone in an aging population? Why does this happen? Why might this be important in terms of diet?
Renin and aldosterone increase, leads to poor electrolyte balances and leads to increase sodium levels in blood and water following, leading to high BP. Gotta eat less salt!
A 57-year-old female with a history of hypertension comes to the physician because of shortness of breath. She says that she has been experiencing progressively worsening dyspnea while climbing the stairs in her house. She denies both chest pain and dyspnea at rest. She appears comfortable at rest. She is on aspirin and metoprolol. Physical examination shows a regular heart rate and rhythm with absence of murmurs or rubs but does have an S4. Blood pressure is 150/80 mm Hg and pulse 55/min. Pulmonary exam reveals rales at the bases. She has lower extremity edema. Echocardiogram shows increased LV filling pressures with a normal ejection fraction. Which of the following is the next best step?
A. Candesartan
B. Digoxin
C. Reduce the dose of metoprolol
D. Verapamil
E. Transesophageal echocardiography
A
How can smoking lead to hypertension?
Damage of arterial walls which leads to fibrosis and fat buildup in those areas leading to hypertension
A 55-year-old woman presents to her primary care physician for a follow-up appointment for elevated blood pressure measurements. Two weeks ago, her blood pressure was 134/81 mmHg. She reports occasional headaches and fatigue and denies chest pain, weight loss, or changes in bowel habits. She has no significant past medical history and does not take any medications. Her family history is notable for dyslipidemia in her father and hypertension in her mother. She has a 20-pack-year smoking history and exercises infrequently. Her BMI is 28 kg/m2. Physical examination is unremarkable. Her 24-hour ambulatory blood pressure monitoring reveals a mean blood pressure of 136/82 mmHg. Laboratory results are unremarkable. Her 10-year ASCVD risk is calculated at 6%. Which of the following is the most appropriate next step in the management of this patient’s blood pressure?
A. DASH diet and increased physical activity
B. Smoking cessation
C. Renal ultrasound
D. ACE inhibitor therapy
E. Beta-blocker therapy
A.
B. Smoking cessation
Incorrect: While smoking cessation is important for overall cardiovascular health, it does not directly lower blood pressure. The primary intervention for this patient should be lifestyle changes that directly influence blood pressure, including dietary modifications and increasing physical activity.
D. ACE inhibitor therapy
Incorrect: ACE inhibitors are the first-line treatment option for the management of stage 1 hypertension in patients with a 10-year ASCVD risk of 10% or more. In this patient with a low ASCVD risk, management consists of lifestyle modifications with dietary modifications and increased physical activity.