Adult Flashcards
Normal BP
SBP <120 and DBP <80
Elevated BP
SBP 120-129 and DBP <80
Stage 1 HTN
SBP 130-139 or DBP 80-89
Stage 2 HTN
SBP ≥ 140 or DBP ≥ 90
Hypertensive Crisis
SBP ≥ 180 and/or SBP ≥ 120
Diuretic patient education
- Low blood pressure may be a side effect
- Take this diuretic in the morning as it will cause you to urinate and interrupt your ability to sleep.
- Weigh yourself weekly to monitor fluid balance.
- You may need to change your diet to maintain normal electrolyte balance. Depending on the specific medication, you may need to increase potassium intake or limit it. You may also need to limit sodium intake so that the diuretic is more effective.
- Taking this medication with food may decrease GI upset
What are Healthy People 2030 objectives for HTN
- Reduce the proportion of adults with high blood pressure
- Increase control of high blood pressure in adults
- Improve cardiovascular health in adults
- Reduce the proportion of adults with CKD who have elevated blood pressure
ACE Inhibitors
MOA: Decrease BP by acting to block angiotensin I conversion to angiotensin II; prevents vasoconstriction and aldosterone release.
USE: Hypertension: first line in HF and with other drugs; helpful in diabetic neuropathy.
Dose: Oral: 10 mg daily; max 40 mg/day
SEs: Hypotension, dizziness, increased serum K+, decreased serum sodium; cough, angioedema (rare but serious)
Take on empty stomach 1 hour before a meal or 2 hours after a meal; decrease dose in renal failure; assess for angioedema.
Caution use with NSAIDs. Change to another agent for persistent cough.
ARBs
Decreases BP by binding with receptors of angiotensin II in vascular smooth muscle and adrenal glands.
Use if ACE intolerant.
May slow diabetic neuropathy and renal disease in diabetic patients.
Oral: 50 mg daily; may need to adjust does for patients with hepatic impairment.
SEs: Dizziness, anxiety, fatigue, hypotension, angioedema.
Assess for orthostatic hypotension, angioedema.
Monitor daily weights and signs of fluid overload; liver function studies; many drug-drug interactions.
Patient education for ACE Inhibitors and ARBs
Monitor BP daily 1 hour after dose when the medication is initiated for a week and also daily for a week when the dose is changed.
Assess for any changes in voice or swelling of the tongue (signs of angioedema) with the first dose and report to the prescriber.
The prescriber will monitor lab values frequently (renal function for ACEIs and ARBs; liver function for ARBs).
Beta Blockers
MOA: Decrease cardiac workload through negative chronotropic and inotropic effects but are not the first choice for initial pharmacological management.
Classified based on selectivity in blocking alpha & beta receptors
Nonselective adrenergic beta blockers block both alpha and beta receptors and may exacerbate asthma or bronchospasms because they cause the lungs to lose their bronchodilatation ability
Both nonselective alpha- and beta-adrenergic beta blockers may mask the patient’s usual cues of hyperglycemia and hypoglycemia and should be used cautiously in these patients
Common SE: hypotension & bradycardia
Patient education for Beta Blockers
If you have diabetes, this medication may affect the signs and symptoms of hypoglycemia, so you need to check your blood glucose level if you suspect a problem.
Do not abruptly stop taking this medication; it will need to be weaned slowly by the prescriber.
Report wheezing or difficulty breathing immediately.
Food affects absorption, so take consistently, either with or without food.
Calcium Channel Blockers
- Inhibits calcium transport into the cells, resulting in vasodilation and decreased BP.
- Also treats angina pectoris, vasospastic angina, SVT; atrial flutter, atrial fibrillation with rapid ventricular rates.
- Oral: 30–120 mg tid comes as SR, CD, or XR capsules
- Caution: dose no more than 240 mg daily when given with simvastatin (10 mg/day)
- SEs: Hypotension, bradycardia, peripheral edema, abnormal dreams, confusion, dizziness, and other CNS effects; Stevens-Johnson syndrome. Common SE: dizziness, hypotension, headache, syncope, fluid retention, constipation, and photosensitivity.
- Interacts with grapefruit juice.
- Take pulse before administration; assess for HF, assess for rash intermittently during therapy; monitor serum K+. SR has fewer side effects.
Patient Education for Calcium Channel Blockers
Call your health-care provider if you experience chest pain.
This medication may interact with grapefruit juice, cold remedies, and alcohol.
Increase dietary fiber to prevent constipation.
Limit sun exposure and use sunscreen
Diuretics
- MOA: work to decrease blood pressure by decreasing extracellular fluid (ECF) volume.
- Thiazide type drugs are mild and often tried first in HTN. Work in the loop of Henle to block chloride and sodium from being reabsorbed. K wasting.
- Loop Diuretics are K wasting and work in loop of Henle. Used more with renal disease or acid-base/electrolyte imbalances
- K Sparing Diuretics are best for patients at risk for hypokalemia (cardiac arrythmia or digoxin use). Can be given with other diuretics to counteract K wasting.
- Common AE for all diuretics: electrolyte imbalances, hypotension, blood glucose intolerance (which may be related to hypokalemia, which blocks glucose from entering cells) with prolonged use, and hyperlipidemia
Patient Education for Diuretics
Low blood pressure may be a side effect
Take this diuretic in the morning as it will cause you to urinate and interrupt your ability to sleep.
Weigh yourself weekly to monitor fluid balance.
You may need to change your diet to maintain normal electrolyte balance. Depending on the specific medication, you may need to increase potassium intake or limit it. You may also need to limit sodium intake so that the diuretic is more effective.
Taking this medication with food may decrease GI upset.
Vasodilators
- Vasodilation by acting directly on peripheral arteries.
- Lowers BP and decreases afterload in HF.
- Oral: maximum dose 300 mg/day
- IV: 5–40 mg may repeat as needed
- SEs: Tachycardia, sodium retention, drug-induced lupus syndrome, dizziness, headache, drowsiness.
- Monitor BP and pulse carefully when starting therapy. Increased risk for toxicity in patients of Chinese, Alaska Native, and Japanese ethnicity
Four underlying causes of DM
An autoimmune response (Type 1)
Insulin resistance (Type 2)
Glucose intolerance during pregnancy (Gestational)
Medication or disease induced
Patho of DM 1
Autoimmune response causes the destruction of islet of Langerhans beta cells -> prevents insulin production -> hyperglycemia. Often presents with DKA
Patho of DM 2
a. Insulin resistance and insufficient insulin production
b. Beta cell destruction does not occur
c. Fat and muscle cells are more resistant to insulin
d. The pancreas is stimulated to produce more insulin to cover the rising blood glucose levels impaired pancreatic function
e. Ketones not present
f. HHS
Patho of Gestational DM
a. Glucose intolerance during pregnancy
b. Increased risk for developing GDM in future pregnancies and T2DM later in life
c. Risk Factors: hypertension, obesity, history of previous GDM, birth of a child weighing more than 9 pounds or with a birth deficit, or history of stillbirth
d. Screening: All non-diabetic patients at 24 to 28 weeks’ gestation using a fasting (8 hours) oral glucose tolerance test (OGTT)
Patho of secondary causes of DM
a. Corticosteroids
b. Endocrine disorders
c. Pancreatitis
d. Cystic fibrosis
Patho of DKA
- Unable to produce enough insulin for homeostasis, excess glucose remains in blood
- Cells begin to starve
- Increased appetite but weight loss
- Gluconeogenesis causes rise in glucose and ketones
- Ketones cause fruity odor to breath, urine, and sweat
- Metabolic acidosis (DKA)
- Glucose > 250, pH > 7.3, Bicarb < 15
- Hyperventilate (Kussmaul respirations)
- Medical emergency that lead to coma and death if untreated
How high is BS in DKA
> 250 mg/dl
