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PathoPharm 2 > ch 32 hypertension > Flashcards

ch 32 hypertension Flashcards

1
Q

what two things control blood pressure

A
  • cardiac output

- systemic vascular resistance

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2
Q

what location in body do alpha 1 receptors act on (2)

A
  • vascular smooth muscle

- heart

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3
Q

what location in body do alpha 2 receptors act on

A

vascular smooth muscle

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4
Q

how do alpha 1 and 2 receptors affect bp

A

vasoconstriction

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5
Q

how do beta 1 receptors affect bp (3)

A
  • increase heartrate
  • increase force of contraction
  • increase speed of conduction
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6
Q

what location in body do beta 1 receptors act on

A

heart

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7
Q

what location in body do beta 2 receptors act on (2)

A
  • heart

- lungs

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8
Q

example of beta 2 agonist med that causes bronchodilation

A

albuterol

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9
Q

what is the effect of angiotensin II on bp

A

vasoconstriction

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10
Q

what is the effect of aldosterone on the body (4)

A
  • decreases urine output
  • increases sodium
  • increases fluids
  • increases bp flow
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11
Q

what is considered normal bp

A

<120/<80

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12
Q

what is considered elevated bp

A

120-129/<80

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13
Q

what is considered stage 1 HTN

A

130-139/80-89

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14
Q

what is considered stage 2 HTN

A

> 140/>90

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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
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16
Q

4 contributors to primary HTN

A
  • sympathetic nervous system
  • renal system
  • insulin resistance
  • endothelial cell damage
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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
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18
Q

force opposing movement of blood within blood vessels

A

systemic vascular resistance

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19
Q

what hormone from SNS do alpha receptors respond to

A

norepinephrine

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20
Q

what hormone(s) from SNS do beta 1 receptors respond to

A

epinephrine + norepinephrine

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21
Q

what hormone(s) from SNS do beta 2 receptors respond to

A

epinephrine

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22
Q

how do beta 2 receptors affect bp (1)

A

vasodilation

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23
Q

how do baroreceptors affect bp (3)

A
  • decrease heart rate
  • decrease force of contraction
  • vasodilation
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24
Q

what 2 substances are produced by the endothelium that cause vasodilation

A
  • nitric oxide

- prostacyclin

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25
Q

what substance is produced by the endothelium that causes vasoconstriction

A

endothelin

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26
Q

what 2 things can reduce endothelial cell function

A
  • smoking

- diabetes

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27
Q

how does angiotensin II increase bp (2)

A
  • vasoconstrictor

- stimulates adrenal cortex to secret aldosterone

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28
Q

how do prostaglandins secreted by renal medulla affect bp

A

vasodilation, lowers bp

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29
Q

what age range is more common for HTN to develop in men

A

before early middle age

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30
Q

what factors in women are linked with higher prevalence of HTN (4)

A
  • use of oral contraceptives
  • h/o preeclampsia
  • post-menopause (64 yo+)
  • older age (70-79)
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31
Q

hemodynamic hallmark that is pathophysiology of primary HTN

A

persistently increased systemic vascular resistance

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32
Q

target organs of hypertension (5)

A
  • heart
  • brain
  • peripheral vessels
  • kidneys
  • eyes
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33
Q

4 conditions of the eyes resulting from HTN

A
  • AV nicking
  • narrowing or retinal arterioles
  • hemorrhages
  • papilledema
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34
Q

2 conditions of the brain resulting from HTN

A
  • stroke

- transient ischemic attack

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35
Q

3 conditions of the kidneys resulting from HTN

A
  • microalbuminuria
  • proteinuria
  • serum creatinine >1.5
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36
Q

3 conditions of the heart resulting from HTN

A
  • CAD
  • heart failure
  • left ventricular hypertrophy
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37
Q

1 condition of the sexual organs resulting from HTN

A

erectile dysfunction

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38
Q

2 conditions of the peripheral vascular system resulting from HTN

A
  • intermittent claudication

- faint/absent peripheral pulses

39
Q

S+S HTN (4) seen with severe HTN

“silent killer”

A
  • fatigue
  • dizziness
  • palpitations, chest pain
  • dyspnea
40
Q

diagnostic studies looking for target organ damage or evaluating for secondary HTN (6)

A
  • urinalysis
  • metabolic panel
  • complete blood count
  • ECG
  • TSH
  • serum lipid profile
41
Q

how many separate occasions does a pt have to have high blood pressure to be considered hypertensive

A

2 separate occasions

42
Q

what will happen to bp if bp cuff is too big

A

false low bp reading

43
Q

what will happen to bp if bp cuff is too smal

A

false high bp reading

44
Q

recommended lifestyle changes for pt with HTN (6)

A
  • stop smoking
  • exercise (150 mins/week)
  • lose weight
  • moderate alcohol consumption
  • stress management
  • diet (low salt, low cholesterol, healthy fats)
45
Q

how much will bp decrease for every 1 kg weight loss

A

1 mmHg

46
Q

how much sodium should pt with HTN consume per day

A

1500 mg/day or less

47
Q

common side effect and rare side effect of ACE inhibitors (2)

A

cough

angioedema

48
Q

what side effect can result from the combo of aspirin + furosemide

A

tinnitus

49
Q

what labs should you check before administering thiazide diuretics (2)

A
  • sodium

- chloride

50
Q

effect of thiazide diuretics

A
  • inhibits sodium and chloride reabsorption on distal tubule

- lowers bp by reducing blood volume

51
Q

what time of day should pt take diuretic

A

morning

52
Q

what side effects should you monitor for with diuretics (4)

A
  • hypokalemia
  • hyponatremia
  • hyperglycemia
  • orthostatic hypotension
53
Q

effect of loop diuretics

A

-increases urine output on loop of henle

54
Q

example of 1 loop diuretic

A

furosemide

55
Q

what ending characterizes ACE inhibitors

A

-pril

56
Q

effect of ACE inhibitors

A

-prevents conversion angiotensin 1 to angiotensin 2

57
Q

are ACE inhibitors or ARBs preferred for patients with T2 diabetes

A

ACE

-they can help prevent neuropathy

58
Q

can pregnant pts take ACE inhibitors, ARBs, or calcium channel blockers

A

no

very teratogenic

59
Q

can you combine ACE inhibitors with ARBs

A

no! very potent

60
Q

when should you hold anti-HTN meds

A

if systolic is less than 110

61
Q

what ending characterizes ARBs

A

-sartans

62
Q

effect of ARBs

A

blocks receptor sites for angiotensin 2

produce vasodilation

63
Q

effect of calcium channel blockers

A
  • blocks calcium to myocardium

- decreases cardiac output and force

64
Q

what VS should you check before admin of calcium channel blockers (2)

A
  • bp

- HR

65
Q

what food cannot be given with calcium channel blockers

A

grapefruit juice

66
Q

preferred anti-HTN med for african american pt

A

calcium channel blockers

67
Q

what pt should we use cautious use of calcium channel blockers with

A

pts with conditions that affect cardiac output (HF)

68
Q

common side effect dihydropiridines

A

peripheral edema

69
Q

common ending for dihydropiridines

A

-pine

+verapamil

70
Q

common ending for beta blockers

A

-lol

71
Q

what area of body does b1 blockers and b2 blockers affect

A

b1=heart

b2=lungs

72
Q

what pt should we use cautious use of b2 blockers with (3)

A
  • asthma
  • COPD
  • T1 DM
73
Q

what adverse effect can b2 blockers have in pts with T1 DM

A

suppresses SNS response

*hypoglycemic unawareness

74
Q

effect of b blockers

A

decreases HR and force

75
Q

when should you hold b blocker

A

if HR less than 60 bpm

76
Q

side effects b blockers (6)

A
  • hypotension
  • bradycardia
  • drowsiness
  • SOB
  • edema
  • cough
77
Q

effect of a blockers

A
  • vasodilation

- decreased bp

78
Q

side effects a blockers (4)

A
  • vertigo
  • sexual dysfunction
  • palpitations
  • orthostatic hypotension
79
Q

preferred a blocker during pregnancy

A

methyldopa

80
Q

a blocker used for HTN emergency as IVP (and frequently used for pts with renal impairment)

A

hydralazine

81
Q

a blockers (4)

A
  • doxazosin
  • clonidine
  • methyldopa
  • hydralazine
82
Q

what pt should anti-HTN meds be held for on treatment morning

A 
dialysis patients
(exception = give b blockers)
83
Q

important nursing considerations with HTN in older adults (2)

A
  • may be auscultatory gap (inflate cuff high enough to get 1st beat)
  • higher risk falls with orthostatic hypotension
84
Q

severe abrupt. increase in bp

A

hypertensive crisis

85
Q

what bp is considered urgent and what is considered emergent

A

-around 180/100 for both
urgent has no S+S end organ damage
emergent has S+S end organ damage

86
Q

treatment hypertensive crisis (3)

A
  • IV bp meds (calcium channel blocker and diuretics)
  • monitor neuro status
  • don’t lower bp too fast (=stroke)
87
Q

what time of day should methyldopa and doxazosin be taken

A

bedtime

  • reduces sedative effect methyldopa
  • reduces orthostatic hypotension doxazosin
88
Q

3 1st line drugs for HTN

A
  • thiazide diuretic
  • calcium channel blocker
  • ACE inhibitor or ARB
89
Q

high risk OTC meds for pts with HTN

A
  • high sodium antacids
  • NSAIDs
  • appetite suppressants
  • cold + sinus meds
90
Q

what should pts on anti-HTN meds avoid for 3 hours after taking meds (3)

A
  • hot baths
  • strenuous exercise
  • excessive alcohol
91
Q

possible emergent causes of hypertensive crisis (8)

A
  • encephalopathy
  • head injury (hemorrhage)
  • dissecting aortic aneurysm
  • pheochromocytoma
  • stopped taking meds (rebound HTN)
  • recreational drugs
  • preeclampsia
  • renovascular HTN
92
Q

S+S aortic dissection (2)

A
  • sudden severe back pain

- chest pain

93
Q

most effective IV drug for hypertensive crisis

A

sodium nitroprusside

PathoPharm 2 (33 decks)

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