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Pharmacology for Advanced Practice Nurses > Cardio 10 > Flashcards

Cardio 10 Flashcards

1
Q

Regulation of blood pressure (BP)

A

Baroreceptors
Endothelial factors
Kidneys
Genetic influences

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2
Q

BP =

A

cardiac output (CO) x pulmonary vascular resistance (PVR)

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3
Q

Most essential: patients with hypertension

A

(HTN) have increased peripheral resistance and normal CO

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4
Q

Baroreceptor how do they work

A

Baroreceptor exerts control of mean arterial pressure as a negative feedback loop. Nerve impulses from arterial baroreceptors are tonically active; increases in arterial blood pressure will result in an increased rate of impulse firing.

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5
Q

Endotheial Factors how do they work

A

These endothelial factors modulate the effects of norepinephrine (NE) released by sympathetic nerves (SN), and the effects of tissue metabolites and humoral factors. The three most important endothelial-derived substances are: nitric oxide (NO), endothelin (ET-1), and prostacyclin (PGI2).

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6
Q

Most common cause of HTN

A

primary (95%) caused by atherosclerosis

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7
Q

other kind of HTN

A

secondar (5%) caused by adrenal, renal factors

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8
Q

BP relies on

A

balance of CO and PVR

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9
Q

HTN lab workup 7 items

A 
Electrocardiography (ECG)
Urine analysis
Blood glucose
Serum potassium, creatinine, calcium
Lipid profile
C-reactive protein
Homocysteine
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10
Q

When can you dx HTN

A

HTN on two separate readings

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11
Q

Single high reading on one occasions

A

dx elevated BP

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12
Q

normal BP

A

less than 120 and less than 80

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13
Q

early HTN

A

120 to 139 and 80 to 89

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14
Q

stage 1

A

140 to 159 and 90 to 99

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15
Q

stage 2

A

greater than or equal to 160 or greater than or equal to 100

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16
Q

The old term “pre-hypertension” no longer used

A

Patients did not appreciate degree of risk or true impact of being outside of normal range

new term is early hypertension

Therapy adherence there an issue

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17
Q

National Guidelines Updates older adults

A

Changes definitions of control for older adults to allow higher values to avoid orthostatic falls and increase adherence

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18
Q

National Guidelines Updates medications (two items)

A

Beta blockers no longer first-line drugs

Emphasis on multiple therapeutic agents at lower doses rather than one agent at maximum dose

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19
Q

Goal of HTN treatment

Three items

A

Prevent the rise of BP with age.

Improve control of HTN to below 140/90 mm Hg

The primary focus should be on obtaining the systolic blood pressure (SBP) goal

20
Q

In patients with concurrent HTN

A

and diabetes or renal disease, the BP goal is less than 130/80 mm Hg

21
Q

There is a little correlation of ___ with HTN

A

Vit D3

22
Q

Goals of Treatment Continued for HTN Two Items

A

Improve recognition of the importance of risk factors on the development of HTN.
Reduce ethnic, socioeconomic, and regional variations in HTN care.

23
Q

Step one and two of treatment of HTN

A

lifesytle

medication

24
Q

Benefits of Lowering BP

A

Storke reduced 35 to 50%
MI by 20% to 25%
Heart Faliure 50%

25
Q

In stage 1 HTN and more cardiovascular disease risk factors, achieving a sustained 12 mm Hg reduction in SBP over 10 years will prevent

A

1 death/11 patients treated.

26
Q

DASH diet

A

Dietary Approaches to Stop Hypertension (DASH) diet
Dietary sodium reduction (most consume too much; not a restriction, but conscious effort)

Limit alcohol consumption
Physical activity

27
Q

For every 10% reduction in BMI over 30 you will see

A

a significant reduction in risk for cardiovascular disease

28
Q

ETOH to recomendations

A

0 to 1 for women

0 to 2 for men

29
Q

What is very important to lower BP

A

physical activity. This works even if you are overweight

30
Q

physcial activity recomendation

A

150 min a week

31
Q

Stepped Therapy (first 4 steps)

A

Set an appropriate minimum therapeutic BP goal: no longer less than 120/80. (under 140/90 RESTING)

Be patient, and work on attaining the BP goal over many weeks to months.

Titrate BP medications no more often than every 4 to 6 weeks.

Do not automatically assign to the drug symptoms reported by patients.

32
Q

Lisinopril side effect

A

cough

33
Q

Stepped therapy (5 through 7)

A

Plan at the beginning of therapy for the use of more than one drug.

Treat to achieve goal SBP in older adults even if diastolic blood pressure is normal, but go more slowly, allowing SBP of 150 to 160 mm Hg if asymptomatic.

Extracellular fluid volume must be controlled to achieve BP goals.

34
Q

Initial therapy for HTN

A

Angiotensin-converting enzyme inhibitors (ACEIs), or calcium channel blockers (CCBs) if:

35
Q

ACE or CCB is used if

A

BP is more than 20 mm Hg above the systolic goal or 10 mm Hg above the diastolic goal

36
Q

early HTN you may want to

A

start with a mild diuretic or add on quickly to achieve goals

37
Q

Drugs that work on cardiac output

A

Beta blockers

Calcium channel blockers

Diuretics

38
Q

Drugs that work on total peripheral resistance

A 
ACEIs
Angiotensin II receptor blockers (ARBs)
Direct renin inhibitors
Beta blockers
Alpha agonists
CCBs
Diuretics 
Sympatholytics
Vasodilators
39
Q

Drugs indicated for Heart Failure

A

Diuretics, beta blockers, ACEIs, ARBs, aldosterone antagonists

40
Q

Drugs indicated post MI

A

Beta blockers, ACEIs, aldosterone antagonists

41
Q

Drugs indicated for High coronary disease risk

A

Diuretics, beta blockers, ACEIs, CCBs

42
Q

early hypertension probably will use

A

diuretic

43
Q

stage one HTN will likely use

A

ACE or CCB

44
Q

Drugs indicated for Diabetes and HTN

A

Diuretics, ACEIs, ARBs, CCBs

45
Q

Drugs indicated for CKD and HTN

A

ACEIs, ARBs until stage 3 chronic kidney disease (CKD)

46
Q

Drugs indicated with recurrent stroke prevention and HTN

A

Diuretics, ACEIs

Pharmacology for Advanced Practice Nurses (50 decks)

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