HTN Flashcards

1
Q

What is the FIRST medication response to HTN?

A

Diuretics

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2
Q

The biggest ways to lower BP with diet

A

Reduce sodium intake

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3
Q

how do diuretics work

A

Block the reabsorption of sodium, forcing it’s excretion

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4
Q

Lasix acts where

A

Loop of henle

Site of GREATEST sodium reabsorption

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5
Q

Thiazides act where

A

Acts on distal convoluted tubule

More moderate diuresis

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6
Q

Reason for diuretics given in HF

A

Decrease fluid bulidiup

drop in wt, edema, better breathingetc.

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7
Q

Big concerns when giving lasix

A

HOTN
Electrolyte depletion

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8
Q

Calcium channe lblockers

A

Prevent ca from entery muscel cells causing contraction

Limits/slows muscle contraction

  • some block channels of arterioles and relax sooth muscel, decreasing BP
  • Some decrease heart contractility and wt

NOT useful in HF, because they decrease heart rate and contractility

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9
Q

ACE inhibitors

A

Block the formation of angiotensin 2
Causing dilation
Blocks the reabsorption of sodium, causing fluid excretion

BP decreases

Prevents ace converting enzyme from converting ang 1 to 2

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10
Q

RAAS system

A

Renin
Angiotensin 1
ACE converting enzyme
Angiotensin 2 (Vasoconstrictor)
- Causes vasocontriction
Stimulates release of aldosterone
- Causing reabsorption of sodium
Stimulates ADH, increasing fluid retention

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11
Q

Angiotensin receptor blockers

A

Do not effect angiotensin formation
Instead, attatch to receptors that cause reaction of ADH stimulation and Aldosterone stimulation

Therefore, same effect as ACE inhibs

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12
Q

Beta Blockers

A

Selective/Non selective

Blocks the beta-anergics recetpors

Slows HR

Used w/ caution in HF

Blocks production of Renin

Decreases Blood pressure

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13
Q

When Beta 1 recepots ar eblocked

A

Heart rate is slowed - negative chronotrope

and contractility is decreased - negative inotrope

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14
Q

chronotrope

A

Heart rate

Negative chronotrope = Slows HR
Positive Chronotrope = Increases HR

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15
Q

Inotrope

A

Contractility

Negative inotrope = decreased contractility

Positive inotrope = Increased Contractility

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16
Q

Most common CVD

A

HTN

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17
Q

Primary/essential

A
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18
Q

BP is effected by 3 factors

A

Cardiac Output
Volume (More = higher BP)
Peripheral resistance - increasing resistance by narrowing BV

Pharmacotherapy for HTN always focuses on reducing one of these factors

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19
Q

HTN risk factors

A

Risk factors for HTN include:
Diet
Exercise
Age
Smoking
Genetic factors which may alter renal function, and secretion of hormones that regulate blood pressure (angiotensin II, aldosterone, ADH)

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20
Q

Normal BP regulation

A

Blood pressure is regulated through homeostatic mechanisms

If blood pressure increases, nervous and endocrine mechanisms become active that reduce blood pressure:

CO is decreased

arterioles dialet

Kidneys increase urine output

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21
Q

Vasomotor centre

A

Regulates activity of SNS
Baroreceptors/chemoreceopters alter CO

21
Q

Complications of HTN

A

As blood pressure increases, heart must work harder to eject blood into circulation contributing to the following
Ventricular hypertrophy
Angina, MI, CVA, peripheral vascular disease
Heart failure
Kidney failure
Blindness

22
Q

Local mediator of vascular tone

A

Vasoconstrictors (ang 2, endothelin)
Vasodialtors
-Nitorc oxide, prostoglandins

23
Q

Minute to minute BP regulation

A

Vasomotor center
Local mediators of vascular tone

24
Q

Dayu to day regulation of BP

A

Aldosterone
ADH alter Blood volume

25
Q

Guidelines for management of HTN

A

First approach is lifestyle mod

If BP does not change, druags are added
- Diuretics, ACE inhibitors, Angiotensin II receptor blockers, calcium channel blockers, beta-blockers (Sometimes need more than one)

26
Q

HTN diet

A

Low alcohol
low Sodium

27
Q

Non pharm treatments for HTN

A

Exercise
WT reduction
Diet
Stress reduction
Smoking cessaiton

28
Q

Diet for HTN

A

Dietary Approaches to Stop Hypertension

The DASH eating plan includes whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium, and magnesium, as well as protein and fiber. Eating foods lower in salt and sodium also can reduce blood pressure.

29
Q

Alcohol Consumption reccomendation

A

Should be limited to 2 drinks or fewer per day.

Should not exceed 9 drinks per week for women 14 for men.

30
Q

Why are diuretics often first choice

A

Bc of few side effects

31
Q

Adverse effects of diuretics

A

Electrolyte depletion
Fall risk

32
Q

3 categories of Ca channel blockers

A

Areteiole selective durgs

Cardioselective drugs (ie. diltiazem)

Non-selective drugs (ie. Verapamil)

33
Q

Adverse effects of Ca channel blockers

A

Adverse effects
Dizziness, flushing, hypotension
Reflex tachycardia (with nifedipine)
Peripheral edema (Bc vasodilation and lower BP)
Dysrhythmias
Exacerbation of heart failure why?

34
Q

Reflex tachycardia

A

When BP drops suddenly
HR increases

35
Q

Prototype Drug Nifedipine (Adalat) (2 of 2)

A

A Ca channel blocker

Used for HTN and Chronic stable or variant angina

Selectively blocks calcium channels in myocardial and vascular smooth muscle,(including the coronary arteries) causing vasodilation which reduces resistance and blood pressure

Adverse effects

HOTN, flushing, headaches, dizziness, peripheral edema, Hepatotoxicity
Paradoxical angina
Severe hypotension
Exacerbation of heart failure

36
Q

Nursing considerations for pts recieving calcium channel blockers

A

Obtain complete health history including allergies and drug history
Obtain baseline vital signs, and ECG
Assess for pulmonary and peripheral edema
Assess neurological status and level of consciousness (LOC)
Planning
Patient to exhibit reduced systolic and diastolic blood pressure

37
Q

Nursing interventions (What to monitor) for Ca Channel blockers

A

Monitor :
BP
HR (Reflex tachycardia)
Signs of Ortho HOTN
Signs of HF (Fluid overload0
Monitor wt
I&O
Liver function
Kidney functions

38
Q

Ace inhibs adverse effects

A

Persistant cough
HOTN
Hyperkalemia
Angioedema (Hypersensitivity rxn) -constricts airway

39
Q

What to monitor for pts on ACE inhibs

A

Obtain complete health history including allergies and drug history
Obtain baseline ECG and vital signs
Assess neurological status and level of consciousness (LOC)
Obtain blood and urine samples for laboratory testing

Monitor Potassium and Sodium

40
Q

Interventions ACE Inhib

A

When giving the first dose, monitor for first dose phenomenon syncope
Pbserve for hypersensitivity
Monitor

41
Q

INterventions for Ace inhibi

A

Dizziness
S/S of bruising (Can effect platlets)
Monitor for persistant cough
Monitor electrolyte levels
Monitor liver and kidney function

42
Q

Prototype: Enalapril (Vasotec)

A

ACE inhib

Has prolonged half life which permits administration once or twice a day.

uses

43
Q

Adrenregic antogonists

A

Block Alpha 1 receptors resulting in vasodialtion

Can cause Nausea, tachycardia, palpitations

44
Q

Beta adrenergic antagonist

A

Indicated for
Hypertension, dysrhythmias, angina

Mech of action
Decrease CO and HR
Mask signs of Hypoglycemia
Nonspecficic can also act on resp system causing bronchioconstriction

Take BG regularal

44
Q

Direct acting vasodialtors

A

Pretty severe adverse effects, only indicated for severe HTN

Relax arteriol smooth muscle causing vasodialtion

Causing reflex tachycardia

45
Q

Prototype Drug Hydralazine (Apresoline) (1 of 2)

A

Used in HTN emergencies
Moderate to severe hypertension
Hypertensive emergencies
Acute heart failure

Causes
Causes peripheral vasodilation of arterioles, reducing peripheral resistance and pressure

Adverse effects
Lupus-lke syndromes

45
Q

What should nurses monitor for vasodilatlors

A

BP, carefully with titration
Dizziness and LOC

45
Q

If a drug ends in Lol

A

Beta Blocker

46
Q

If it ends in pril

A

Ace inhibitor