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Pharm EXAM 2 > Chapter 26- hypertension > Flashcards

Chapter 26- hypertension Flashcards

1
Q

what is the heart normally labeled as?

A

A pump

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2
Q

what is the function of the heart?

A

delivers o2 and nutrients to the myocardium and tissues

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3
Q

What is the cardiac cycle in 10 steps

A
  1. blood enters from veins -vena cava
  2. into the right atrium
  3. through tricuspid
  4. into the right ventricle
  5. through pulmonary valve and artery
  6. back to the heart through pulmonary veins
  7. into the left atrium
  8. though mitral valve
  9. into the left ventricle
  10. through the aorta and to the body
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4
Q

what is systole

A

contraction of the ventricles – blood going out

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5
Q

what is diastole

A

the heart refills with blood

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6
Q

what is stroke volume

A

amount of blood ejected from the left ventricle during contraction

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7
Q

what is preload

A

the end-diastolic volume, the amount of blood still in the left ventricle

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8
Q

what is afterload

A

resistance to left ventricle ejection, affected by aortic pressure

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9
Q

what is cardiac output and how do we find it

A

amount of blood pumped in a minute, HRxSV

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10
Q

what is contractility

A

ability for the heart to contract

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11
Q

what does the electrical conduction system use

A

electrolytes

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12
Q

what is the conduction pathway of the heart

A

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)

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13
Q

are veins or arteries high-pressure?

A

arteries

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14
Q

why are there valves in veins

A

for low-pressure movement

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15
Q

what is the job of coronary arteries

A

to give oxygen-rich blood to the heart, received during diastole.

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16
Q

how do you find pulse pressure?

A

difference between pressure in the aorta during systole and diastole

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17
Q

what do ECGs and EKGs measure

A

the conduction of the heart

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18
Q

what does the p wave represent

A

atrial depolarization

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19
Q

what does the PR interval represent

A

the atrial impulse from AV to bundle branches

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20
Q

what does the QRS complex represent

A

depolarization of the ventricles

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21
Q

what does the ST segment represent

A

the end of depolarization and the beginning of repolarization

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22
Q

what does the T wave represent

A

repolarization

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23
Q

what will be altered for atrial arrhythmias

A

the p wave

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24
Q

the vasomotor center has two components, baroreceptors and chemoreceptors, what do they do?

A

baro: respond to pressure/stretch changes
chemo: respond to o2, co2, and pH

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25
Q

how does RAAS work

A

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

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26
Q

where and why is ADH secreted, and when will it be inhibited

A

hypothalamus
-concentrated electrolytes, IE low fluid volume
-will be inhibited when BP is high

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27
Q

how does ADH affect BP

A

increases BP
-retention of water

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28
Q

what is autoregulation of blood flow controlled by and what is the main trigger

A

heart, brain, kidneys
nutritional needs of the tissues
-ex: decreased o2 and increased co2 in sepsis

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29
Q

what does histamine do to BP

A

dilates the blood vessels, lowering BP

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30
Q

what does bradykinin do to BP

A

is a potent peptide, causing vasodilation

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31
Q

what do prostaglandins do to BP

A

can vasoconstrictor or dilate

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32
Q

what is arterial blood pressure, and what are the two main determinants

A

the force exerted on arterial walls by the blood flow
- cardiac output (systolic)
-peripheral vascular resistance (diastolic)

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33
Q

what is Frank’s law

A

the greater the volume in diastole, the more forceful the contraction, the more blood that the heart will pump
-not true for HF

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34
Q

what is considered hypotensive and what is the body’s response

A

systolic under 90
-SNS stimulated
-adrenal medulla will excrete epinephrine and norepinephrine
-RAAS and ADH
-kidneys retain fluid and BP is increased

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35
Q

the main cause of hypotension

A

fluid loss

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36
Q

what is considered hypertensive and what is the body’s response

A

systolic over 140 diastolic over 90
-renal secretion
-fluid loss and decreased circulating volume
-decreased CO and decreased arterial BP
-BP is lowered

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37
Q

difference between primary and secondary HTN

A

P: In most cases, unknown, hereditary, diet, or lifestyle
S: renal, endocrine, or CNS disorders and medications

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38
Q

negative effects of HTN

A

MI, CHF, strokes, renal disease, retinal damage

39
Q

what does synthetic vasopressin treat

A

diabetes and hypotensive crisis

40
Q

list the levels of hypertension, for diagnosis pt, has to experience levels from 2 readings on 2 occasions

A

elevated= 120-129 and >80
stage 130-139 and 80-89
stage 2 >140 and >90

41
Q

what are the joint commission goals for BP based on age

A

<150/90 for people greater than 60
<140/90 for people less than 60 or have DM or chronic kidney disease

42
Q

nonpharmacological management for HTN

A

-limit alcohol
-reduce sodium
-reduce fat and cholesterol
-increase fruits and veggies
-increase aerobic activity
-discontinue tobacco
-maintain optimum weight
-STRESS MANAGEMENT

43
Q

is it better to change an HTN med or increase the dose?

A

change the medication group

44
Q

how do ace inhibitors work

A

they inhibit the conversion of angiotensin to angiotensin 2

45
Q

most common ace inhibitors

A

LISINOPRIL
-captopril
-enalapril
-ramipril

46
Q

what suffix do ace inhibitors have

A

-pril

47
Q

side effects of Ace inhibitors

A

TICKY COUGH, HYPERKALEMIA, ANGIOEDEMA
-orthostatic hypotension
-GI upset
-acute renal failure
-HA and dizziness

48
Q

black box warning for ace inhibitors

A

pregnancy

49
Q

who besides pregnant people should not take an ace inhibitor

A

people with impaired renal function and CHF

50
Q

how do arbs work

A

selectively bind to angiotensin 2 receptors

51
Q

why would someone take an arb even though its expensive

A

side effects from ace

52
Q

examples of ARBS

A

LOSARTAN
-valsartan
-olmesartan

53
Q

suffix of arbs

A

-sartan

54
Q

side effects to arbs

A

ANGIO EDEMA, ACUTE RENAL FAILURE, HYPERKALEMIA
-orthostatic hypotension
-ha, dizziness
-dry mouth
-diarrhea

55
Q

who can not take arbs besides pregnant people

A

hepatic and renal impairment

56
Q

black box for arbs

A

pregnancy

57
Q

what is the dose for arbs for htn and chf

A

-once a day for htn
-twice a day for chf

58
Q

how do calcium channel blockers work

A

inhibit the movement of calcium, causing decreased HR and vasodilation

59
Q

common calcium channel blockers

A

amlodipine, diltiazem, nicardipine, nifedipine

60
Q

suffix of SOME calcium channel blockers

A

-dipine

61
Q

common side effects of calcium channel blockers

A

SEXUAL DYSFUNCTION
-flushed skin, muscle cramps, peripheral edema
-ha, dizziness, hypotension
-hepatotoxicity
-angioedema

62
Q

who can not take calcium channel blockers

A

hepatic and renal impairment, CHF/heart block, pregnancy

63
Q

what do calcium channel blockers interact with

A

macrolide antibiotics and grapefruit juice

64
Q

how do alpha 1 blockers work

A

inhibit SNS
-dilate blood vessels and decrease PVR

65
Q

common alpha one blockers

A

doxazosin, prazosin, terazosin

66
Q

side effects of alpha one blockers

A

FIRST DOSE: orthostatic hypotension, dizziness, palpitation, syncopal episode – FIRST DOSE IS HIGHER
-can cause fluid retention
-given at bedtime

67
Q

how do alpha two agonists work

A

inhibit SNS: decreased CO, decreased HR, decreased PVR, decreased BP

68
Q

common alpha two agonists

A

CLONIDINE
-methyldopa and guanfacine

69
Q

side effects of alpha two agonists

A

FIRST DOSE: orthostatic hypotension, dizziness, palpitation, syncopal episode – FIRST DOSE IS HIGHER
-can cause fluid retention
-given at bedtime

70
Q

is clonidine often used

A

no, it is a last-resort med that needs monitoring

71
Q

how do beta blockers work

A

decrease HR, contraction, CO, and renin release

72
Q

common beta blockers

A

atenolol, metoprolol, propranolol

73
Q

suffix for beta blockers

A

-olol

74
Q

why are beta blockers popular?

A

-first to be used for pts under 50
-first to be used for selective meds, for pts with asthma, PVD, or DM

75
Q

what do beta blockers treat

A

HTN, dysrhythmias, HF, MI, glaucoma

76
Q

side effects of beta blockers

A

hypotension, bradycardia, dizziness, erectile dysfunction

77
Q

black box warning for beta blockers

A

have to be titrated off, which can cause angina, arrhythmias and MI

78
Q

how do alpha-beta blockers work

A

the dual effect, works well

79
Q

common alpha-beta blockers

A

carvedilol, labetalol

80
Q

are diuretics a first-line med

A

yes, good for mild/moderate HTN

81
Q

how do thiazide diuretics work

A

block Na reabsorption
increase K and H20 secretion

82
Q

most common thiazide diuretic and treatment of HTN

A

hydrochlorothiazide HCTZ

83
Q

How do potassium-sparing diuretics work

A

excretion of Na and retention of K
-blocks aldosterone

84
Q

common potassium-sparing diuretic

A

spironolactone

85
Q

what to know about potassium-sparing diuretics

A

can increase the effects of digoxin
can cause hyperkalemia if taking ACE or ARB

86
Q

how do loop diuretics work

A

Inhibits the reabsorption of Na, Cl, and K in the loop of Henle

87
Q

concerns of loop diuretics

A

can increase digoxin and cause hypokalemia

87
Q

most common loop diuretic

A

furosemide –LASIX

88
Q

what can cause a hypertensive emergency

A

malignant HTN, cerebral hemorrhage, dissecting aortic aneurysm, renal disease

89
Q

symptoms of hypertensive emergency

A

HA, H/V, visual changes, neuro changes, disorientation, decreased consciousness

90
Q

how do direct-acting vasodilators work

A

relax smooth muscles in blood vessels

91
Q

common direct-acting vasodilators

A

hydralazine and nitroprusside (IV only)

92
Q

broad things to monitor for HTN meds

A

-bradycardia
-hypotension and orthostatic (fall risk)
-monitor I&O – diuetics
-heart healthy and Na restrictive diet
-electrolytes
-telemetry monitoring
-supplements used
-specialty populations

Pharm EXAM 2 (8 decks)

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