Exam 3 (Cardio-1) Flashcards
PVR
peripheral vascular resistance
preload, afterload, contractility
CO x PVR = ?
CO x PVR = BP
BP of 139/82 , what is the plan, what is the stage
start with hydrochlorothiazide (diuretic) as the first line anti HTN medication
STAGE 1
Drug therapy and lifestyle modifications combined can control BP in most patients with chronic hypertension
True
which 2 medications primarily work for the hypertensive patient by decreasing HR and contractility
Beta Blockers (beta 1), Calcium Channel Blockers
in the patient with hypertension and _______, decreasing contractility must be approached with great caution
!heart failure!
we dont want to lose more contractility
would the nurse recommend the use of a beta blocker for a person with hyperthyroidism or hypothyroidism?
hyperthyroidism
would the nurse recommend the use of a beta blocker for a person with an AV block?
no
how do beta blockers mask hypoglycemia?
they block the classic signs, like an increased heart rate
how do diuretics work?
decrease the reabsorption of sodium and chloride
(solutes stay IN the nephron, this allows water to follow and increase flow of urine)
which type of diuretic places the patient at greatest risk for hypokalemia?
loop diuretic, because we are disrupting the sodium potassium pump
by decreasing the reabsorption of sodium and chloride, it puts the patients at risk for
hyponatremia, hypovolemia, hypokalemia, dehydration, hyperuricemia (uric acid), hyperglycemia
why are we causes with people with unstable glucose levels?
at risk for hyperglycemia
in GM patients, it inhibits the release of insulin, so glucose goes up
a patient with HTN will start HCTZ what labwork will the nurse check prior to starting the medication
renal function labs
which of these lab results would cause the nurse to hold the furosemide ?
A) glucose 109
B) Na+ 135
C) K+ of 3.1
D) Ca+ 6.9
the potassium, should be 3.5-5
The patient on a beta blocker and a loop diuretic reports a change in balance and hearing. these changes are because of which medication?
the loop diuretic
what are the two main results of the the RAAS?
increased volume in blood pressure &
vasoconstriction
What are three indications for Aldosterone Receptor Blockers? What are three ADRs for ARBs?
indications: Heart Failure, MI, Stroke, Diabetic Nephropathy
ADR: dizziness, headache, fatigue, angio edema (swelling of the airway), fetal danger, renal failure, orthostatic hypotension
what are four indications for ACE inhibitors? What are three ADRs for ACE inhibitors?
indications: HTN, Heart Failure, M.I., Diabetic and non-diabetic Nephropathy
ADRs: orthostatic HTN, angio edema (swelling of the airway), hyperkalemia, persistent dry cough, kidney failure, fetal danger
what is the role of aldosterone in normal situations and with RAAS agents?
it reabsorbs sodium which leads to water reabsorption
(with too much aldosterone we have a decreased potassium reabsorption)
how is renal stenosis related to ace inhibitors?
you wouldnt want to give an ace inhibitor to someone with renal stenosis because kidney failure is an ADR
who is more at risk for hyperkalemia, someone on ACE or ARBs?
ACE
what are signs of hyperkalemia? what can we teach our patient about avoiding hyperkalemia?
muscle weakness, nausea and vomiting,
*avoid salt substitutes (which contain potassium)
when do we use nitroprusside? how does it work? how long can we keep the drip going?
in a hypertensive crisis, so diastolic over 110
it relaxes arteries and the veins
it decreases preload and afterload
not more than 72 hrs because of toxicity
drugs that inhibit RAAS decrease BP by which mechanism?
A) decrease vasoconstriction by angiotensin 2
B) decrease resistance and decrease volume expansion
C) decrease contractility
decrease resistance and decrease volume expansion
for which drug is impotence, menstrual irregularities, and gynecomastia and ADR?
the aldosterone antagonist diuretic
SPIRONOLACTONE
MOA of
1) Enalapril
2) Losartan
3) Eplerenone
Enalapril: blocks conversion of angiotensin 1 to 2
Losartan: blocks the action of angiotensin 2
Eplerenone: aldosterone receptor blockade
MOA of
1) Nitroprusside
2) Clonidine
3) Metoprolol
4) Doxazosin
1) Nitroprusside - relaxes smooth muscle of arterioles and veins
2) Clonidine - decrease outflow of the sympathetic nervous system
3) Metoprolol - decrease peripheral resistance and HR
4) Doxazosin - decrease stimulation of alpha 1 receptors
what of the following medications might cause flushing dizziness and headache?
vasodilators, beta blockers, ace inhibitors, or diuretics
for those what are the two common ADRs?
vasodilators
adr: reflex tachycardia and orthostatic hypotension
a pt has severe fluid overload, causing acute SOB, swollen ankles, fatigue
What medication would you recommend?
a loop diuretic such as Furosemide
troponin is associated with ____
BNP is associated with _____
troponin = Cardiac damage and an MI
BNP = Heart Failure
T/F
Diuretics are contraindicated in the treatment of a client with heart failure
false
T/F
A client with heart failure might be prescribed an ACE inhibitor
true
what are signs of hypokalemia
muscle weakness, lowered T waves
alkalosis
drowsiness, confusion
fatigue
nausea vomiting
thready pulse
if the nurse administers nifedipine to the patient with cerebral vasospasm. which part of the CV system will be affected?
A) arterioles
B) arterioles and the heart
just the arterioles
because nifedipine is a selective calcium channel blocker
Nifedipine and Amlodipine (they are N/A to the heart)
what are the non selective calcium channel blockers?
Verapamil and Diltiazem (which have a Very Definite effect on the heart)
they effect both he hear and arterioles/vessels
An elderly patient is taking daily doses of the calcium channel blocker Verapamil for atrial fib, what are two things the nurse will teach the patient?
at risk for constipation
drink adequate amount of water each day and eat plenty of fiber in your heart
ALSO
avoid products containing grapefruit, because the grapefruit juice inhibits the metabolism of calcium, increasing the calcium level in the body
overuse of CCBs can result in which condition?
serious cardio-suppresion with bradycardia and AV block
drugs that are preferred in HTN and pregnancy?
methyldopa
which of the drugs can be effective to treat supraVentricular dysrythmias?
Diltiazam, and Metroprolol
What is the priority concert for the patient starting on an alpha 1 blocker ?
falls & safety
-osin
hypotension
Do calcium channel blockers act similarly to beta blockers
Yes
Decrease conduction, contractility, vasodilate
