drug therapy for hypertension Flashcards
(111 cards)
1
Q
what is the function of the cardiac cycle
A
essential in delivery of O2 and nutrients to myocardium and tissues
2
Q
what are the two cycles in the cardiac cycle
A
systolic and diastolic
3
Q
what is the systolic cycle
A
the contraction of the ventricles of the heart that occurs between the first and second heart sounds of the cardiac cycle
4
Q
what is the diastolic cycle
A
the part of the cardiac cycle during which the heart refills with blood after the emptying done during systole
5
Q
what is stroke volume
A
the amount of blood ejected from the left ventricle with each contraction
6
Q
what three factors effect stroke volume
A
preload, after load, contractility
7
Q
what is preload
A
end diastolic volume: the amount of blood left in the left ventricle
8
Q
what is after load
A
resistance to left ventricular ejection: the work the heart must overcome to eject blood
9
Q
what is contractility
A
ability of heart muscle to contract
10
Q
what is cardiac output
A
the amount of blood pumped by the heart each minute
11
Q
what is the equation for cardiac output
A
HR x SV = CO
12
Q
what artery is the only artery that carries deoxygenated blood
A
pulmonary artery
13
Q
cardiac conduction pathway
A
SA node -> AV node -> bundle of his -> right and left bundle branches -> purkinje fibers
14
Q
the SA node has what job in the heart
A
pacemaker; sets the pace of the heart
15
Q
functions of the AV node
A
receives messages from SA node; has the ability to slow conduction of the heart; the filter
16
Q
purkinje fibers cause what
A
the contraction or squeeze of the ventricles
17
Q
cardiac blood flow: arteries
A
carry oxygenated blood away from the heart, delivers it to the tissue in the body; high pressure system
18
Q
cardiac blood flow: veins
A
carries deoxygenated blood back to the heart; low pressure system
19
Q
coronary arteries are the arteries in the veins that feed what
A
the heart muscle with oxygenated and deoxygenated blood
20
Q
Right and left coronary arteries branch off at
A
base of the heart
21
Q
coronary arteries receive blood when
A
during diastole
22
Q
pulse pressure
A
systolic minus diastolic; represents the filling pressure of the coronary arteries
23
Q
electrocardiography; ECG or EKG
A
conduction of the patients heart
24
Q
each part of the ECG/EKG
A
p wave, pr interval, qrs complex, st segment, t wave
25
what Is the P wave
atrial depolarization; conduction of an electrical impulse through the atria
26
what is the PR interval
tracks the atrial impulse through the AV node, bundle of his and Rt/Lt bundle branches
27
what is the QRS complex
depolarization of the ventricles
28
what is the ST segment
end of ventricular conduction/ depolarization; beginning of ventricle depolarization; or rest when it rebuilds
29
what is the T wave
ventricular recovery or depolarization
30
what is the T wave
ventricular recovery or depolarization
31
what are the three components of the physiological regulation of blood pressure
vasomotor center, emotions, and hormones
32
what is included in the vasomotor center
baroreceptors and chemoreceptors
33
what are baroreceptors
they respond to increase or decrease in pressure or stretch
34
what are chemoreceptors
they respond to oxygen, carbon dioxide and pH changes
35
emotions effect blood pressure thru what system
sympathetic system; anger or stress will elevate BP: or parasympathetic; depression or lethargy will lower BP
36
what hormones regulate Blood pressure
antidiuretic hormone (ADH) and renin-angiotensin aldosterone system (RAAS)
37
in hypertension/ high BP your body will do what with ADH
body will no excrete ADH, it will shut it down because it wants the body to increase urination to decrease vascular volume
38
three primary areas to look at when taking about blood pressure
blood volume, peripheral resistance/ diameter of arterioles, cardiac output
39
what could affect blood volume
fluid loss; dehydration -> low BP or fluid retention; aldosterone or ADH
40
what could affect peripheral resistance/ diameter of arterioles
sympathetic nervous system activity, renin/angiotension II, increase in viscosity
41
what could affect the cardiac output
stroke volume: preload, contractility, afterload; heart rate: sympathetic system activity, parasympathetic system activity, epinephrine
42
T/F hypertension increases the risk of cancer
false; HTN increase risk of MI, CHF, renal disease, CVA
43
autoregulation of blood flow
ability of organ/body tissues to regulate own blood flow (heart, brain, kidneys)
44
autoregulation occurs primarily by
nutritional needs of tissue; lack of O2 or cellular metabolism by-product accumulation(lactic acid)
45
important factors that the body releases
histamine, bradykinin, prostaglandins
46
what does histamine do
the release dilates blood vessel -> lowers BP
47
what does bradykinin do
potent peptide causing vasodilation -> lowers BP
48
what does prostaglandins do
include both vasodilators and vasoconstrictors
49
what is arterial blood pressure
the force exerted on arterial walls by blood flow
50
what are the two main determinants of blood pressure
cardiac output (systolic) and peripheral vascular resistance (diastolic)
51
Stroke volume is
the amount of blood ejected/ heart beat
52
frank starlings law
the greater the volume of blood in the heart during diastole(resting state), the more forceful the cardiac contraction, the more blood the ventricle will pump
53
if you increase urine output, that decrease blood volume resulting in what BP
a lower BP
54
what is the response to hypotension
the SNS is stimulated, adrenal medulla secretes epinephrine and norepinephrine, angiotensin II and aldosterone are formed, kidneys retain fluid and BP is increased
55
what is the response to hypertension
increased renal secretion (increase urine output), fluid loss decreases circulating volume, decrease cardiac output, decrease arterial BP, decrease BP
56
what can cause hypotension
vomiting, diarrhea, excessive sweating
57
s/sx hypotension
dizzy, light headed, dehydrated
58
definition of hypertension
persistently high blood pressure (increase force in the arteries) that results from abnormalities in regulatory mechanisms
59
hypertension considered over
systolic < 140
diastolic < 90
60
prehypertension considered between
systolic 120-139
diastolic 80-89
61
primary HTN is what % of cases
90%-95%
62
secondary HTN may result from
renal (renal artery stenosis), endocrine, or CNS disorders or from medications
63
danger of HTN
its can be asymptomatic for years
64
hypertension increases the risk of
target organ damage, MI, CHF, renal disease, retinal damage, increased cardiac workload=CHF
65
physiological BP regulation of ADH released in response to
increased blood osmolarity -> promotes reabsorption of water by kidneys -> decrease urine output -> increases circulating volume of Na+ and H2O -> loss of K+ in urine -> potent vasoconstrictor: synthetic vasopressin admin to treat DI and hypotensive crisis
66
physiological BP regulation of renin-angiotensin- aldosterone system (RAAS)
renin -> angiotensinogen -> angiotensin I -> angiotensin converting enzyme (ACE) -> angiotensin II -> vasoconstriction -> aldosterone -> reabsorption or Na+ and H2O
67
HTN goals for > 60
< 150/90
68
HTN goals for <60 that have DM, CKD or with or without
<140/ 90
69
nonpharmacolgical management/ stress management
lifestyle changes: reduce Na+, reduce fat & cholesterol, increase fruits & veggies, increase aerobic physical activity, discontinue tobacco products, maintain optimum weight, limit alcohol
70
factors that affect HTN
age, ethnicity, CV disorders
71
medication guidelines for HTN
start in the lowest available dose, if one med doesn't work do not increase the dose if ineffective-> change med group, many its will require 2+ meds
72
antihypertensive drug class medications
angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, antiadrenergics, direct vasodilators, diuretics
73
action of angiotensin-converting enzyme inhibitors (ACE)
inhibit the conversion of angiotensin I to angiotensin II
74
examples of angiotensin-converting enzymes (ACE)
captopril, enalapril, lisinopril, ramipril: ends in PRIL
75
side effects of ACE inhibitors
ACE cough, hyperkalemia(avoid K+ supplements, K+ salt substitutes), angioedema
76
action of angiotensin II receptor blockers (ARBs)
selectivity bind to angiotensin II receptors in vascular smooth muscle and adrenal cortex
77
examples of angiotensin II receptor blockers (ARBs)
losartan, valsartan, olmesartan: ending in SARTAN
78
ARB side effects
orthostatic hypotension, angioedema, acute renal failure (monitor BUN, creatinine), hyperkalemia
79
contraindications of ARB
hepatic or renal failure impairment
80
action of calcium Chanel blockers
inhibit the movement of Ca2+ across the membrane of myocardial and arterial muscle cells= decrease in HR and causes vasodilation of the peripheral vasculature
81
examples of calcium Chanel blockers
amlodipine, nicardipine, nifedipine: ending in DIPINE
82
Ca2+ blocker side effects
flushed skin, muscle cramps, peripheral edema, dizziness, angioedema, sexual dysfunction
83
contraindications of Ca2+ blockers
hepatic/ renal impairment, CHF/ heart block, pregnancy
84
calcium channel blockers interferes with
macrolide antibiotics/ grapefruit juice
85
action of antiadrenergic (sympatholytics)/ adrenergic receptor blockers
inhibit SNS = decrease HR, decrease force of myocardial contraction, CO and blood pressure
86
examples of alpha 1 adrenergic receptor blocker
doxazosin, prazosin, terazosin: ending in OSIN
87
alpha 1 adrenergic receptor blocker work in what way
dilate blood vessels and decreases peripheral vascular resistance (PVR)
88
side effects of alpha 1 adrenergic receptor blocker
orthostatic hypotension, dizzy, increase of Na+/ fluid retention(may need diuretic Rx)
89
action of alpha2 receptor agonists
inhibits norepinephrine = antiadrenergic effect = decreased CO, decreased HR, decreased PVR, decreased BP
90
examples of alpha2 receptor agonists
clonidine, methyldopa, guanfacine
91
action of beta adrenergic blockers (beta blockers)
decrease HR, decrease force of myocardial contraction, decrease CO and renin relaxes from the kidneys
92
examples of beta adrenergic blockers (beta blockers)
atenolol, metoprolol, propranolol: ending in OLOL
93
patients under 50 with cardio selective mediations are given what medication (asthma, PVD, DM)
beta adrenergic blockers (beta blockers)
94
beta adrenergic blockers (beta blockers) treat
HTN, dysrrhythmias, HF, MI and narrow angle glaucoma
95
side effects of beta adrenergic blockers (beta blockers)
hypotension, bradycardia, dizziness (use caution in patient with liver impairment)
96
examples of alpha-beta adrenergic blockers
carvedilol, labetalol
97
black box for all beta adrenergic blockers for patients with
CAD
98
action of diuretics
reduction of blood volume through urinary excretion of H2O and electrolytes
99
types of diuretics
thiazide and thiazide like diuretics, potassium-sparing diuretics, loop diuretics
100
examples of thiazide diuretics
hydrochlorothiazide (HCTZ)
101
action of thiazide diuretics
block Na+ reabsorption, increase K+ and H2O secretion
102
action of potassium- sparing diuretics
excretion of Na+ and retention of K+
103
example of potassium-sparing diuretics
spironolactone (blocks aldosterone)
104
effects of spironolactone
can increase effects of digoxin, monitor hyperkalemia in patients also taking n ACE/ARB
105
actions of loop diuretics
reabsorption of Na+ and Cl- in loop of henle
106
example of loop diuretic
furosemide (can increase digoxin levels and can cause hypokalemia)
107
episodes of Beverly elevated BP caused by
extension of malignant HTN, cerebral hemorrhage (brain bleed), dissecting aortic aneurysm, renal disease
108
symptoms of hypertensive emergency
severe HA, N/V, visual disturbances, neurologic disturbances, disorientation, decrease level of consciousness
109
direct acting vasodilators used in hypertensive emergencies because they
directly relax smooth muscles in the blood vessels = dilation and decreased PVR
110
examples of direct acting vasodilators
hydralazine, nitroprusside (IV only)
111
nursing implications for anti-HTN: monitor what
bradycardia, hypotension/orthostatic(falls risk), I&Os, heart healthy/Na+ restriction diet, electrolyte, telemetry monitoring, dietary supplement use
