Chapter 26- hypertension Flashcards
what is the heart normally labeled as?
A pump
what is the function of the heart?
delivers o2 and nutrients to the myocardium and tissues
What is the cardiac cycle in 10 steps
- blood enters from veins -vena cava
- into the right atrium
- through tricuspid
- into the right ventricle
- through pulmonary valve and artery
- back to the heart through pulmonary veins
- into the left atrium
- though mitral valve
- into the left ventricle
- through the aorta and to the body
what is systole
contraction of the ventricles – blood going out
what is diastole
the heart refills with blood
what is stroke volume
amount of blood ejected from the left ventricle during contraction
what is preload
the end-diastolic volume, the amount of blood still in the left ventricle
what is afterload
resistance to left ventricle ejection, affected by aortic pressure
what is cardiac output and how do we find it
amount of blood pumped in a minute, HRxSV
what is contractility
ability for the heart to contract
what does the electrical conduction system use
electrolytes
what is the conduction pathway of the heart
SA node (sets pace)
AV node (receives messages, can slow conduction/filter)
bundle of his (sends messages to right and left bundle)
left/right bundle (sends messages to Purkinje)
Purkinje fibers (causes contraction)
are veins or arteries high-pressure?
arteries
why are there valves in veins
for low-pressure movement
what is the job of coronary arteries
to give oxygen-rich blood to the heart, received during diastole.
how do you find pulse pressure?
difference between pressure in the aorta during systole and diastole
what do ECGs and EKGs measure
the conduction of the heart
what does the p wave represent
atrial depolarization
what does the PR interval represent
the atrial impulse from AV to bundle branches
what does the QRS complex represent
depolarization of the ventricles
what does the ST segment represent
the end of depolarization and the beginning of repolarization
what does the T wave represent
repolarization
what will be altered for atrial arrhythmias
the p wave
the vasomotor center has two components, baroreceptors and chemoreceptors, what do they do?
baro: respond to pressure/stretch changes
chemo: respond to o2, co2, and pH
how does RAAS work
responds to low BP or sodium
- the liver releases angiotensinogen
- the kidney releases renin
- reaction creates angiotensin 1
- lungs release ACE
- reaction creates angiotensin 2
- makes adrenal glands make aldosterone
- increase reabsorption of sodium, increasing fluid and bp, will decrease potassium levels
- aldosterone will also affect kidneys, causing vasoconstriction
where and why is ADH secreted, and when will it be inhibited
hypothalamus
-concentrated electrolytes, IE low fluid volume
-will be inhibited when BP is high
how does ADH affect BP
increases BP
-retention of water
what is autoregulation of blood flow controlled by and what is the main trigger
heart, brain, kidneys
nutritional needs of the tissues
-ex: decreased o2 and increased co2 in sepsis
what does histamine do to BP
dilates the blood vessels, lowering BP
what does bradykinin do to BP
is a potent peptide, causing vasodilation
what do prostaglandins do to BP
can vasoconstrictor or dilate
what is arterial blood pressure, and what are the two main determinants
the force exerted on arterial walls by the blood flow
- cardiac output (systolic)
-peripheral vascular resistance (diastolic)
what is Frank’s law
the greater the volume in diastole, the more forceful the contraction, the more blood that the heart will pump
-not true for HF
what is considered hypotensive and what is the body’s response
systolic under 90
-SNS stimulated
-adrenal medulla will excrete epinephrine and norepinephrine
-RAAS and ADH
-kidneys retain fluid and BP is increased
the main cause of hypotension
fluid loss
what is considered hypertensive and what is the body’s response
systolic over 140 diastolic over 90
-renal secretion
-fluid loss and decreased circulating volume
-decreased CO and decreased arterial BP
-BP is lowered
difference between primary and secondary HTN
P: In most cases, unknown, hereditary, diet, or lifestyle
S: renal, endocrine, or CNS disorders and medications
negative effects of HTN
MI, CHF, strokes, renal disease, retinal damage
what does synthetic vasopressin treat
diabetes and hypotensive crisis
list the levels of hypertension, for diagnosis pt, has to experience levels from 2 readings on 2 occasions
elevated= 120-129 and >80
stage 130-139 and 80-89
stage 2 >140 and >90
what are the joint commission goals for BP based on age
<150/90 for people greater than 60
<140/90 for people less than 60 or have DM or chronic kidney disease
nonpharmacological management for HTN
-limit alcohol
-reduce sodium
-reduce fat and cholesterol
-increase fruits and veggies
-increase aerobic activity
-discontinue tobacco
-maintain optimum weight
-STRESS MANAGEMENT
is it better to change an HTN med or increase the dose?
change the medication group
how do ace inhibitors work
they inhibit the conversion of angiotensin to angiotensin 2
most common ace inhibitors
LISINOPRIL
-captopril
-enalapril
-ramipril
what suffix do ace inhibitors have
-pril
side effects of Ace inhibitors
TICKY COUGH, HYPERKALEMIA, ANGIOEDEMA
-orthostatic hypotension
-GI upset
-acute renal failure
-HA and dizziness
black box warning for ace inhibitors
pregnancy
who besides pregnant people should not take an ace inhibitor
people with impaired renal function and CHF
how do arbs work
selectively bind to angiotensin 2 receptors
why would someone take an arb even though its expensive
side effects from ace
examples of ARBS
LOSARTAN
-valsartan
-olmesartan
suffix of arbs
-sartan
side effects to arbs
ANGIO EDEMA, ACUTE RENAL FAILURE, HYPERKALEMIA
-orthostatic hypotension
-ha, dizziness
-dry mouth
-diarrhea
who can not take arbs besides pregnant people
hepatic and renal impairment
black box for arbs
pregnancy
what is the dose for arbs for htn and chf
-once a day for htn
-twice a day for chf
how do calcium channel blockers work
inhibit the movement of calcium, causing decreased HR and vasodilation
common calcium channel blockers
amlodipine, diltiazem, nicardipine, nifedipine
suffix of SOME calcium channel blockers
-dipine
common side effects of calcium channel blockers
SEXUAL DYSFUNCTION
-flushed skin, muscle cramps, peripheral edema
-ha, dizziness, hypotension
-hepatotoxicity
-angioedema
who can not take calcium channel blockers
hepatic and renal impairment, CHF/heart block, pregnancy
what do calcium channel blockers interact with
macrolide antibiotics and grapefruit juice
how do alpha 1 blockers work
inhibit SNS
-dilate blood vessels and decrease PVR
common alpha one blockers
doxazosin, prazosin, terazosin
side effects of alpha one blockers
FIRST DOSE: orthostatic hypotension, dizziness, palpitation, syncopal episode – FIRST DOSE IS HIGHER
-can cause fluid retention
-given at bedtime
how do alpha two agonists work
inhibit SNS: decreased CO, decreased HR, decreased PVR, decreased BP
common alpha two agonists
CLONIDINE
-methyldopa and guanfacine
side effects of alpha two agonists
FIRST DOSE: orthostatic hypotension, dizziness, palpitation, syncopal episode – FIRST DOSE IS HIGHER
-can cause fluid retention
-given at bedtime
is clonidine often used
no, it is a last-resort med that needs monitoring
how do beta blockers work
decrease HR, contraction, CO, and renin release
common beta blockers
atenolol, metoprolol, propranolol
suffix for beta blockers
-olol
why are beta blockers popular?
-first to be used for pts under 50
-first to be used for selective meds, for pts with asthma, PVD, or DM
what do beta blockers treat
HTN, dysrhythmias, HF, MI, glaucoma
side effects of beta blockers
hypotension, bradycardia, dizziness, erectile dysfunction
black box warning for beta blockers
have to be titrated off, which can cause angina, arrhythmias and MI
how do alpha-beta blockers work
the dual effect, works well
common alpha-beta blockers
carvedilol, labetalol
are diuretics a first-line med
yes, good for mild/moderate HTN
how do thiazide diuretics work
block Na reabsorption
increase K and H20 secretion
most common thiazide diuretic and treatment of HTN
hydrochlorothiazide HCTZ
How do potassium-sparing diuretics work
excretion of Na and retention of K
-blocks aldosterone
common potassium-sparing diuretic
spironolactone
what to know about potassium-sparing diuretics
can increase the effects of digoxin
can cause hyperkalemia if taking ACE or ARB
how do loop diuretics work
Inhibits the reabsorption of Na, Cl, and K in the loop of Henle
concerns of loop diuretics
can increase digoxin and cause hypokalemia
most common loop diuretic
furosemide –LASIX
what can cause a hypertensive emergency
malignant HTN, cerebral hemorrhage, dissecting aortic aneurysm, renal disease
symptoms of hypertensive emergency
HA, H/V, visual changes, neuro changes, disorientation, decreased consciousness
how do direct-acting vasodilators work
relax smooth muscles in blood vessels
common direct-acting vasodilators
hydralazine and nitroprusside (IV only)
broad things to monitor for HTN meds
-bradycardia
-hypotension and orthostatic (fall risk)
-monitor I&O – diuetics
-heart healthy and Na restrictive diet
-electrolytes
-telemetry monitoring
-supplements used
-specialty populations
