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Nursing 232 > HTN > Flashcards

HTN Flashcards

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1
Q

What is a lipid profile? Why is it important in HTN?

A

-Measure cholesterol, triglycerides + lipoproteins to see risk of atherosclerotic disease or to diagnose specific lipoprotein abnormality

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2
Q

Signs + Symptoms of HTN

A

Raised BP

Late: dizziness, fatigue, palpitations, AM headaches, blurred vision
from patho

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3
Q

Important diagnostics for HTN?

**

A 
Lipid Profile
Urinalysis
Electrolytes 
Fasting Blood Glucose
CBC
BUN &Creatinine
Lipid Profile (Total Chol, HDL, LDL, Triglyceride)
CRP 
12-lead ECG
Echocardiogram

(BP, HR)

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4
Q

Pharmacological interventions for HTN?

**

A 
Thiazide/Loop Diuretics
Beta Blockers
ACE Inhibitors, ARB’s
Calcium Channel Blockers
Vasodilators
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5
Q

3 step approach to managing HTN?

**

A

1) Lifestyle modifications
2) Start with one drug at low dose and increase if necessary
3) Addition of a 2nd anti-hypertensive
medication until results are achieved

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6
Q

Recommended lifestyle changes for those with HTN

**

A 
Smoking Cessation 
Alcohol use  - 1-2 standard drinks/day
 Diet/Weight loss -  DASH diet
 Exercise: light weights/aerobic
 (tight) 
Blood glucose control for people with Diabetes
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7
Q

Differentiate between CHEP guidelines and AHA as teaching/learning resources

A

x

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8
Q

4 systems of BP regulation in body:

**

A

Arterial Baroreceptors/ Chemoreceptors

Regulation of body fluid volume

Renin-angiotensin aldosterone system

Vascular autoregulation

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9
Q

Name 7 kinds of HTN

**

A 
Primary hypertension
Secondary hypertension
“White coat” hypertension
Isolated systolic hypertension
Malignant (persistent severe) hypertension
Pregnancy Induced Hypertension (PIH)
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10
Q

SBP = ?

DBP = ?

**

A

Systolic BP
pumping pressure

Distolic BP
filling pressure

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11
Q

Ranges for stages of HTN?

**

A

High Normal: 130-139 S or 85-89D
Stage 1: ≥140-159 S or ≥90-99D
Stage 2: 160-179S or 100-109D
Stage 3: ≥= 180S or ≥=110D

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12
Q

How do we diagnose HTN?

A
  • Conventional route for diagnosis = 6 measures over 6 months…unrealistic + high risk of complciations
  • Urgent cases (BP needs to be lowered within few hours) can be diagnosed on initial visit – BP taken every 5 min, monitor for rapid drop

From class: 2 BP readings are taken 5 minutes apart
no caffeinated drinks
no smoking
no alcohol

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13
Q

Possible adverse effects of HTN? Why is this condition such a concern?

A
  • Target Organ Damage
  • Stress on the heart  L ventricular hypertrophy
  • HF
  • Stress on blood vessels  atherosclerosis, CVA
  • Renal disease (hypertensive nephropathy)
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14
Q 
Non-modifiable risk factors for HTN?
*From class PP's
A

Age
Family hx
Gender: men over women until age 55; over 74  women
Ethnicity
Insulin resistance syndrome/Metabolic Syndrome
hyperinsulinemia + obesity + Type 2 Diabetes + hyperlipidemia

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15
Q

Modifiable risk factors for HTN?

A 
Stress  fight/flight
Obesity: BMI > 25
Nutrition:  Na+ diet; high fat 
Substance abuse
smoking, alcohol, cocaine, caffeine
Oral contraceptives
Sedentary lifestyle
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16
Q

Risk factors for primary HTN?

A 
genetic heritage( African descent, First nations, Inuit, Metis, South Asians, Chinese)
excess sodium intake
alcohol intake
body weight
physical inactivity
lipid levels
personality traits (those with hostile attitudes)
vitamin D deficiency
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17
Q

What is the biggest risk factor for CVD?

A

HTN

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18
Q

Conditions that lead to secondary HTN?

A

o Primary renal disease (acute + chronic)
o Oral contraceptives
o Pharmaceuticals
o Chronic alcohol intake
o Pheochromocytoma (a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache)
o Primary aldosteronism (excess aldosterone secretion)
o Renovascular disease
o Cushing syndrome (htn major cause of death in those with this condition)
o Other endocrine disorders: hypothyroidism, hyperthyroidism, hyperparathyroidism
o Obstructive sleep apnea
o Coarctation of the aorta

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19
Q

How frequent are follow-ups with patients with diagnosed HTN?

A

q1-2months for those on antihypertensives until 2 readings find below target values(more frequent for symptomatic patients, severe cases, intolerance to antihypertensives, those with organ damage), then seen q3-6months

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20
Q

How does the outcome of a lipid profile relate to risk of CAD?

A

-Risk of CAD inc as ratio of LDL to HDL or total cholesterol (HDL + LDL) to HDL increases

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21
Q

When is a lipid profile measured?

A

-Obtained after 12 hour fast (though lipid levels remain quite constant)

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22
Q

What is cholesterol required for? High in what tissues?

A

oRequired for hormone synthesis + cell membrane formation

oHigh in brain + nervous tissue

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23
Q

HDL’s:

  • Relationship with CAD risk?
  • fx
  • Dec with?
A

o inverse relationship between inc + risk of CAD → have protective quality, transport cholesterol away from tissues + cells of arterial wall, bring to liver
• Dec with smoking, diabetes, physical inactivity

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24
Q

Triglycerides:

  • Made up of (2)?
  • Blood levels inc when?
  • Correlative relationship between triglycerides and LDL and HDLs?
A

o Composed of fatty acids + glycerol
o Stored in adipose, source of energy
o Levels inc after meals, affected by stress
o Inc with diabetes, alcohol use, obesity
o Direct correlation w LDL, inverse with HDL

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25
Q

What factors determine which antihypertensive is used?

A

•In choosing drug, will consider general health, sex, age, race, severity of BP, any additional underlying medical conditions, and whether particular drugs should not be used

26
Q

Is the kind of antihypertensive used important in reducing risk of CVD? What is?

A

• Amount of BP reduction is major determinant of reduction in CVD, not choice of antihypertensives

27
Q

To increase effectiveness, is an antihypertensive dose typically increased?

A

•Typically begin with one drug, then add a second if not managing (rather than inc dose – but can do this too) → using combo drug therapy usually more effective than inc dose + has less side effects

28
Q

Without a specified determination in HTN, which kind of antihypertensives are NOT typically used?

A

beta blockers not typically used as initial therapy in absence of specific determination

29
Q

In absence of particular determination, which 3 kinds of drug classes are typically used with HTN?

A

1) thiazide diuretics
2) long-acting Ca channel blockers
3) ACE inhibitors or ARB’s

30
Q

What is “nondipping” HTN and how to manage this pharmacologically?

A

= failure of BP to fall at least 10mmHg during the night;

= a stronger predictor of adverse CVD effects than daytime pressure → shifting one drug to nighttime may help this

31
Q

Goal of HTN phamacologic therapy (target BP range)?

A

for noncomplicated cases, to get below 140/90 or 150/90 (for those >60)

32
Q

For systolic HTN, why do you need to be careful not to push diastolic P too low?

A

…r/t MI + stroke

33
Q

What is “resistant HTN”? What is it due to?

A

DBP of >90mmHg despite taking 3 drugs; could be d/t suboptimal therapy, extracellular volume expansion, poor compliance, secondary htn, office or white coat htn, ingestion of substances that elevate BP

34
Q

In HTN treatment, When are the following drugs recommended?

1) ACE inhibitors
2) Beta blockers

A

1) for DM with proteinuria, HR or prior MI

2) HF or prior MI

35
Q

Which drugs are recommended for control of symptoms of angina pectoris?

A

Beta blockers or calcium channel blockers

36
Q

Which antihypertensives are NOT recommended during pregnancy?

A

ACE inhibitors + Angiotensin II receptor blockers (ARB’s)

37
Q

What does the DASH diet include?

General recommendations for diet in HTN?

A
  • DASH = high in fruits + veggies & low fat dairy products
  • Choose diet low in meats, sweets, refined grains, high in vegs + fruit
  • Dietary salt restriction
  • Vitamin D supplementation
38
Q

Exercise recommendations for HTN?

A

Do something active for at least 30 mins a day on most days of the week; aerobic exercise has benefit on systolic BP

39
Q

Limit alcohol intake to?

A

1 drink for women, 2 for men/day (5oz wine, 1 beer, 1.5oz hard)

40
Q

General approach to lifestyle modifications in treatment of HTN?
(what “moto” is used?)

A

“Start low and go slow” – don’t have to change everything at once, choose one thing first and try until becomes habit

41
Q

Limiting intake of what drugs is recommended in lifestyle changes for HTN?

A

NSAIDS + acetaminophen

42
Q

At what BP should antihypertensives be held?

A

Bottom line systolic P (when to not administer antihypertensive) = 100mmHg
90mmHg needed to perfuse organs

43
Q

Approach for Angina?

A 
M- Morphine
O- Oxygen
N- Nitroglycerine
A- ASA (plavix)
- First have sit down, give O2 and see if this is enough
- IF pain doesn’t subside, start Nitro
44
Q

Pulse pressure reflects?

A

force of heart each time it contracts

45
Q

What is attributed with an inc in HTN in children?

A

Rising obesity rates

46
Q

Relationship between sex and BP?

A

Women: lower sys BP than men until 50, then rises significantly to surpass that of men

(women have overall higher risk of developing HTN)

47
Q

What is CHEP?

A

Canadian Hypertension Education Program - evidence informed guidelines for the accurate measurement of and treatment of HTN

o CHEP’s intent is to edu HCW and the public abt the consequences of HTN and the imp of adequate prevention and Tx in order to reduce the burden of CVD

48
Q

Major points in CHEP?

A
  • Encourage pts to use approved BP measuring devices + proper technique when measuring at home (home measurements highly encouraged)
  • Adults with high normal BP require annual assessment
  • All Canadian adults need to have BP assessed at all appropriate clinical visits
  • Optimal management requires assess of overall cardiovascular risk
  • Lifestyle modifications important - introduce small managemable changes
  • Treat to target

Managment recommendations:

  • Healthy diet w reduced cholesterol, saturated fat, dec sodium
  • Inc fruits, veggies, low fat dairy products, dietary fibre, whole grains, proteins from plant products
  • Inc physical activity to prevent childhood obesity
49
Q

Which is a stronger predictor of CV evets, that done at home or in a clinical setting?

A

Home

50
Q

Idiopathic HTN aka?

A

Essential

Primary

51
Q

Secondary HTN generally results from?

A

Other disease such as adrenal tumour, pre-eclampsia, or renal artery disease
May also be result of medications

52
Q

Normal CO?

BP =

A

4-8L/min

BP = CO + SVR (systemic vascular resistance)

53
Q

What is SVR?

A

Systemic Vascular Resistance

= the forece (resistance) the left ventricle has to overcome to eject its volume of blood

54
Q

How is HTN drug tx determined?

A

Very individualized

Must think about whether patient has other medical problems and impact of drug tx on pt quality of life

55
Q

What is a common side effect of antihypertensives in men?

A

sexual dysfunction…leads to noncompliance (why must choose drug carefully, taking into account how it will affect quality of life)

56
Q

How is HTN defined in terms of percentiles?

A

o HTN is defined as BP > or = to the 95 percentile for age gender and height on 3 sep occasions
o PreHTN=90-95th percentile

57
Q

What is “masked” HTN?

A

•normal when in DRs office and high when at home

58
Q

General guidelines for when a patient will be on one or two drugs?

A

If pt has stage HTN 140-159/90-99 theyre most likely given thiazide diuretic; may consider ACE I, ARB, BB, CCB or combo

If pt has stage II HTN theyre most likely on two drug combo

59
Q

Where do adrenergic drugs work on?

A

o Have either central action in brain or peripheral action in the heart and blood vessels

60
Q

How do vasodilators work?

A

Act directly on smooth muscle cells, not through alpha or beta receptors

61
Q

What is a more reliable indicator of long term effectiveness of antihypertensives than BP?

A

looking at fundus of eye

Nursing 232 (12 decks)

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