ch 32 hypertension Flashcards
1
Q
what two things control blood pressure
A
- cardiac output
- systemic vascular resistance
2
Q
what location in body do alpha 1 receptors act on (2)
A
- vascular smooth muscle
- heart
3
Q
what location in body do alpha 2 receptors act on
A
vascular smooth muscle
4
Q
how do alpha 1 and 2 receptors affect bp
A
vasoconstriction
5
Q
how do beta 1 receptors affect bp (3)
A
- increase heartrate
- increase force of contraction
- increase speed of conduction
6
Q
what location in body do beta 1 receptors act on
A
heart
7
Q
what location in body do beta 2 receptors act on (2)
A
- heart
- lungs
8
Q
example of beta 2 agonist med that causes bronchodilation
A
albuterol
9
Q
what is the effect of angiotensin II on bp
A
vasoconstriction
10
Q
what is the effect of aldosterone on the body (4)
A
- decreases urine output
- increases sodium
- increases fluids
- increases bp flow
11
Q
what is considered normal bp
A
<120/<80
12
Q
what is considered elevated bp
A
120-129/<80
13
Q
what is considered stage 1 HTN
A
130-139/80-89
14
Q
what is considered stage 2 HTN
A
> 140/>90
15
Q
common causes that can cause secondary HTN (7)
A
- cirrhosis
- drug related (estrogen, oral contraceptives, NSAIDs, SNS stimulants)
- endocrine disorders (pheochromocytoma, cushing syndrome, thyroid disease)
- neurologic disorders (brain tumors, TBI)
- pregnancy induced HTN
- renal disease (renal artery stenosis, glomerulonephritis)
- sleep apnea
16
Q
4 contributors to primary HTN
A
- sympathetic nervous system
- renal system
- insulin resistance
- endothelial cell damage
17
Q
risk factors for developing primary HTN (8)
A
- hereditary
- environment (diet and exercise)
- demographic (older age)
- water and sodium retention
- smoking
- alcohol abuse
- hyperglycemia
- increased cholesterol
18
Q
force opposing movement of blood within blood vessels
A
systemic vascular resistance
19
Q
what hormone from SNS do alpha receptors respond to
A
norepinephrine
20
Q
what hormone(s) from SNS do beta 1 receptors respond to
A
epinephrine + norepinephrine
21
Q
what hormone(s) from SNS do beta 2 receptors respond to
A
epinephrine
22
Q
how do beta 2 receptors affect bp (1)
A
vasodilation
23
Q
how do baroreceptors affect bp (3)
A
- decrease heart rate
- decrease force of contraction
- vasodilation
24
Q
what 2 substances are produced by the endothelium that cause vasodilation
A
- nitric oxide
- prostacyclin
25
what substance is produced by the endothelium that causes vasoconstriction
endothelin
26
what 2 things can reduce endothelial cell function
- smoking
| - diabetes
27
how does angiotensin II increase bp (2)
- vasoconstrictor
| - stimulates adrenal cortex to secret aldosterone
28
how do prostaglandins secreted by renal medulla affect bp
vasodilation, lowers bp
29
what age range is more common for HTN to develop in men
before early middle age
30
what factors in women are linked with higher prevalence of HTN (4)
- use of oral contraceptives
- h/o preeclampsia
- post-menopause (64 yo+)
- older age (70-79)
31
hemodynamic hallmark that is pathophysiology of primary HTN
persistently increased systemic vascular resistance
32
target organs of hypertension (5)
- heart
- brain
- peripheral vessels
- kidneys
- eyes
33
4 conditions of the eyes resulting from HTN
- AV nicking
- narrowing or retinal arterioles
- hemorrhages
- papilledema
34
2 conditions of the brain resulting from HTN
- stroke
| - transient ischemic attack
35
3 conditions of the kidneys resulting from HTN
- microalbuminuria
- proteinuria
- serum creatinine >1.5
36
3 conditions of the heart resulting from HTN
- CAD
- heart failure
- left ventricular hypertrophy
37
1 condition of the sexual organs resulting from HTN
erectile dysfunction
38
2 conditions of the peripheral vascular system resulting from HTN
- intermittent claudication
| - faint/absent peripheral pulses
39
S+S HTN (4) seen with severe HTN
| "silent killer"
- fatigue
- dizziness
- palpitations, chest pain
- dyspnea
40
diagnostic studies looking for target organ damage or evaluating for secondary HTN (6)
- urinalysis
- metabolic panel
- complete blood count
- ECG
- TSH
- serum lipid profile
41
how many separate occasions does a pt have to have high blood pressure to be considered hypertensive
2 separate occasions
42
what will happen to bp if bp cuff is too big
false low bp reading
43
what will happen to bp if bp cuff is too smal
false high bp reading
44
recommended lifestyle changes for pt with HTN (6)
- stop smoking
- exercise (150 mins/week)
- lose weight
- moderate alcohol consumption
- stress management
- diet (low salt, low cholesterol, healthy fats)
45
how much will bp decrease for every 1 kg weight loss
1 mmHg
46
how much sodium should pt with HTN consume per day
1500 mg/day or less
47
common side effect and rare side effect of ACE inhibitors (2)
cough
| angioedema
48
what side effect can result from the combo of aspirin + furosemide
tinnitus
49
what labs should you check before administering thiazide diuretics (2)
- sodium
| - chloride
50
effect of thiazide diuretics
- inhibits sodium and chloride reabsorption on distal tubule
| - lowers bp by reducing blood volume
51
what time of day should pt take diuretic
morning
52
what side effects should you monitor for with diuretics (4)
- hypokalemia
- hyponatremia
- hyperglycemia
- orthostatic hypotension
53
effect of loop diuretics
-increases urine output on loop of henle
54
example of 1 loop diuretic
furosemide
55
what ending characterizes ACE inhibitors
-pril
56
effect of ACE inhibitors
-prevents conversion angiotensin 1 to angiotensin 2
57
are ACE inhibitors or ARBs preferred for patients with T2 diabetes
ACE
| -they can help prevent neuropathy
58
can pregnant pts take ACE inhibitors, ARBs, or calcium channel blockers
no
| very teratogenic
59
can you combine ACE inhibitors with ARBs
no! very potent
60
when should you hold anti-HTN meds
if systolic is less than 110
61
what ending characterizes ARBs
-sartans
62
effect of ARBs
blocks receptor sites for angiotensin 2
| produce vasodilation
63
effect of calcium channel blockers
- blocks calcium to myocardium
| - decreases cardiac output and force
64
what VS should you check before admin of calcium channel blockers (2)
- bp
| - HR
65
what food cannot be given with calcium channel blockers
grapefruit juice
66
preferred anti-HTN med for african american pt
calcium channel blockers
67
what pt should we use cautious use of calcium channel blockers with
pts with conditions that affect cardiac output (HF)
68
common side effect dihydropiridines
peripheral edema
69
common ending for dihydropiridines
-pine
| +verapamil
70
common ending for beta blockers
-lol
71
what area of body does b1 blockers and b2 blockers affect
b1=heart
| b2=lungs
72
what pt should we use cautious use of b2 blockers with (3)
- asthma
- COPD
- T1 DM
73
what adverse effect can b2 blockers have in pts with T1 DM
suppresses SNS response
| *hypoglycemic unawareness
74
effect of b blockers
decreases HR and force
75
when should you hold b blocker
if HR less than 60 bpm
76
side effects b blockers (6)
- hypotension
- bradycardia
- drowsiness
- SOB
- edema
- cough
77
effect of a blockers
- vasodilation
| - decreased bp
78
side effects a blockers (4)
- vertigo
- sexual dysfunction
- palpitations
- orthostatic hypotension
79
preferred a blocker during pregnancy
methyldopa
80
a blocker used for HTN emergency as IVP (and frequently used for pts with renal impairment)
hydralazine
81
a blockers (4)
- doxazosin
- clonidine
- methyldopa
- hydralazine
82
what pt should anti-HTN meds be held for on treatment morning
```
dialysis patients
(exception = give b blockers)
```
83
important nursing considerations with HTN in older adults (2)
- may be auscultatory gap (inflate cuff high enough to get 1st beat)
- higher risk falls with orthostatic hypotension
84
severe abrupt. increase in bp
hypertensive crisis
85
what bp is considered urgent and what is considered emergent
-around 180/100 for both
urgent has no S+S end organ damage
emergent has S+S end organ damage
86
treatment hypertensive crisis (3)
- IV bp meds (calcium channel blocker and diuretics)
- monitor neuro status
- don't lower bp too fast (=stroke)
87
what time of day should methyldopa and doxazosin be taken
bedtime
- reduces sedative effect methyldopa
- reduces orthostatic hypotension doxazosin
88
3 1st line drugs for HTN
- thiazide diuretic
- calcium channel blocker
- ACE inhibitor or ARB
89
high risk OTC meds for pts with HTN
- high sodium antacids
- NSAIDs
- appetite suppressants
- cold + sinus meds
90
what should pts on anti-HTN meds avoid for 3 hours after taking meds (3)
- hot baths
- strenuous exercise
- excessive alcohol
91
possible emergent causes of hypertensive crisis (8)
- encephalopathy
- head injury (hemorrhage)
- dissecting aortic aneurysm
- pheochromocytoma
- stopped taking meds (rebound HTN)
- recreational drugs
- preeclampsia
- renovascular HTN
92
S+S aortic dissection (2)
- sudden severe back pain
| - chest pain
93
most effective IV drug for hypertensive crisis
sodium nitroprusside
