PCM Orthostatic hypertension flashcards.txt

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Anonymous
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116822
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PCM Orthostatic hypertension flashcards.txt
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2011-11-14 20:13:07
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PCM Hypotension
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Orthostatic hypotension and POTS and delayed hypotension
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  1. Define Orthostatic intolerance
    Family of disorders that produce symptoms of cerebral hypoperfusion in response to postural challenge; they involve the dysfunction or disregulation of postural reflexes
  2. What 4 syndromes cause Orthostatic intolerance?
    • Orthostatic hypotension
    • delayed orthostasis
    • postural orthostatic tachycardia syndrome
    • neurally mediated hypotension (vasovagal reflex or reflex syncope)
  3. What are the symptoms of orthostatic Intolerance
    • Dizziness or lightheadedness
    • Visual blurring
    • Darkening of visual fields
    • Generalized weakness
    • Loss of conciousness
  4. immediate orthostasis is defined as a postural decrease in BP of >____mmHg for systolic BP and a decrease of >____ mmHg for diastolic BP
    • SBP>20 mmHg
    • DBP>10 mmHg
  5. Immediate Orthostasis can occur with ______ insufficiency where there is inadequate tachycardial compensation or with ____ depletion where the patient becomes tachycardic but not enough to compensate.
    • Autonomic insufficiency
    • Volume depletion
  6. What are 4 classes of medications that can cause Euvolemic orthostatic hypotension
    • antihypertensive agents
    • tricyclic agents
    • monoamine oxidase inhibitors
    • dopamine agonists
  7. What are 2 endocrine diseases that can cause Euvolemic orhtostatic hypotension?
    • Adrenocortical deficiency
    • Pheochromocytoma
  8. What are some Neurological conditions that can cause euvolemic orthostatic hypotension?
    • Parkinson's disease
    • multisystem failure
    • CNS tumor
    • Myelopathy
    • Dementia/multi-infarct
  9. What are 3 things you can educate an orthostatic hypertension patient to do in order to reduce episodes?
    • Orthostatic precautions � pause at the side of the bed
    • Small, frequent, low carbohydrate meals- increased shunt to internal organs with large meals or meals heavy on carbs which are vasodilitory
    • Avoid alcohol- vasodilitor and diuretic
  10. What type of clothing can a person with orthostatic hypotension wear to decrease symptoms?
    Compressive stockings
  11. What physical maneuvers can help prevent falls in an orthostatic hypotension pt.?
    • Leg crossing
    • isometric hand gripping
    • respiratory manuvers pursed lip or sniff
    • Exercise
    • Elevate the head of the bed at night (activates the RAS reducing nocturnal diuresis)
  12. What dietary changes would you make for a patient with orthostatic hypotension?
    Increase sodium in diet
  13. What medication can you perscribe for an OH patient with anemia?
    Erythropoietin- use in anemic patients less than 35% aim for normal hct
  14. How does caffeine help pts with orthostatic hypotension?
    Inihibits vasodilating effects of adenosine and increases sympathetic tone
  15. What medications could you give a patient with OH to improve their symptoms? (5)
    • Florinef
    • Midodrine
    • NSAIDs
    • Caffeine
    • Erythropoietin
  16. What med for OH should you avoid in a patient with urinary retention?
    Midodrine (also dose while pt is awake)
  17. How do NSAIDs help to raise BP?
    Prostacyclin inhibition, vasoconstrictor and activation of RAS
  18. What NSAIDs are used for OH?
    Indomethacin
  19. What is the biggest problem with medical management of OH?
    BP effects of therapy are posture independent so when the patient moves to sitting or laying position their BP jumps to hypertensive state
  20. The Goals of OH therapy are a standing SBP > ___ mmHg and a Supine BP of <___ mmHg which can be achieved with timing of midodine dosing, HOB and nocturnal nitrates
    90mmHG and 180 mmHG
  21. What med can you add at night to a patient with OH who is hypertensive at rest?
    Nocturnal nitrates
  22. Your patient is a 78 year old female who reports feeling faint at different times of the day she does not think it occurs with postural change because it never occurs directly after standing. She also has not noticed any abnormal heart flutters or palpitations, anxiousness or neurological changes. You suspect...
    Delayed Orthostasis
  23. Delayed orthostasis can be __ -__ mins after postural challenge
    10-45 mins
  24. True or false Delayed orthostasis is more likely to be associated with vasovagal symptoms
    True
  25. _____ should be considered when lightheadedness in an older individual is recurrent, consistent, persistent, but does not occur with immediate postural challenge, the patient may not recognize the postural connection
  26. What is the most prevalent form of orthostatic intolerance
    POTS
  27. What age range does POTS present in
    14-45 years old
  28. What does POTS stand for
    Postural orthostatic tachycardia syndrome
  29. Who is more likely to get POTS men or women?
    Women
  30. What are the 4 possible pathophysiologies of POTS?
    • Reduction in effective circulating blood volume (ECBV) � (peripheral venous sympathetic denervatino with preserved cardiac innervation, dynamic orthostatic hypovolemia)
    • Acutal reduction in effective circulating blood volume- (possible renal sympathetic denervation decreased activation of RAAS, reduction in red cell mass)
    • Parasympathetic insufficency leading to attenuated baroreceptor responses
    • Primary sympathetic excess
  31. What are some symptoms of POTS
    racing heart, palpitations, anxiety, tremulousness, irritability, difficulty concentrating, difficulty focusing, sleeplessness, headache, lightheaded, fatigue, SOB, Exercise intolerance, nausea, bloating, abdominal cramping, constipation, diarrhea, cutaneous mottleing, dependent rubor, cold intolerance, heat intolerance, hear fainting, fainting, sweats, good days, bad days (I'm having a bad day b/c of this exam)
  32. What are some common misdiagnoses of POTS
    anxiety disorders, ADHD, depression, somatization, deconditioning
  33. What are some Hyperadrenergic symptoms of POTS
    • anxiety, fight of flight hyperactivity, overfocused concentration, mimicking ADHD, Inability to shut down at night or sleeplessness
    • Gastrointestinal dysmotility, Raynaud's symptomatology, cutaneous vasomotor abnormalities
  34. What are some hypoperfusion symptoms of POTS?
    • Postural
    • fatigue
    • headache
    • lightheadedness
  35. What are some cardiopulmonary symptoms of POTS?
    Exertional fatigue and breathlessness
  36. What are some of the POTS symptoms that are due to cardiac ventricular baroreceptors?
    • Postural neurocardiogenic symptoms
    • nausea
    • diaphoresis
    • pallor
    • profound episodic fatigue
  37. What are dome superimposed situational depression symptoms of POTS
    • patients feel miserable
    • misunderstood
    • often ridiculed
    • depondent about normal functioning
  38. What are the diagnostic criteria for POTS?
    30 point orthostatic rise in heart rate or maximum orthostatic heart rate >120/min and less than 10 mmHg drop in SBP
  39. 3 diagnostic tests for pots
    • bedside postural vital signs
    • tilt table testing
    • holter monitor
  40. Accelerated heart rate of __ -___ bpm due to postural challenge or daily activities is diagnostic of POTS
    130-150
  41. ____ POTS is a milder form of the disaease with partial recovery in several years
    idiopathic
  42. POTS caused by ______ is chronic and potentially progressive
    Mitochondrial disease
  43. What are the treatments for POTS?
    • High sodium diet
    • Florinef
    • Midodrine
    • NSAIDs
    • periodic saline infusion
    • Beta blockers
    • Clonadine
    • SSRIs
    • Erythropoeitin
  44. What medications are used in POTS to correct hyperadrenergic tone?
    Beta blockers
  45. What type of beta blockers are used in POTs and why?
    • Hydrophilic agents to minimize risk of fatigue
    • Nadolol
    • Bisprolol
    • Atenolol
    • Metoprolol
  46. What agent is used for Insomina and BP in POTS?
    • Clonidine
    • very helpful for insomnia, reduces supine BP but not upright BP
    • Beta blockers before bed
  47. Why are SSRIs used for POTS?
    Serotonergic pathoways appear to mediate between vagal afferens and sympathetic efferents
  48. what two methods can you use to enhance preload in POTS patients?
    • Erythropoietin
    • continuous saline infusion
  49. How do you enhance cardiovagal tone in a POTS patient?
    Pyridostigmine- therapy is limited by gastrointestinal hypermotility symptoms
  50. What would you do to optimize preload in a POTS patients
    • High sodium diet
    • florinef
    • midodrine
    • indomethacin

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