drug therapy for hypertension Flashcards
(132 cards)
1
Q
what is the function of the cardiac cycle?
A
essential in delivery of O2 to myocardium and tissues
2
Q
what are the two parts of the cardiac cycle?
A
systole and diastole
3
Q
describe…
systole
A
-contraction of the ventricles of the heart that occurs between the first and second sounds of the cardiac cycle
-pushes blod out
4
Q
describe…
diastole
A
-part of the cardiac sysle dutring which the heart refills with blood after emptying during systole
-relaxation, resting state
5
Q
describe…
stroke volume
A
amount of blood ejected from the left ventricle with each contraction
preload, afterload, contractility
6
Q
describe…
preload
A
-end diastolic volume
-the amount of blood left in the left ventricle
7
Q
describe…
afterload
A
-resistance to left ventriclular ejection
-the work the heart muscle must overcome to eject blood
-effected by aortic pressure and vascular resistance
8
Q
describe…
contractility
A
ability of heart muscle to contract
9
Q
describe…
cardiac output
A
-amount of blood pumped by the heart each minute
- HR x SV = CO
heartrate x stroke volume = cardiac output
10
Q
what is the process of the cardiac conduction pathway?
A
SA node -> AV node -> bundle of his -> right and left bundle -> purkinje fibers
the heart is an electrical conduction pathway
11
Q
what is the process of the cardiac conduction pathway?
A
SA node -> AV node -> bundle of his -> right and left bundle -> purkinje fibers
the heart is an electrical conduction pathway
12
Q
cardiac conduction pathway
describe the SA node
A
pacemaker of the heart, sets the pace for contraction
13
Q
cardiac conduction pathway
describe the AV node
A
-receives message from SA node
-has the ability to slow or delay the conduction so the ventricles fill properly
14
Q
cardiac conduction pathway
describe bundle of his
A
-receives message from AV node
-sends message to right and left bundle branches
15
Q
cardiac conduction pathway
describe purkinje fibers
A
-gets message from bundle branches
-causes contraction of the ventricles
16
Q
describe…
cardiac blood flow
A
-venous system brings deoxygenated blood back to the heart
-arterial system brings oxygenated blood out of the heart and to the body
17
Q
what are the differences between the venous and arterial systems
think about pressures
A
-venous is a low pressure system with valves
-arterial is a high pressure system with no valves
18
Q
describe…
coronary circulation
A
-arteries and veins that supply the heart muscle itself
-right and left coronary arteries branch off base of aorta
-receive blood during diastole
19
Q
describe…
pulse pressure
A
-SBP minus DBP
-represents filling pressure of coronary arteries
20
Q
describe…
electrocardiography
ECG/EKG
A
measurment tool used to evaluate conduction of the heart
includes P wave, PR inerval, QRS complex, ST segment, T wave
21
Q
describe…
P wave
A
atrial depolarization (conduction of electrical umplse through the atria)
22
Q
describe…
PR interval
A
tracks the atrial impulse through the AV node, buncle of HIS and right and left bundle branches
23
Q
describe…
QRS complex
A
depolarization of ventricles
24
Q
describe…
ST segment
A
-end of ventricular conduction/depolarization
-beginning of ventricular repolarization (rest)
25
# describe...
T wave
ventricular recovery or repolarization
26
what are the three components of the physiological regulation of blood pressure
-vasomotor center
-emotions
-hormones
27
what are the components of the vasomotor center
-baroreceptors
-chemoreceptors
28
# describe...
baroreceptors
| what do they respond to?
respond to increase or decrease in pressure or stretch
29
# describe...
chemoreceptors
| what do they respond to?
respond to changes in oxygen, carbon dioxide, and pH
30
how can emotions effect blood pressure?
-anger or stress elevate BP
-depression or lethargy decrease BP
31
what hormones impact BP?
-antidiuretic hormone (ADH)
-renin-angiotensin-aldosterone system (RAAS)
32
where is ADH released from?
hypothalamus
33
# describe...
ADH
-keeps fluids in the body
-secreted when electrolytes get concentrated
-secreted when BP is too low
-inhibited when BP is too high
**released to increase BP and increase fluid volume**
34
# describe...
RAAS
-in response to low BP or in response to low fluid volume (low Na+), RAAS kicks in to compensate
-in place to regulate BP by bringing it up
35
how does RAAS work?
-causes increase in Na+ which increases fluid and BP
-causes decrease in K+
-causes vasoconstriction in arterioles which increases BP
36
name 3 factors that effect BP
-blood volume
-peripheral resistance/diameter of arterioles
-cardiac output
37
how can blood volume affect BP?
-fluid loss (dehydration, bleeding) can lower BP
-fluid retention can increase BP
38
describe how peripheral resistance/diameter of arteriales can impact BP
-SNS activity (activation can increase HR and vasoconstriction)
-renin and angiotensin 2 are released as the bodys response to BP change
-increase in blood viscosity increases BP
39
describe how cardiac output can impact BP
-stroke volume (preload, contractility, afterload)
-HR (SNS activity, PNS activity, epinephrine)
40
# true or false?
hypertension increases the risk of cancer
false
## Footnote
HTN increases the risk of MI, CHF, cerebral infarction/hemorrhage, and renal disease
41
describe the autoregulation of blood flow
ability of the organ/body tissues to regulateown blood flow (heart, brain, kidneys)
42
why does autoregulation of blood flow occur
occurs primarily by nutritional needs of the tissues:
-lack of o2 (BP increases)
-cellula metabolism byproduct accumulation (CO2/lactic acid)
43
what are some important factors in BP regulation?
| think of things that are released
-histamine
-bradykinin
-prostaglandins
44
what does histamine release do?
dilates the blood vessels and lowers BP
45
what does bradykinin release do?
causes vasodilation and lowers BP
## Footnote
bradykinin is a potent peptide
46
what does bradykinin release do?
causes vasodilation and lowers BP
## Footnote
bradykinin is a potent peptide
47
what are prostaglandins indcluded in?
vasodilators and vasoconstrictors
48
# describe...
arterial blood pressure
force exerted on arterial walls by blood flow
49
what are the two main determinants of arterial blood pressure?
-cardiac output (sytolic pressure)
-peripheral vascular resistance (diastolic pressure)
50
how do yu determine cardiac output?
| whats the formula?
CO = HR x SV
51
# describe...
frank starlings law
the greater the volume of blood in the heart during diastole, the more forceful the cardiac contraction, the more blood the ventricle will pump (to a point)
52
what are some causes of hypotension?
frequent diarrhea, emesis, or diaphoresis
## Footnote
may result in dizzines or lightheadedness
53
describe the body's response to hypotension
SNS stimulated -> adrenal medulla secretes epinephrine and norepinephrine -> angiotensin 2 and aldosterone are formed -> kidneys retain fluid and BP in increased
54
describe the body's response to hypertension
increased renal secretion (increased urine output) -> fluid loss and decreased circulating volume -> decreased cardiac output -> decreased arterial blood pressure -> decreased blood pressure
55
define hypertension
-common, chronic disorder affecting approximately 50-60 mil adults in the U.S.
-persistently high BP (increase force in the arteries) that results from abnormalities in regulatory system
56
what BP values are considered hypertensive?
systolic greater than 140mmhg and diastolic greater than 90mmhg
57
what BP values are considered pre hypertensive
systolic 120-139 and diastolic 80-89
58
# describe...
primary HTN
-HTN with no identifiable cause
-90-95% of known cases
59
# describe...
secondary HTN
-results from identifiable cause
-may result from renal (renal artery stenosis), endocrine, CNS disorders, or from medications
60
why is HTN dangerous?
pts can be asymptomatic for years
61
what ae the risks of HTN?
-increases the risk of target organ damage
-MI, CHF, stroke, renal disease, retinal damage
-increased cardiac workload = myocardium hypertrophy = CHF
62
when is ADH released
released in response to increased blood osmolality (when blood gets thicker, usually in a dehydrated state)
63
what does ADH do to urine output?
decreases it
64
how does ADH affect Na+, H2O, and K+
-increases circulatin Na+ and H2O
-losss of K+ in the urine
65
what does ADH promote?
reabsorption of water by kidneys
66
what is another name for ADH?
vasopressin
67
what does ADH do to the vessels?
ADH is a potent vasoconstrictor
68
synthetic vasopressin is used to treat....
diabetes insipidus and hypotensive crisis
69
RAAS is used to...
increase blood pressure
70
please look at this stuff about the RAAS thingy
71
BP indicates blood pressure based on...
-average of >2 careful readings obtained on >2 occasions, as deatiled in DBP and SBP
72
# SBP and DBP in category of...
normal
sbp: <120mmhg
and
dbp: <80mmhg
73
# SBP and DBP in category of...
elevated
sbp: 120-129mmhg
and
dbp: <80mmhg
74
# SBP and DBP in category of...
stage 1 hypertension
sbp: 130-139mmhg
or
dbp: 80-89mmhg
75
# SBP and DBP in category of...
stage 2 hypertension
sbp: >140mmhg
or
dbp: >90mmhg
76
what is the goal BP of ppl over the age of 60
<150/90
77
what is the goal BP of ppl less than 60 with diabetes of all ages (no CKD) and ppl of all ages with CKD (with or without diabetes)
<140/90
78
if somebody consistently has BP <120/90 whatre you gonna do
promote optimal lifestyle habits and reasses in one year
79
if somebody consitently has BP 120-129/<80 whatre you gonna do
nonpharmacologic therapy and reassess in 3-6 months
80
if somebody consistently has BP 130-139/80-89 and has no estimated CVD risk whatre you gonna do
nonpharmacologic therapy
81
if somebody consistently has BP 130-139/80-89 and has estimated CVD risk whatre you gonna do
nonpharmacologic therapy and BP lowering meds
82
if somebody consistently has BP >140/90 whatre you gonna do
nonpharmacologic therapy and BP lowering meds
83
what are some nonpharmacologic management techniques of HTN
-**stress management**
-limit ETOH (male <2/day, women <1/day)
-reduce na+
-reduce fat and cholesterol
-increase fruit and veggies
-increase aerobic physical activity
-discontinue tobacco products
-maintain optimum weight
84
describe the HTN management guidelines
-factors to be considered (age, ethnicity, CV disorders)
-start med in lowest available dose
-change med groups instead of increasing the dose if first med is ineffective
-many pts require 2+ meds for adequate BP control
-meds are titrated and dispensed according to individual response
85
what are some antihypertensive drug class meds
-angiotensin-converting enzyme (ACE) inhibitors
-angiotensin II receptor blockers (ARBs)
-calcium channel blockers
-antiadrenergics
-direct vasodilators
-diuretics
86
what is the action of ACE inhibitors
inhibit the conversion of angiotensin I to angiotensin II
87
what are some examples of ACE inhibitors
| and which is most common
-capro**pril**
-enala**pril**
-lisino**pril** (most common)
-rami**pril**
88
what are some side effects of ACE inhibitors
-**ACE cough**
-orthostatic hypotension
-peptic ulcers, gastric irritation
-**hyperkalemia** (avoid K+ supplements, K+ salt substitutes, and K+ sparing diuretics)
-**angioedema**(swelling of mouth)
-acute renal failure (kidneys regulate K+)
-HA, dizziness
89
what are soe special instructions involved with ACE inhibtors
-take one hour before or two hours after meal (lisinopril you can take wihtout regard to food)
-take caution in patients with impaired renal function/CHF
-no potassium supplements
90
what black box warning is on all ACE inhibitors
pregnancy known to cause injury/death to fetus
91
what foods are high in K+
| soooo not for pts taking ACE inhibitors
raisins, bananas, apricots, oranges, beans, potatos, carrots, and celery
92
describe the action of ARBs
| (angiotensin II receptor blockers)
selectively bind to angiontensin II receptors in vascular smooth muscle and adrenal cortex
93
what are some examples of ARBs
-lo**sartan**
-val**sartan**
-olme**sartan**
94
what are some side effects of ARBs
-orthostatic hypotension
-HA, dizziness, diarrhea
-dry mouth
-**angioedema**
-**acute renal failure** (monitor CRT, BUN, and GFR)
-**hyperkalemia** (blocking the angiotensinogen II in the cascade)
95
what are some contraindications of ARBs
hepatic or renal failure impariment
96
describe how ARBs are dose dependent
-once daily for HTN tx
-twice daily for CHF (monitor K+)
97
what is the black box warning for all ARBs
pregnancy - known to cause injury/death to fetus
98
describe the action of calcium channel blockers
inhibit the movement of Ca+ across the membranes of mycardial and arterial muscle cells = decrease in HR and causes vasodilation of the peripheral vasculature
99
what are some examples of Ca+ channel blockers
-amlo**dipine**
-diltiazem
-verapamil
-nicar**dipine**
-nife**dipine**
100
what are some side effects of Ca+ channel blockers
-flushed skin, muscle cramps, peripheral edema
-HA, dizziness, hypotension
-impotence, sexual dysfunction
-hepatotoxicity
-angioedema
101
what are some contraindications of Ca+ channel blockers
hepatic/renal impairment, CHF/heart block, or pregnancy
102
what do Ca+ channel blockers interact with
macrolide antibiotics and grapefruit juice
103
what do antiadrenergic (sympatholytics) drugs do to the body?
inhibit SNS - decrease HR, decrease force of myocardial contraction, cardiac output and blood pressure
104
describe what alpha1 adrenergic receptor blockers do
dilate blood vessels and decrease peripheral vasular resistance (PVR)
105
what are some examples of alpha1 adrenergic receptor blockers
-doxaz**osin**
-praz**osin**
-teraz**osin**
106
name four antiadrenergic (sympatholytic) meds
-alpha1 adrenergic receptor blockers
-alpha2 receptor agonists
-beta adrenergic blockers
-alpha-beta adrenergic blockers
107
describe what alpha2 receptor agonists do
inhibit norepinephrine = have antiadrenergic effect = decreased CO, decreased HR, decreased PVR, decreased BP
108
what are some examples of alpha2 receptor agonists
-clonidine (super strong)
-methyldopa
-guanfacine
109
what are some side effects of alpha1 adrenergic receptor blockers and alpha2 receptor agonists
-first dose phenomenon orthostatic hypotension, palpitations, syncopal episodes
-start low first dose and increase slowly to prevent side side effects
-can have increase Na+/fluid retention (may need diuretic Rx as well)
110
describe how beta andrenergic blockers work
decrease HR, force of myocardial contraction, cardiac output, and renin release from the kidneys
111
what are some special characteristics of beta adrenergic blockers?
-first med for pts under 50 with cardio selective meds
-first choice in pts with asthma, PVD, or DM
-do not stop with med abruptly
-may cause erecetile dysfunction - men will stop or ot take it
-sometimes in hospital setting, perameters are set to hold the med if HR is not at certain numbers
112
what are some examples of beta adrenergic blockers?
-aten**olol**
-metopr**olol**
-propran**olol**
113
what are beta adrenergic blockers used for?
tx of:
-HTN
-dysrhythmias
-HF
-MI
-narrow angle glaucoma (eye drops)
114
what are some side effects of beta adenergic blockers?
-hypotension
-bradycardia
-dizziness
-use caution in pts with liver impairment
115
what is the black box warning on all beta adrenergic blockers?
for pt with CAD, dose must be titrated down prior to discontinuing med... if not there is high risk of rebound angina, ventricular dysrhythmias, and MI
116
describe alpha-beta adrenergic blockers
-achieve dual effect as a combination med
-dual action in one tablet
-also less side effects
117
what are some examples of alpha-beta adrenergic blockers
| and which is most common
-**carvedilol**(most common)
-labetalol
118
describe how diruetics work
-reduction of blood volume through urinary excretion of H2O and electrolytes
119
which type of med is used as first line of treatment for mild-moderate HTN
diuretics
120
do they exact mechanisms of action of diuretics differ by the type?
yeppers
121
describe thiazide and thiazide-like diuretics
-block Na+ reabsorption
-increase K+ and H2O secretion
122
what is an example of thiazide and thiazide-like diuretics
hydrochlorothiazide (HCTZ)
123
describe potassium sparing diuretics
-excretion of Na+ and retantion of K+
-can increase effects of digoxin, monitor for hypekalemia in pts also taking ACE inhibitors or ARBs
| most often used for pts with low K+ levels
124
what is an example of potassium sparing diuretics
spironolactone
| (blocks aldosterone)
125
describe loop diuretics
-reabsorption of Na+ and Cl- in the loop of henle
-K+ wasting diuretic
-can increase digoxin levels and cause hypokalemia
## Footnote
ALWAYS MONITOR K+ LEVELS
126
what is an example of a loop diuretic
furosemide
127
# hypertensive emergencies
episodes of severly elevated BP caused by...
-extension of malignant HTN
-cerebral hemorrhage
-dissecting aortic aneurysm
-renal diease
-etc
128
what are some sx of hypertensive emergencies
-severe HA
-N/V
-visual disturbances
-neurologic disturbances
-disorientation
-decreased level of consciousness
129
how do you treat hypertensive emergencies?
direct acting vasodilators
130
how do direct acting vasodilators work?
directly relax smooth muscles in the blood vessels = dilation and decreased peripheral vascular resistance
131
what are some examples of direct acting vasodilators
-hydralazine
-**nitroprusside (IV only)**
132
what are some nursing implications for anti hypertension treatments?
monitor for:
-bradycardia
-hypotension, orthostatic hypotension (falls risk)
-monitor I+O PRN
-heart healthy/low Na+ diet
-electrolyte
-telemetry
-herbal and dietary supplement use
-specialty populations
