Antihypertensive

Question 1

What is blood pressure?

Answer 1

The measure of how hard blood is pressing against artery walls

Question 2

What is systolic pressure?

Answer 2

The maximum pressure felt on the artery during left ventricular contraction

Question 3

What is diastolic pressure?

Answer 3

The resting pressure that blood exerts constantly between each contraction

Question 4

What is the formula for finding blood pressure?

Answer 4

BP = Cardiac Output (CO) x Peripheral Vascular Resistance (PVR)

Question 5

What are the classifications of blood pressure?

Answer 5

Normal
Prehypertension
Stage 1 Hypertension
Stage 2 Hypertension

Question 6

What is the numeric value of normal blood pressure?

Answer 6

SBP < 120

DBP < 80

Question 7

What is the numeric value of prehypertension?

Answer 7

SBP 120 - 139

DBP 80 - 89

Question 8

What is the numeric value of stage 1 hypertension?

Answer 8

SBP 140 - 159

DBP 90 - 99

Question 9

What is the numeric value of stage 2 hypertension?

Answer 9

SBP > 160

DBP > 100

Question 10

What is primary hypertension also known as?

Answer 10

Essential/idiopathic hypertension

Question 11

What is the cause of primary hypertension?

Answer 11

Unknown

Question 12

What is the percentage of hypertension cases that is primary hypertension?

Answer 12

90% of cases

Question 13

What is the percentage of hypertension cases that is secondary hypertension?

Answer 13

10% of cases

Question 14

What are the consequences of untreated hypertension?

Answer 14

End organ damage:

• Stroke
• Heart failure
• End stage renal failure
• Coronary artery disease
• Peripheral vascular disease

Question 15

What are the classes of drugs used to treat hypertension?

Answer 15

Diuretics
Drugs inhibiting RAAS (reninangiotensin aldosterone system)
Drugs inhibiting the SNS
Calcium channel blockers (CCB)
Direct-acting vasodilators

Question 16

What are some lifestyle modifications to treat hypertension?

Answer 16

Weight reduction
DASH eating plan
Dietary sodium restriction (decrease sodium intake)
Aerobic activity
Moderation of alcohol consumption

Question 17

What is the mechanism of action of ACE inhibitors?

Answer 17

Blocks the conversion of angiotensin I to angiotensin II through inhibition of ACE, leading to vasodilation

Question 18

What are the drug effects of ACE inhibitors?

Answer 18

Vasodilation (decreases afterload)
Excretion of sodium and water (decreases preload)
Renal protective

Question 19

What are some ACE inhibitors?

Answer 19

Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Prinivil)
Ramipril (Altace)
Benazepril (Lotensin)

Question 20

What is the suffix of ACE inhibitors?

Answer 20

-pril

Question 21

What is the suffix of beta blockers?

Answer 21

-olol

Question 22

What is the suffix of ARBS?

Answer 22

-sartan

Question 23

What are the indications of ACE inhibitors?

Answer 23

Hypertension (especially those with renal disease)

Question 24

What are the contraindications of ACE inhibitors?

Answer 24

Previous reaction of angioedema

Question 25

What is angioedema?

Answer 25

Type of swelling that affects deeper layers of skin (swelling of lips, mouth, tongue)

Question 26

What are the adverse effects of ACE inhibitors?

Answer 26

Angioedema Cough (dry) Extra potassium (hyperkalemia)

Question 27

What is the mechanism of action of ARBs?

Answer 27

Block binding of angiotensin II to angiotensin II receptors which prevents vasoconstriction and aldosterone formation

Question 28

What are the drug effects of ARBs?

Answer 28

Vasodilation of arterioles (decreases afterload) | Excretion of sodium and water (decreases preload)

Question 29

What are some ARBs?

Answer 29

Iosartan (Cozaar) Valsartan (Diovan) Olmesartan (Benicar)

Question 30

What are indications of ARBs?

Answer 30

Antihypertensive for those who can not tolerate ACEI due to cough

Question 31

What are adverse reactions of ARBs?

Answer 31

Similar to ACE I except for cough Hypotension Angioedema Hyperkalemia

Question 32

What is the mechanism of action of CCBs?

Answer 32

Prevents influx of calcium ion across cell membrane of vascular smooth muscle

Question 33

What are the drug effects of CCBs?

Answer 33

Dilation of peripheral and coronary arteries and arterioles (decreases afterload)

Question 34

What are some CCBs?

Answer 34

``` Amlopdipine (Norvasc) Diltiazem (Cardizem) Nicardipine (Cardene) Nifedipine (Procardia) Verapamil (Calan) ```

Question 35

What are indications of CCBs?

Answer 35

Hypertension | Angina

Question 36

What is angina?

Answer 36

Chest pain caused when the heart doesn't get enough oxygen-rich blood

Question 37

What are the adverse effects of CCBs?

Answer 37

``` Constipation Dizziness Hypotension Peripheral edema Suppression of cardiac function ```

Question 38

What are the nursing implications of CCBs?

Answer 38

Monitor blood pressure | Monitor heart rate

Question 39

What should you teach patients concerning CCBs?

Answer 39

Change positions slowly Avoid hazardous activities while dizzy Increase fluid and fiber intake to prevent constipation

Question 40

What is the mechanism of action of beta blockers?

Answer 40

Prevent sympathetic stimulation of beta receptors in the heart which decreases heart rate (negative chronotropic), myocardial contractility (negative inotropic), and rate of conduction thorugh AV node (negative dromotropic)

Question 41

What are the drug effects of beta blockers?

Answer 41

Decreased cardiac output

Question 42

What are some cardioselective beta 1 blockers?

Answer 42

Metoprolol (Lopressor) Atenolol (Tenormin) Esmolol (Brevibloc)

Question 43

What are some nonselective beta 1 and beta 2 blockers?

Answer 43

Propranolol (Inderal) | Nadolol (Corgard)

Question 44

What are indications for beta blockers?

Answer 44

Hypertension

Question 45

What are contraindications of beta blockers?

Answer 45

Bradycardia AV block Asthma

Question 46

What are adverse effects of beta blockers?

Answer 46

``` Dizziness Bradycardia, AV block Bronchoconstriction Mask s/s of hypoglycemia in diabetics Black Box Warning: rebound myocardium excitation ```

Question 47

What are the nursing implications for beta blockers?

Answer 47

Assess for contraindications Assess vital signs (notify if HR <60) Monitor s/s of decreased cardiac output

Question 48

What should you teach the patient concerning beta blockers?

Answer 48

Change positions slowly Avoid hot tubs/showers due to vasodilation Monitor glucose closely if diabetic Do not stop abruptly (BBW: cause severe rebound hypertension)

Question 49

What is the mechanism of action and drug effect of alpha 1 and beta blockers?

Answer 49

Alpha 1 blockade promotes dilation of arterioles and veins Beta 1 blockade reduces heart rate and contractility Blockade of beta 1 receptors on justaglomerular cells suppresses release of renin

Question 50

What are some alpha 1 and beta 1 blockers?

Answer 50

Carvedilol (Coreg) | Labetalol (Trandate)

Question 51

What is the mechanism of action and drug effect of vasodilators?

Answer 51

Direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure

Question 52

What are indications for vasodilators?

Answer 52

Hypertensive crisis

Question 53

What are adverse effects of vasodilators?

Answer 53

Excessive hypotension Monitor EKG Avoid prolonged use due to cyanide poisoning (BBW)

Question 54

What are examples of vasodilators?

Answer 54

Nitroprusside (Nitropress) IV only

Question 55

What is end organ damage?

Answer 55

The damage to a target organ due to uncontrolled hypertension

Question 56

Why is hypertension called the "silent killer"?

Answer 56

There are no early signs and symptoms of hypertension