HTN

Question 1

primary htn

Answer 1

Family history
African American
Hyperlipidemia
Smoking
Age > 60 or post-
menopausal
Excessive sodium or
caffeine intake
Obesity
Sedentary lifestyle
Excessive alcohol
Low potassium,
calcium or
magnesium intake
Excessive stress

Question 2

secondary htn

Answer 2

Kidney disease
Adrenal-mediated
causes:
 Primary aldosteronism
 Pheochromocytoma
 Cushing’s disease
Coarctation of the aorta
Brain tumors
Encephalitis
Pregnancy
Drugs –
 Estrogen
 Glucocorticoids/
mineralocorticoids
 Sympathomimetics

Question 3

what is bp

Answer 3

co X pvr

Question 4

what is pvr depending on

Answer 4

Autonomic Nervous System
Circulating Hormones
 Norepinephrine & Epinephrine

Question 5

pathophysiologic processes

Answer 5

Can result from
increases in cardiac
output, peripheral
resistance, or both
Must also be a
problem with the
body’s control
system
Dysfunction of the
autonomic nervous
system
Increased renin–
angiotensin–
aldosterone system
Resistance to
insulin action
Activation of the
immune system

Question 6

heart damage from htn(3)

Answer 6

CAD
 Left Ventricular Hypertrophy
 Heart Failure

Question 7

kidney damage from htn

Answer 7

nephrosclerosis

Question 8

brain damage htn

Answer 8

cerebrovascular disease

Question 9

eye damage htn

Answer 9

retinal damage

Question 10

peripheral vessel damage htn

Answer 10

Peripheral Vascular Disease - (more
specifically, Peripheral ARTERIAL
Disease)

Question 11

hypertensive emergency

Answer 11

BP greater than 180/120 with new or
worsening target organ damage.
Requires critical care monitoring and
intervention:
 Continuous IV infusion of anti-hypertensive
medication
 Frequent, or possibly continuous, BP
monitoring
 Watch for neurological or cardiac
complications:
 Seizures
 Numbness, weakness, tingling of
extremities
 Stroke
 Chest pain, dysrhythmias, LV heart failure

Question 12

hypertensive urgency

Answer 12

BP greater than 180/120 in stable patients
without target organ damage as evidenced
based on clinical examination and results of
laboratory studies.
Investigate cause of hypertension (ex.
Nonadherence to medications).
Requires close monitoring of blood pressure
and cardiovascular status.

Question 13

how much sodium for dash diet

Answer 13

no more than 2g per day

Question 14

what is the goal of dash diet

Answer 14

,aintain bp <130/80

Question 15

thiazide diruetics
name(1)
moa
se

Answer 15

Hydrochlorothiazide
* Inhibit sodium, chloride, and water
reabsorption
* Monitor for orthostatic hypotension and
hypokalemia

Question 16

ccbs
names(3)
moa
se

Answer 16

Amlodipine, Diltiazem, Verapamil
* Lower blood pressure by interfering with
the transmembrane flux of calcium ions
resulting in vasodilation
* Side effects of flushing, peripheral
edema, HA
* Block SA and AV node conduction –
decreases HR
* Most effective in older adults and African
Americans

Question 17

ace inhibitors
names(3)
moa
se

Answer 17

Captopril, Lisinopril, Enalapril
 Block ACE from converting angiotensin I to angiotensin II –
inhibiting vasoconstriction
 Decreases sodium and water retention at kidneys – lowering
PVR
 Most common side effect is a nagging dry cough
 Monitor for hyperkalemia and orthostatic hypotension
 Caution in clients with renal impairment
 Neutropenia, angioedema (rare but serious)

Question 18

arbs
name(3)
moa
se

Answer 18

Losartan, Valsartan, Candesartan
 Block angiotensin II from binding with receptor sites
 Inhibits vasoconstriction
 Decrease sodium and water retention
 Monitor for hyperkalemia and orthostatic hypotension
 Caution in clients with renal impairment

Question 19

ace inhibitors end in….

Answer 19

pril

Question 20

arbs end in….

Answer 20

sartan

Question 21

loop diruetics
name(1)
moa
se

Answer 21

Furosemide
 Inhibit sodium, chloride and water
reabsorption and promote potassium
excretion
 Monitor for orthostatic hypotension and
hypokalemia
 Ototoxicity risk
 Fall Risk in older adults

Question 22

aldosterone antagonist
name1
moa
se

Answer 22

Spironolactone
 Competitive inhibitors of aldosterone binding
(doesn’t allow aldosterone to become
functional)
 Side effects: drowsiness, lethargy headache
 Monitor for hyperkalemia (especially if also on
an ACE inhibitor or ARB

Question 23

potassium sparing diuretics
name(1)
moa
se

Answer 23

Amiloride
 Blocks sodium reabsorption
 Side effects: drowsiness, lethargy headache
 Monitor for hyperkalemia

Question 24

beta blockers

Answer 24

Metoprolol, Atenolol,
Bisoprolol
Cardio-selective – Beta-1
are used in the
management of
hypertension
*Block beta-1 receptors in the
heart and peripheral vessels
Decreases heart rate and
contractility
Monitor for bradycardia,
hypotension, fatigue,
weakness, depression, and
sexual dysfunction
Clients with diabetes need
to be monitored closely for
hypoglycemia (“masked
symptoms”)
Drug of choice for clients
with history of MI or stable
heart failure

Question 25

alpha-adrenergic antagonists
name(3)
moa
se

Answer 25

Doxazosin, Prazosin, Terazosin
Block alpha1-adrenergic effects
* Produces peripheral vasodilation
Monitor for orthostatic hypotension
Primarily used for treatment of BPH

Question 26

hydralazine

Answer 26

Reduces peripheral vascular resistance
and blood pressure by direct arterial
vasodilation
Can be given PO or IV (for
hypertensive crisis)