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Pharm 1 > drug therapy for hypertension > Flashcards

drug therapy for hypertension Flashcards

1
Q

what is the function of the cardiac cycle?

A

essential in delivery of O2 to myocardium and tissues

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2
Q

what are the two parts of the cardiac cycle?

A

systole and diastole

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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

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4
Q

describe…

diastole

A

-part of the cardiac sysle dutring which the heart refills with blood after emptying during systole
-relaxation, resting state

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5
Q

describe…

stroke volume

A

amount of blood ejected from the left ventricle with each contraction

preload, afterload, contractility

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6
Q

describe…

preload

A

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

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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

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8
Q

describe…

contractility

A

ability of heart muscle to contract

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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

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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

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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

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12
Q

cardiac conduction pathway

describe the SA node

A

pacemaker of the heart, sets the pace for contraction

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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

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14
Q

cardiac conduction pathway

describe bundle of his

A

-receives message from AV node
-sends message to right and left bundle branches

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15
Q

cardiac conduction pathway

describe purkinje fibers

A

-gets message from bundle branches
-causes contraction of the ventricles

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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

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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

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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

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19
Q

describe…

pulse pressure

A

-SBP minus DBP
-represents filling pressure of coronary arteries

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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

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21
Q

describe…

P wave

A

atrial depolarization (conduction of electrical umplse through the atria)

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22
Q

describe…

PR interval

A

tracks the atrial impulse through the AV node, buncle of HIS and right and left bundle branches

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23
Q

describe…

QRS complex

A

depolarization of ventricles

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24
Q

describe…

ST segment

A

-end of ventricular conduction/depolarization
-beginning of ventricular repolarization (rest)

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25
Q

describe…

T wave

A

ventricular recovery or repolarization

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26
Q

what are the three components of the physiological regulation of blood pressure

A

-vasomotor center
-emotions
-hormones

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27
Q

what are the components of the vasomotor center

A

-baroreceptors
-chemoreceptors

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28
Q

describe…

baroreceptors

what do they respond to?

A

respond to increase or decrease in pressure or stretch

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29
Q

describe…

chemoreceptors

what do they respond to?

A

respond to changes in oxygen, carbon dioxide, and pH

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30
Q

how can emotions effect blood pressure?

A

-anger or stress elevate BP
-depression or lethargy decrease BP

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31
Q

what hormones impact BP?

A

-antidiuretic hormone (ADH)
-renin-angiotensin-aldosterone system (RAAS)

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32
Q

where is ADH released from?

A

hypothalamus

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33
Q

describe…

ADH

A

-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

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34
Q

describe…

RAAS

A

-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

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35
Q

how does RAAS work?

A

-causes increase in Na+ which increases fluid and BP
-causes decrease in K+
-causes vasoconstriction in arterioles which increases BP

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36
Q

name 3 factors that effect BP

A

-blood volume
-peripheral resistance/diameter of arterioles
-cardiac output

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37
Q

how can blood volume affect BP?

A

-fluid loss (dehydration, bleeding) can lower BP
-fluid retention can increase BP

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38
Q

describe how peripheral resistance/diameter of arteriales can impact BP

A

-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

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39
Q

describe how cardiac output can impact BP

A

-stroke volume (preload, contractility, afterload)
-HR (SNS activity, PNS activity, epinephrine)

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40
Q

true or false?

hypertension increases the risk of cancer

A

false

HTN increases the risk of MI, CHF, cerebral infarction/hemorrhage, and renal disease

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41
Q

describe the autoregulation of blood flow

A

ability of the organ/body tissues to regulateown blood flow (heart, brain, kidneys)

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42
Q

why does autoregulation of blood flow occur

A

occurs primarily by nutritional needs of the tissues:
-lack of o2 (BP increases)
-cellula metabolism byproduct accumulation (CO2/lactic acid)

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43
Q

what are some important factors in BP regulation?

think of things that are released

A

-histamine
-bradykinin
-prostaglandins

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44
Q

what does histamine release do?

A

dilates the blood vessels and lowers BP

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45
Q

what does bradykinin release do?

A

causes vasodilation and lowers BP

bradykinin is a potent peptide

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46
Q

what does bradykinin release do?

A

causes vasodilation and lowers BP

bradykinin is a potent peptide

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47
Q

what are prostaglandins indcluded in?

A

vasodilators and vasoconstrictors

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48
Q

describe…

arterial blood pressure

A

force exerted on arterial walls by blood flow

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49
Q

what are the two main determinants of arterial blood pressure?

A

-cardiac output (sytolic pressure)
-peripheral vascular resistance (diastolic pressure)

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50
Q

how do yu determine cardiac output?

whats the formula?

A

CO = HR x SV

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51
Q

describe…

frank starlings law

A

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)

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52
Q

what are some causes of hypotension?

A

frequent diarrhea, emesis, or diaphoresis

may result in dizzines or lightheadedness

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53
Q

describe the body’s response to hypotension

A

SNS stimulated -> adrenal medulla secretes epinephrine and norepinephrine -> angiotensin 2 and aldosterone are formed -> kidneys retain fluid and BP in increased

54
Q

describe the body’s response to hypertension

A

increased renal secretion (increased urine output) -> fluid loss and decreased circulating volume -> decreased cardiac output -> decreased arterial blood pressure -> decreased blood pressure

55
Q

define hypertension

A

-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
Q

what BP values are considered hypertensive?

A

systolic greater than 140mmhg and diastolic greater than 90mmhg

57
Q

what BP values are considered pre hypertensive

A

systolic 120-139 and diastolic 80-89

58
Q

describe…

primary HTN

A

-HTN with no identifiable cause
-90-95% of known cases

59
Q

describe…

secondary HTN

A

-results from identifiable cause
-may result from renal (renal artery stenosis), endocrine, CNS disorders, or from medications

60
Q

why is HTN dangerous?

A

pts can be asymptomatic for years

61
Q

what ae the risks of HTN?

A

-increases the risk of target organ damage
-MI, CHF, stroke, renal disease, retinal damage
-increased cardiac workload = myocardium hypertrophy = CHF

62
Q

when is ADH released

A

released in response to increased blood osmolality (when blood gets thicker, usually in a dehydrated state)

63
Q

what does ADH do to urine output?

A

decreases it

64
Q

how does ADH affect Na+, H2O, and K+

A

-increases circulatin Na+ and H2O
-losss of K+ in the urine

65
Q

what does ADH promote?

A

reabsorption of water by kidneys

66
Q

what is another name for ADH?

A

vasopressin

67
Q

what does ADH do to the vessels?

A

ADH is a potent vasoconstrictor

68
Q

synthetic vasopressin is used to treat….

A

diabetes insipidus and hypotensive crisis

69
Q

RAAS is used to…

A

increase blood pressure

70
Q

please look at this stuff about the RAAS thingy

A
71
Q

BP indicates blood pressure based on…

A

-average of >2 careful readings obtained on >2 occasions, as deatiled in DBP and SBP

72
Q

SBP and DBP in category of…

normal

A

sbp: <120mmhg
and
dbp: <80mmhg

73
Q

SBP and DBP in category of…

elevated

A

sbp: 120-129mmhg
and
dbp: <80mmhg

74
Q

SBP and DBP in category of…

stage 1 hypertension

A

sbp: 130-139mmhg
or
dbp: 80-89mmhg

75
Q

SBP and DBP in category of…

stage 2 hypertension

A

sbp: >140mmhg
or
dbp: >90mmhg

76
Q

what is the goal BP of ppl over the age of 60

A

<150/90

77
Q

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)

A

<140/90

78
Q

if somebody consistently has BP <120/90 whatre you gonna do

A

promote optimal lifestyle habits and reasses in one year

79
Q

if somebody consitently has BP 120-129/<80 whatre you gonna do

A

nonpharmacologic therapy and reassess in 3-6 months

80
Q

if somebody consistently has BP 130-139/80-89 and has no estimated CVD risk whatre you gonna do

A

nonpharmacologic therapy

81
Q

if somebody consistently has BP 130-139/80-89 and has estimated CVD risk whatre you gonna do

A

nonpharmacologic therapy and BP lowering meds

82
Q

if somebody consistently has BP >140/90 whatre you gonna do

A

nonpharmacologic therapy and BP lowering meds

83
Q

what are some nonpharmacologic management techniques of HTN

A

-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
Q

describe the HTN management guidelines

A

-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
Q

what are some antihypertensive drug class meds

A

-angiotensin-converting enzyme (ACE) inhibitors
-angiotensin II receptor blockers (ARBs)
-calcium channel blockers
-antiadrenergics
-direct vasodilators
-diuretics

86
Q

what is the action of ACE inhibitors

A

inhibit the conversion of angiotensin I to angiotensin II

87
Q

what are some examples of ACE inhibitors

and which is most common

A

-capropril
-enalapril
-lisinopril (most common)
-ramipril

88
Q

what are some side effects of ACE inhibitors

A

-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
Q

what are soe special instructions involved with ACE inhibtors

A

-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
Q

what black box warning is on all ACE inhibitors

A

pregnancy known to cause injury/death to fetus

91
Q

what foods are high in K+

soooo not for pts taking ACE inhibitors

A

raisins, bananas, apricots, oranges, beans, potatos, carrots, and celery

92
Q

describe the action of ARBs

(angiotensin II receptor blockers)

A

selectively bind to angiontensin II receptors in vascular smooth muscle and adrenal cortex

93
Q

what are some examples of ARBs

A

-losartan
-valsartan
-olmesartan

94
Q

what are some side effects of ARBs

A

-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
Q

what are some contraindications of ARBs

A

hepatic or renal failure impariment

96
Q

describe how ARBs are dose dependent

A

-once daily for HTN tx
-twice daily for CHF (monitor K+)

97
Q

what is the black box warning for all ARBs

A

pregnancy - known to cause injury/death to fetus

98
Q

describe the action of calcium channel blockers

A

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
Q

what are some examples of Ca+ channel blockers

A

-amlodipine
-diltiazem
-verapamil
-nicardipine
-nifedipine

100
Q

what are some side effects of Ca+ channel blockers

A

-flushed skin, muscle cramps, peripheral edema
-HA, dizziness, hypotension
-impotence, sexual dysfunction
-hepatotoxicity
-angioedema

101
Q

what are some contraindications of Ca+ channel blockers

A

hepatic/renal impairment, CHF/heart block, or pregnancy

102
Q

what do Ca+ channel blockers interact with

A

macrolide antibiotics and grapefruit juice

103
Q

what do antiadrenergic (sympatholytics) drugs do to the body?

A

inhibit SNS - decrease HR, decrease force of myocardial contraction, cardiac output and blood pressure

104
Q

describe what alpha1 adrenergic receptor blockers do

A

dilate blood vessels and decrease peripheral vasular resistance (PVR)

105
Q

what are some examples of alpha1 adrenergic receptor blockers

A

-doxazosin
-prazosin
-terazosin

106
Q

name four antiadrenergic (sympatholytic) meds

A

-alpha1 adrenergic receptor blockers
-alpha2 receptor agonists
-beta adrenergic blockers
-alpha-beta adrenergic blockers

107
Q

describe what alpha2 receptor agonists do

A

inhibit norepinephrine = have antiadrenergic effect = decreased CO, decreased HR, decreased PVR, decreased BP

108
Q

what are some examples of alpha2 receptor agonists

A

-clonidine (super strong)
-methyldopa
-guanfacine

109
Q

what are some side effects of alpha1 adrenergic receptor blockers and alpha2 receptor agonists

A

-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
Q

describe how beta andrenergic blockers work

A

decrease HR, force of myocardial contraction, cardiac output, and renin release from the kidneys

111
Q

what are some special characteristics of beta adrenergic blockers?

A

-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
Q

what are some examples of beta adrenergic blockers?

A

-atenolol
-metoprolol
-propranolol

113
Q

what are beta adrenergic blockers used for?

A

tx of:
-HTN
-dysrhythmias
-HF
-MI
-narrow angle glaucoma (eye drops)

114
Q

what are some side effects of beta adenergic blockers?

A

-hypotension
-bradycardia
-dizziness
-use caution in pts with liver impairment

115
Q

what is the black box warning on all beta adrenergic blockers?

A

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
Q

describe alpha-beta adrenergic blockers

A

-achieve dual effect as a combination med
-dual action in one tablet
-also less side effects

117
Q

what are some examples of alpha-beta adrenergic blockers

and which is most common

A

-carvedilol(most common)
-labetalol

118
Q

describe how diruetics work

A

-reduction of blood volume through urinary excretion of H2O and electrolytes

119
Q

which type of med is used as first line of treatment for mild-moderate HTN

A

diuretics

120
Q

do they exact mechanisms of action of diuretics differ by the type?

A

yeppers

121
Q

describe thiazide and thiazide-like diuretics

A

-block Na+ reabsorption
-increase K+ and H2O secretion

122
Q

what is an example of thiazide and thiazide-like diuretics

A

hydrochlorothiazide (HCTZ)

123
Q

describe potassium sparing diuretics

A

-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
Q

what is an example of potassium sparing diuretics

A

spironolactone

(blocks aldosterone)

125
Q

describe loop diuretics

A

-reabsorption of Na+ and Cl- in the loop of henle
-K+ wasting diuretic
-can increase digoxin levels and cause hypokalemia

ALWAYS MONITOR K+ LEVELS

126
Q

what is an example of a loop diuretic

A

furosemide

127
Q

hypertensive emergencies

episodes of severly elevated BP caused by…

A

-extension of malignant HTN
-cerebral hemorrhage
-dissecting aortic aneurysm
-renal diease
-etc

128
Q

what are some sx of hypertensive emergencies

A

-severe HA
-N/V
-visual disturbances
-neurologic disturbances
-disorientation
-decreased level of consciousness

129
Q

how do you treat hypertensive emergencies?

A

direct acting vasodilators

130
Q

how do direct acting vasodilators work?

A

directly relax smooth muscles in the blood vessels = dilation and decreased peripheral vascular resistance

131
Q

what are some examples of direct acting vasodilators

A

-hydralazine
-nitroprusside (IV only)

132
Q

what are some nursing implications for anti hypertension treatments?

A

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

Pharm 1 (29 decks)

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