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hypertension

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AAFP FMX 2020

...glaucoma, macular degeneration, anxiety, COPD, and she is an active smoker with no interest in quitting because it helps her nerves, and hypertension. 9 10 Risk Factors Intrinsic • Age • Previous falls • Poor vision • Frailty - low endurance, weakness • Weight loss •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-051.pdf

AAFP FMX 2020

...Your patient comes in for a routine check of her chronic disease. She is a 59 yo Caucasian lady with a PMH significant for hypertension, type 2 diabetes, and hyperlipidemia. She has no issue with her medication and feels overall she is doing well. Medication: Metformin 1000mg BID,...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-066.pdf

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

...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

...Hypertension Diabetes Prolactinoma No increased risk or inconclusive Breast Cancer Risks associated with hormone therapy WPATH Standard of Care Specific Considerations with Estrogen •Tobacco Use −Transgender women may be unable or unwilling to quit smoking; this...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-108.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

...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

...− Dilated pupils, hyperthermia, tachycardia, hypertension, diaphoresis, lightheadedness, tremors, mydriasis, hyperreflexia • Mid/Perceptual phase, 30-60 minutes −Visual, auditory, and sensory alterations that last for a few hours with sensations seeming to cross over giving...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-129.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

...2. Screen patients with psoriasis for comorbidities such as cardiovascular disease, diabetes, hypertension and/or hyperlipidemia. 3. Compare mechanisms of treatment for psoriasis, including topical treatments, light therapies and systemic treatments. 3 4 3 AES Question...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-029.pdf

AAFP FMX 2020

...•Those on Beta-blockers, Calcium Channel Blockers etc may not have an increased HR or if poorly controlled HTN may be ‘relatively hypotensive’! Respiratory •Increased RR / Hyperventilation •But may compensate longer in those with COPD ‘until crash’ as rely on baseline...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-035.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

...•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

...•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

...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

AAFP FMX 2020

...Recommendations for Ovulation Disorder WHO Group 2: HPO Dysfunction (PCOS) • Screen for hypertension and diabetes prior to attempting conception • Lose weight if BMI >30 • Offer clomifene citrate or metformin or a combination (NICE) • Offer clomiphene citrate or letrozole, an...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-145.pdf

AAFP FMX 2020

...PMH: no ASCVD, DM, HTN, HL, liver disease, or VTE. PSH: no past surgeries. SH: no tobacco history. FH: no heart disease, VTE, maternal aunt with breast cancer in her 60s LMP 12 months ago BP 120/80, BMI 26, physical exam unremarkable. Screening for cervical, breast and colon...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-147.pdf

AAFP FMX 2020

...Medical Complications (Light, et al) • HTN (12%) • Preterm Labor (10%) • Placental abruption (10%) • Anemia (7%) oNone reported in participants who had previously used testosterone Photo courtesy of The Gender Spectrum Collection Psychological Considerations •Gender...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-150.pdf

AAFP FMX 2020

...Methylergonovine 0.2 mg IM, q 2-4 hrs No Yes Avoid in HTN Misoprostol Prevention 600 mcg po Treatment 600- 1000mcg pr or 600- 800 mcg SL or PO Use only when oxytocin unavailable Yes Caution in CV disease Tranexamic acid 1 gm over 10 min may repeat in 30 min No Yes,...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-153.pdf

AAFP Letter to CMS on the 2018 Quality Payment Program Final Rule with Comment Period -...

...specialists provide a wide variety of clinical services. They treat babies with ear infections, adolescents with depression, adults with hypertension, and seniors with multiple chronic illnesses. With a focus on prevention, primary care, and overall care coordination, they treat...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-2018FinalQPP-121917.pdf

AAFP Letter to CMS with Final Comments on the 2019 Proposed Medicare Physician Fee ...

...Two or more self- limited or minor problems One stable chronic illness, eg, well controlled hypertension, non- insulin dependent diabetes, cataract, BPH Acute uncomplicated illness or injury, eg, cystitis, allergic rhinitis, simple sprain Physiologic tests not under stress, eg,...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-2019ProposedMPFS-090618.pdf

AAFP Letter to Congressional Leadership on Sustaining Primary Care During the COVID-19 ...

...be treated in the primary care setting. The underlying conditions that cause worse outcomes for COVID-19 infections such as diabetes, hypertension, and heart disease are the same ones that family physicians treat and control in an outpatient setting. Any loss of the family physician...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/crisis/LT-Congress-PrimaryCare-050720.pdf

AAFP Letter with Comments to HHS on the Draft 2018-2022 Strategic Plan

...primary care specialists provide a wide variety of clinical services. They treat babies with ear infections, adolescents with hypertension, adults with depression, and seniors with multiple chronic illnesses. With a focus on prevention, primary care, and overall care coordination,...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/legal/administrative/LT-HHS-Draft2018-2022Framework-101917.pdf

AAFP Member Profile

...Diabetes (85%), hypertension (88%), emotional problems (80%), cholesterol problem (79%), and coughs/colds (79%) are the most common categories of problems for patients seen by active members during a typical two-day visit. In 2013, out of a total of 210.8 million visits to family...

About AAFP

https://www.aafp.org/dam/AAFP/documents/about_us/strategic_partnerships/common/2018-member-profile.pdf

AAFP News - Apr 15, 2003 - American Family Physician

Apr 15, 2003 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2003/0415/p1673.html

AAFP News - Aug 1, 2003 - American Family Physician

Aug 1, 2003 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2003/0801/p409.html

AAFP News - Aug 1, 2012 - American Family Physician

Aug 1, 2012 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2012/0801/p225.html

AAFP News - Aug 15, 2008 - American Family Physician

Aug 15, 2008 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2008/0815/p437.html

AAFP News - Dec 15, 2010 - American Family Physician

Dec 15, 2010 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2010/1215/p1437.html

AAFP News - Dec 15, 2017 - American Family Physician

Dec 15, 2017 - Selected policy and health issues news briefs from AAFP News.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2017/1215/p760.html

AAFP News - Feb 1, 2003 - American Family Physician

Feb 1, 2003 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2003/0201/p449.html

AAFP News - Feb 15, 2002 - American Family Physician

Feb 15, 2002 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2002/0215/p543.html

AAFP News - Feb 15, 2005 - American Family Physician

Feb 15, 2005 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2005/0215/p643.html

AAFP News - Feb 15, 2014 - American Family Physician

Feb 15, 2014 - Selected policy and health issues news briefs from AAFP News.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2014/0215/p262.html

AAFP News - Feb 15, 2015 - American Family Physician

Feb 15, 2015 - Selected policy and health issues news briefs from AAFP News.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2015/0215/p218.html

AAFP News - Jan 1, 1999 - American Family Physician

Jan 1, 1999 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/1999/0101/p13.html

AAFP News - Jan 1, 2011 - American Family Physician

Jan 1, 2011 - Selected policy and health issues news briefs from AAFP News Now.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2011/0101/p19.html

AAFP News - Jan 15, 2018 - American Family Physician

Jan 15, 2018 - Selected policy and health issues news briefs from AAFP News.

American Family Physician : AAFP News: AFP Edition

https://www.aafp.org/afp/2018/0115/p72.html

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