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hypertension

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AAFP FMX 2020

...•Risk factors for vascular disease (HTN, DM2, smoking, atrial fibrillation, hyperlipidemia) •Known vascular disease (Claudication, PVD, CAD) https://upload.wikimedia.org/wikipedia/commons/b/bd/INFARCT.jpg "Bluthirnschranke nach Infarkt nativ und KM" by Hellerhoff - Own...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-072.pdf

AAFP FMX 2020

...18 yo AA female. Presents with fatigue. • Mother died 6 mo ago hemorrhagic stroke (HTN) • Heavy periods over the last 3 years • ROS negative for weight change, appetite change, diarrhea, constipation, depression or anxiety • ROS positive for racing heart, irregular periods,...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-076.pdf

AAFP FMX 2020

...but often worsens orthostatic hypertension • Nonpharmacologic treatment of autonomic and orthostatic symptoms is first line therapy • High salt intake, midodrine, salt-retaining steroid therapy can be useful • But supine hypertension is common, elevate head of bed at night...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-079.pdf

AAFP FMX 2020

...uncontrolled HTN or those with liver impairment •Cost: −275mg/1.1ml = $876.00 or approximately $10,000 per pregnancy 15 16 9/11/2020 9 Slynd (Drospirenone) •Progestin-only oral contraception with a 24 hour missed dose window • Indication: −OCP •Dose: −White pill...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-104.pdf

AAFP FMX 2020

...PJ is a 42 year old male patient with alcoholism, depression with anxiety and hypertension, here to establish care. He reports drinking 6-12 beers per day. His previous physician tried everything for his anxiety and nothing works other than alprazolam, 2mg TID. He also takes...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-105.pdf

AAFP FMX 2020

...changing and the patient is asymptomatic. The risk of morbidity without treatment is significant. Examples may include well-controlled hypertension, non-insulin dependent diabetes, cataract, or benign prostatic hyperplasia. • Acute, uncomplicated illness or injury: A recent or...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-116.pdf

AAFP FMX 2020

...•Past medical hx includes HTN, DVT/PE while on OCPs in the past, smoking 1.5 ppd since age 14 •No known CAD, heart failure, asthma or COPD, renal disease •ROS is otherwise negative, including no night sweats •Her weight has been stable •Surgeries - none •Medications: amlodipine 5...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-131.pdf

AAFP FMX 2020

...<3 wks Migraine with aura, any age Liver disease History DVT/PE Hypercoagulable HTN ≥ 160/100 Major surgery Age ≥35 and ≥15 cig/day Post-partum, breastfeeding < 21-30 days Age ≥ 35 and <15 cig/day HTN- controlled Gallbladder disease Meds that effects liver enzymes (rifampin,...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-141.pdf

AAFP FMX 2020

...• Very high risk H/o multiple major ASCVD events H/o 1 major ASCVD event + risk factors (eg, DM, HTN, CKD, HF) Clinical ASCVD ACC/AHA: Beyond Statins Age 20-75 LDL-C ≥190 mg/dL • <50% LDL-C reduction or LDL-C remains ≥100mg/dL: Ezetimibe is reasonable [IIa; B] •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-003.pdf

AAFP FMX 2020

...•Arrhythmias/blocks •Ischemias •PE •Short PR/LGL/WPW •Long QT Syndrome •Short QT Syndrome •ARVD •Brugada Syndrome •HCOM •Pulmonary hypertension 45 46 10/7/2020 24 History and ECG •ECG in addition to history and physical exam yielded a diagnosis in 76% of cases Am...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-015.pdf

AAFP FMX 2020

...Case 3 • 38yo male with HTN and T2DM, presenting with a 3-day h/o mildly tender L upper back infected hair follicle • Also complains of a significantly tender boil on the R upper back Images courtesy of Brian Z. Rayala, MD 17 18 9/10/2020 10 Case 4 • 59yo...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-020.pdf

AAFP FMX 2020

...vs. insulin resistance syndrome Cardiovascular risk factor Effect of pioglitazone Obesity (visceral) Improves - fat redistribution Hypertension Decreases BP Hypertriglyceridemia Decreases TG Low HLD cholesterol Increases HDL Small dense LDL particles Converts to larger, more buoyant...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-037.pdf

AAFP FMX 2020

...• 68 y/o with Diabetes and HTN • Intermittent but Severe Right Knee Pain • Occasional Swelling Behind the Knee 53 54 9/10/2020 28 Case Study Osteoarthritis Goals of Therapy: Education of the Patient Alleviate Pain Optimize Function Modify Progression...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-060.pdf

AAFP FMX 2020

...• PMH: Hypertension • Meds: Metoprolol • SH: Occasional ETOH, Smokes 1/2ppd 63 64 9/11/2020 33 Case 4 • Vitals: BP 132/85, no orthostasis • General: Lying supine, uncomfortable • HEENT: Horizontal left-beating nystagmus with left gaze; decreased hearing in right...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-074.pdf

AAFP FMX 2020

...Hypertension DM II risk proportional to insomnia duration Thyroid Disorder Asthma / Allergy ↑ inflammatory mediators 18 International Classification of Sleep Disorders- (ICSD-III) Insomnia disorder Chronic Insomnia Disorder -- Pt experiences sleep disturbances for...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-077.pdf

AAFP FMX 2020

...•47 y.o. male with: −Hypertension −Hyperlipidemia −Smoking −Lower back pain −Erectile dysfunction •Medications: −Atorvastatin −Enalapril −Oxycodone/acetaminophen (Percocet) −Oxycodone ER (OxyContin) •Reason for follow-up visit −I’m due for my Percocet −15 minute visit and...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-082.pdf

AAFP FMX 2020

...•HTN Screening (A for 18+) •Child Maltreatment Intervention •Suicide Risk Assessment •Drug counseling •Unhealthy Alcohol Use Screen and Counsel (B 18+) https://epss.ahrq.gov/ePSS/search.jsp# 13 14 9/11/2020 8 USPSTF App https://epss.ahrq.gov/PDA/index.jsp...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-091.pdf

AAFP FMX 2020

...• Very low risk of cardiac sequelae (e.g., pulm HTN or ventricular dilation) in the first few years • By preschool age, the fixed splitting will declare itself, and referral can be made. When to Refer? 35 36 When Should We Refer? 1. Cannot distinguish to your (or...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-095.pdf

AAFP FMX 2020

...or high risk for bleeding: GI bleeding or surgery ≤2 weeks ago, stroke ≤1 month ago, bleeding disorder or platelet count < 75/L, uncontrolled HTN (sBP > 180 or dBP > 110) •Oxygen needed to maintain SaO2 > 90% •PE diagnosed while on anticoagulation •Requiring IV pain medication...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-102.pdf

AAFP FMX 2020

...•Don’t use decongestants for patients with hypertension- right? • Oral pseudoephedrine produces a minimal increase (1.5 mmHg) in systolic blood pressure and has no effect on diastolic blood pressure. •Nasal oxymetazoline (Afrin): We aren’t supposed to use that for more than 3...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-107.pdf

AAFP FMX 2020

...Guanfacine Clonidine • Rel nonselective agonist α2 • Action on imidazole receptors • Approved for HTN but not ADHD α2 receptors are primary mediators of effects of NE in PFC regulating symptoms of inattention, hyperactivity, impulsivity in ADHD 29 30 Nonpharm...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-123.pdf

AAFP FMX 2020

...• Metabolic syndrome • Prediabetes • Type 2 diabetes • Dyslipidemia • Hypertension • Nonalcoholic fatty liver disease http://www.medscape.com/viewarticle/825322#vp_2 What can be done? Approaching suspected eating disorders… 35 36 Approaching suspected eating...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-127.pdf

AAFP FMX 2020

...•Thrombosis is the cause usually and is gradual/subacute •Standard risk factors DM, HTN, CVD etc… •Vague blurring to loss completely •Optic disc edema and diffuse retinal hemorrhages (blood and thunder fundus) •?Anticoagulants • Intravitreal injections of growth factor (VEGF),...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-133.pdf

AAFP FMX 2020

...stiffness, vasomotor symptoms, dry eyes, and hypertension US Preventive Services Task Force, Owens DK, Davidson KW, et al. Medication Use to Reduce Risk of Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(9):857-867....

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-138.pdf

AAFP FMX 2020

...GDM Gestational HTN dz Preterm birth Lower birth weight ACOG, 2020 Fox, 2018 Vaccines: Do I need shot too? Pregnant patients should get Tdap at 28 WGA and influenza vaccine as soon as available. Recommend for the other parent, grandparents, and anyone expected to have...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-140.pdf

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