HTN

Question 1

HTN drug types

Answer 1

Diuretics, beta blockers, ace inhibitors, ARBs, CCBs

Question 2

Five related factors in HTN

Answer 2

Cardiac Output, blood volume, peripheral resistance, artery elasticity, blood viscosity

Question 3

Framingham Heart Study

Answer 3

1948: it was started in Massachusetts in 1948. pt between 30 and 62 yr. they try id. Factors, they tracked their htn through life. In 1972, the 2nd generation, that group was much more diverse. The latest group is way more diverse. The latest group are the grandchildren from the first group. They study the heart’s left ventricle

Question 4

Pulse pressure

Answer 4

Systolic minus diastolic. It represents the force that the heart generates each time it contracts.

Question 5

Blood pressure (definition)

Answer 5

Blood pressure is the force exerted on the walls of an artery by the pulsing blood under pressure from the heart.

Question 6

Systolic pressure

Answer 6

The contraction of the heart forces the blood under high pressure into the aorta. The peak of maximum pressure when ejection occurs is the systolic pressure.

Question 7

Diastolic pressure

Answer 7

When the ventricles relax, the blood remaining in the arteries exerts a minimum or diastolic pressure.

Question 8

Factors Influencing Blood Pressure.

Answer 8

Age, stress, ethnicity, gender, daily variation, medications, activity and weight.

Question 9

Diuretics drug names

Answer 9

Furosemide (Lasix), spironolactone (Aldactone), metolazone, polythiazide, benzthiazide.

Question 10

Diuretics action

Answer 10

Lowers blood pressure by reducing resorption of sodium and water by the kidneys, thus lowering circulating fluid volume.

Question 11

Beta-adrenergic blockers drug names

Answer 11

(if it finishes in “lol” is beta-adrenergic blocker) Atenolol (Tenormin), nadolol (Corgard), timolol maleate (Blocadren), propranolol (Inderal).

Question 12

Beta-adrenergic blockers action

Answer 12

Combines with beta-adrenergic receptors in the heart, arteries, and arterioles to block response to sympathetic nerve impulses; reduces heart rate and thus cardiac output.tbu

Question 13

Vasodilators drug names

Answer 13

Hydralazine hydrochloride (Apresoline), minoxidil (Loniten).

Question 14

Vasodilators action

Answer 14

Acts on arteriolar smooth muscle to cause relaxation and reduce peripheral vascular resistance.

Question 15

Calcium channel blocker names

Answer 15

(ends in pine) Diltiazem (Cardizem, Dilacor XR), verapamil hydrochloride (Calan SR), nifedipine (Procardia), nicardipine (Cardene).

Question 16

Calcium channel blocker action

Answer 16

Reduces peripheral vascular resistance by systemic vasodilation.

Question 17

Angiotensin-converting enzyme (ACE) inhibitors names

Answer 17

(ends in pirl) Captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), benazepril (Lotensin).

Question 18

Angiotensin-converting enzyme (ACE) inhibitors action

Answer 18

Lowers blood pressure by blocking the conversion of angiotensin I to angiotensin II, preventing vasoconstriction; reduces aldosterone production and fluid retention, lowering circulating fluid volume.

Question 19

Angiotensin-II receptor blockers names

Answer 19

(ends in tan) Losartan (Cozaar), olmesartan (Benicar).

Question 20

Angiotensin-II receptor blockers action

Answer 20

Lowers blood pressure by blocking the binding of angiotensin II, which prevents vasoconstriction.

Question 21

Normal BP values

Answer 21

Systolic:

Question 22

Pre HTN values

Answer 22

Systolic: 120-139. Diastolic: 80-89

Question 23

Stage 1 HTN values

Answer 23

Systolic: 140-159. Diastolic: 90-99

Question 24

Stage 2 HTNvalues

Answer 24

Systolic: ≥160. Diastolic: ≥100

Question 25

BP definition equation

Answer 25

Cardiac output x peripheral recistance

Question 26

Classifying Hypertension

Answer 26

Persistent SBP ≥ 140, ≥ DBP 90 or current use of anti-HTN meds in the adult patient. One high reading does not mean the pt is hypertensive

Question 27

Measuring BP. (7 tips)

Answer 27

1. Abstain from smoking, caffeine, exercise 30 minutes prior to BP. 2. Rest quietly for 5 minutes 3. Patient: seated, feet on floor, arm at heart level. Place arm on a hard surface. Palm up. Pt can’t talk. 4. Appropriate sized cuff 5. At least 2 measurements,1 minute apart, averaged together & recorded 6. Evaluation of “white coat” hypertension 7. Pt with hx of disease (breat cancer, lymph cancer or other) it is not recommended to take BP in that side

Question 28

Isolated Systolic Hypertension

Answer 28

SBP ≥140 coupled with an average DBP ≤ 90

Question 29

Primary Hypertension (etiology)

Answer 29

Formerly: Essential or Idiopathic Hypertension (same as primary HTN) No identified cause 90-95% of cases Risk factors: Age, African-American, obesity, smokers, excessive ETOH, stress, DM, high lipid levels, sedentary lifestyle.

Question 30

Secondary Hypertension (Etiology)

Answer 30

Results from specific cause or condition. Typically renal related.

Question 31

RAAS mechanism

Answer 31

Renin + angiotensinogen = angiotensin 1 + ACE = Angiotensin 2 = vaso constriction + aldosterone secretion (sodium retention) =

Question 32

Vascular endothelium dysfunction

Answer 32

decrease vasodilator response to nitric oxide | increase endothelin levels result in “prolonged & pronounced” vasoconstriction

Question 33

Nitric Oxide (definition for vascular system)

Answer 33

Is a powerful vasodilator

Question 34

Gerontological Considerations

Answer 34

- Loss of tissue elasticity - Increase stiffness of myocardium & PVR - Blunting of baroreceptor reflex, decrease renal function, renin response to sodium & water depletion - Increase likelihood of auscultatory gap, increase sensitivity to BP changes

Question 35

TOD

Answer 35

Target Organ Damage

Question 36

Dash Diet (food amounts)

Answer 36

``` Grains: 6 - 12 Fruits: 4-6 Veggies: 4-6 Dairy: 2-4 Meats: 2 Nuts: 3-6 a week Fats and sweets: 2-4 ```

Question 37

Diagnostic Studies

Answer 37

``` Accurate BP monitoring Physical exam Target organ focus UA, BUN/creatinine, creatinine clearance Electrolytes (especially potassium) Fasting blood glucose Lipid profile, EKG ```

Question 38

Diuretics overall goal

Answer 38

Decreasing circulating volume by increasing urine output

Question 39

Diuretics major uses

Answer 39

Treat hypertension Remove edema fluids Prevent renal failure

Question 40

Diuretics side effects

Answer 40

Fluid volume deficit, A/B imbalance & electrolyte imbalance

Question 41

Which diuretics inhibit reabsorption of Na, Cl, K, resulting in osmotic water loss

Answer 41

hydrochlorothiazide (HCTZ) and furosemide (Lasix)

Question 42

Which diuretic spares potassium

Answer 42

Aldactone

Question 43

Caution with K+ sparing diuretics:

Answer 43

not given with K supplements or with another K sparing diuretic if patients also taking ACEI’s