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NRSG 220 > Chapter 34: HYPERTENSION (9) > Flashcards

Chapter 34: HYPERTENSION (9) Flashcards

1
Q

HTN

A

consistent elevation of systemic arterial BP

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2
Q

HTN factors

A
  1. Genetic factors
  2. Environmental factors
    - diet
    -exercise
    -age
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3
Q

Primary HTN

A

Also called essential, there is NO identifiable cause

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4
Q

Secondary HTN

A

Caused by another disease

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5
Q

Where does prolonged HTN damage?

A
  1. Heart
  2. Eyes
  3. Brain
  4. Kidneys
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6
Q

How does prolonged HTN damage the heart?

A

Hypertrophy, MI, HF

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7
Q

What to watch for with heart damage from HTN

A

Rapid weight gain (5lbs in 2-3/days), SOB, BLE edema

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8
Q

How does prolonged HTN damage the eyes?

A

Blindness - frequent eye checks

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9
Q

How does prolonged HTN affect the brain?

A

Stroke - assess speech changes, drooping face, one sided weakness

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10
Q

How does prolonged HTN affect the kidneys?

A

Kidney failure

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11
Q

What to watch for with the kidneys and prolonged HTN?

A

protein in the urine (micro-macro albuminuria)
Kidneys like fishing nets, let micro pass but not macro
if macro is in urine = kidney problem

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12
Q

What arterial changes occur with prolonged HTN

A

Endothelial inflammation
arteriosclerosis
Atherosclerosis

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13
Q

What do arterial changes with prolonged HTN end with?

A

increased afterload leading to hypertrophy
CAD leading to MI
Cerebrovascular disease leading to stroke

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14
Q

What can lifestyle changes do for HTN

A

May eliminate the need for pharmacotherapy

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15
Q

What are some lifestyle changes to non pharmacologically treat HTN?

A
  1. Limit alcohol
  2. Restrict sodium consumption
  3. Dash diet
  4. Aerobic exercise at least 30 mins 3-5x/week
  5. Tobacco cessation
  6. Stress management
  7. Maintain optimum weight
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16
Q

What is the DASH diet?

A

rich in fruits, veggies, whole grains, and low fat dairy foods (includes meat fish, poultry, nuts and beans)
limited in sugar sweetened foods and drinks, red meat and added fats

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17
Q

What are racial differences associated with HTN treatment

A

Same therapy for blacks and nonblacks with CKD
Different therapy for blacks and nonblacks without CKD
Lower systolic BP with diabetics (decreased resistance to kidneys)

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18
Q

What’s important to note when managing HTN?

A

Not all people with a BP higher than 140/90 need pharmacotherapy

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19
Q

What are the different types of antihypertensives? (9)

A
  1. Diuretics
  2. Angiotensin-converting enzyme inhibits (ACEI)
  3. Angiotensin 2 receptor blockers (ARBS)
  4. Calcium channel blockers (CCBs)
  5. Beta 1 blockers (BBs)
  6. Beta 2 blockers
  7. Alpha 1 blockers
  8. Alpha 2 agonists
  9. Vasodilators
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20
Q

Goal of pharmacotherapy?

A

To reduce morbidity and mortality

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21
Q

What is pharmacotherapy individualized to?

A

Patients risk factors
Comorbid medical conditions
degree of BP elevation

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22
Q

What are some patient adherence factors to consider?

A
  1. Difficult of changing established lifestyle habits
  2. Choose generic forms to decrease cost of drug for pt
  3. occurrence of ADEs
  4. Encourage patient to report ADEs to adjust dosage (BB, depression, fatigue)
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23
Q

Diuretics are

A

often the 1st choice in treating mild-moderate HTN

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24
Q

What diuretic is first line treatment?

A

Thiazide diuretics

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25
Q

What do diuretics do?

A

Decrease blood volume and decrease pressure

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26
Q

ADEs of diuretics

A

Dehydration
Hyponatremia
hypokalemia (less with K+ sparing)
Nocturne (if given too late in the day)
Orthostatic hypotension

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27
Q

What are the 3 kinds of diuretics + prototype drug

A
  1. Thiazide/thiazide like diuretics
    - most common for HTN
    - HYDROCHLOROTHIAZIDE
  2. Potassium-sparing diuretics
    - TRIAMTERENE, SPIRONOLACTONE
  3. Loop (high-ceiling) diuretics
    - usually not used for HTN
    - FUROSEMIDE, BUMETANIDE = K+
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28
Q

What do ACEIs do?

A

Vasodilation by reducing angiotensin 2
- decreased aldosterone effects
increases effectiveness of diuretics
- protect kidney

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29
Q

Common ACEI agents

A

enalpril, lisinopril, captopril

30
Q

ACEI ADEs

A

Persistent cough
postural hypotension
hyperkalemia
angioedema

31
Q

ARBS

A

Inhibit effects of angiotensin 2
- similar effects to ACEIs

32
Q

ARBS ADEs

A

hypotension
angioedema (less common compared to ACEIs)
more expensive
no cough

33
Q

Calcium channel blockers selective drugs

A

DIHYDROPIRIDINE
- relax arterial smooth muscle
- nifiedipine, amlodipine

34
Q

CCBs Nonselective drugs

A

NONDIHYPROPIRIDINE
- relax arterial smooth muscle
- affect myocardial contraction and HR
- verapamil, diltiazem

35
Q

CCBs ADEs

A

reflex tachycardia
peripheral edema
exacerbation of some dysrhythmias
worsens HF

research shows greater efficacy in African Americans and elderly patients

36
Q

Adrenergic Antagonists

A
  • used for cardio disorders
  • block adrenergic receptors in SNS
37
Q

What receptors do adrenergic antagonists block?

A
  1. Beta 1 adrenergic receptors
  2. Alpa 1 adrenergic receptors
  3. Alpha 2 and beta adrenergic receptors
  4. peripheral adrenergic neurons
38
Q

Nonselective ABs and BBs

A

Carvedilol, labetalol
- block both alpha 1 and beta adrenergic receptors

39
Q

How do nonselective ABs and BBs act in the body

A

decrease CO
decrease renin secretion
block vasoconstriction of arterioles and veins

40
Q

Nonselective ABs and BBs ADEs

A

orthostatic hypotension
bradycardia
bronchoconstriction
potential for arrhythmias

watch with asthmatics, COPD, and DMs

41
Q

What do BBs do

A

decrease HR, contractility, and cardiac conduction velocity = decreased BP

42
Q

BB agents

A

Propanolol
metoprolol
atenolol
timolol

43
Q

BB ADEs:

A

High doses:
- fatigue, activity intolerance
-erectile dysfunction
- masks symptoms of hypoglycemia
- clinical depression

44
Q

Direct acting vasodilators

A

relax arterial smooth muscle directly = decrease resistance and decreased afterload

45
Q

Vasodilators can also affect

A

some drugs affect veins which decrease preload (eg isosorbide denigrate)

46
Q

Vasodilators ADEs

A
  • reflex tachycardia & hypotension (compensatory increase in HR due to sudden BP drop)
  • fluid retention (can be minimized with BBs and diuretics)
47
Q

Vasodilators agents

A

hydralazine, diazoxide, nitroprusside

48
Q

Vasodilators prototype drug?

A

Hydralazine

49
Q

Hydralazine therapeutic

A

Antihypertensive

50
Q

Hydralazine pharmacologic

A

direct vasodilator

51
Q

Hydralazine uses

A

moderate to severe HTN
hypertensive emergiences
acute HF

52
Q

Hydralazine MOA

A

Causes peripheral vasodilation
decrease PVR, HR, and CO
decreases afterload
selective for arterioles

53
Q

Hydralazine ADEs

A

HA
tachycardia
palpitations
flushing
N/V/D
Orthostatic Hypotension
Lupus like syndrome

54
Q

Hydralazine serious ADEs

A

Blood dyscrasia

55
Q

Hydralazine contraindications/precautions

A

Lupus
CV disease
rheumatic Heart disease
renal impairment
slow aetylators
CAD

56
Q

Hydralazine drug interactions

A
  • severe hypotension with antihypertensives of MAOIs
  • NSAIDs may decrease antihypertensive action
57
Q

Hydralazine pregnancy category

A

C

58
Q

Hydralazine OD treatment

A
  • gastric lavage, activated charcoal, administration of a plasma volume expander
  • treat tachycardia with a beta blocker
59
Q

Hydralazine Considerations

A

Hx and Px
monitor lab tests fro antinuclear antibody timer before and during lab therapy
monitor I&O
watch for ADEs
Assess for rapid drop in BP and subsequent tachycardia

60
Q

What classifies a Hypertensive emergency

A

Diastolic over 120
evidence of organ damage
most common cause is untreated/poorly controlled essential HTN

61
Q

Urgency classification of HTN

A

Diastolic over 120
no evidence of organ damage
more conservative treatment

62
Q

What is the prototype drug used for hypertensive emergencies?

A

Nitroprusside sodium (nitropress)

63
Q

Nitroprusside therapeutic

A

Antihypertensive

64
Q

Nitroprusside pharmacologic

A

direct vasodilators

65
Q

Nitroprusside uses

A

aggressive, life threatening HTN

66
Q

Nitroprusside MOA

A

direct relaxation of arteries and veins

67
Q

Nitroprusside ADEs

A

Hypotension
headahce
dizziness
skin flushing

68
Q

Nitroprusside contraindications

A

high ICP
inadequate cerebral circulation
compensatory HTN
serious renal impairment

69
Q

Nitroprusside Pregnancy category

A

C

70
Q

Nitroprusside treatment of OD

A

Vasopressor for extreme hypotension
cyanide antidote kit for cyanide toxicity

NRSG 220 (8 decks)

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