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Med surg exam 3 > HTN and CAD > Flashcards

HTN and CAD Flashcards

1
Q

HTN stage 1

A

2+ BP readings with

SBP 140-159

or

DBP 90-99

or

current use of antihypertensives

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2
Q

HTN Stage 2

A

2+ BP readings with

SBP over 160

or

DBP over 100

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3
Q

Prehypertension range

A

SBP 120-139

DBP 80-89

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4
Q

primary HTN

A

90-95% of all cases

No identified cause

Factors:
Alcohol/tobacco
Age
Inc. lipids
Younger men
Older women
DM
Obesity
Genetics
Stress
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5
Q

Secondary HTN

A

Elevated BP w/specific cause

5-10% of cases in adults

80% of cases in kids

If under 20 or over 50 and BP spikes suspect secondary

Treatment: fix the cause- can be congenital narrowing of aorta, renal disease, sleep apnea, cirrhosis

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6
Q

BP equation

A

BP=CO x Vascular Resistance

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7
Q

renin-angiotensin function

A

Constricts vesels
Stimulate ADH release
Stimulate thirst
Stimulate aldosterone

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8
Q

Aldosterone function

A

Cause kidneys to retain sodium and water

Increases blood volume and CO

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9
Q

Atrial naturetic factor

A

Produced by Renin-Angiotensin, excretes sodium and water

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10
Q

Humoral BP influencers

A

Vasoconstrictors

Angiotensin

Catecholamines

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11
Q

HTN diagnosis

A

BP measured in both arms

Use arm with higher reading

BP highest early morning, lowest night

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12
Q

Urinalysis labs

A

clear or cloudy

pH 4.5-8

Specific gravity 1.001-1.025

Bilirubin: may indicate liver damage

Protein: Should be trace to zero

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13
Q

Cholesterol ranges

A

0-200: desirable

201-239: elevated

240+: high

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14
Q

Drug choice without compelling indications for stage 1 HTN

A

SBP 140-159 or DBP 90-99

Thiazides

May consider ACE inhibitor, ARB, Beta blocker, calcium channel blockers

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15
Q

Drug choice without compelling indications for stage 2 HTN

A

SBP 160+ or DBP 100+

Two drug combination for most

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16
Q

Drug choice for HTN with compelling indications

A

More than two drugs as needed

17
Q

Lifestyle modifications to reduce bp

A

22lb weight loss can reduce bp by 5-10 systolic

Decrease Na <2.4g/day

18
Q

Priority problems for HTN

A

Tissues perfusion
Ineffective health maintenance
Compliance

19
Q

Preload

A

Pressure from volume of blood in ventricles

End diastolic pressure

Increased in

  • Hypervolemia
  • Valve regurgitation
  • Heart failure
20
Q

Afterload

A

Resistance L ventricle must overcome to circulate blood

Inc. in HTN and vasoconstriction

21
Q

Review drug therapy on table 32-7

A 
Diuretics
Adrenergic inhibitors
Direct vasodilators
Angiotensin inhibitors
Ca channel blockers
22
Q

Diuretics

A

Reduce preload

inhibit sodium reabsorption
inc. excretion of sodium and water

23
Q

HCTZ- Hydrochlorothiazide

A

Diuretic

Can result in low electrolyte values, hyperglycemia, dehydration, renal calcium

watch electrolytes

24
Q

Adrenergic inhibitors

A

Reduce afterload

Alpha and beta blockers

Lower sympathetic (fight or flight) activity
lowers vasoconstriction

Monitor pulse- Needs to be ABOVE 60 BPM

May cause severe orthostatic hypotension,

25
Q

Alpha blockers

A

vertigo, tachycardia, sexual dysfunction

ex. doxasozin (Cardura), prazosin (Minipress)

26
Q

Prazosin (Minipress)

A

Give initial dose at bedtime to avoid first dose effect (fainting after taking first dose)

Side effects: Orthostatic Hypotension
Reflex tachycardia
Inhibition of ejaculation
Nasal congestion

27
Q

Beta blockers

A

Examples:
Propranolol
Atenolol
Metoprolol

Blocks beta receptors in heart: lowers HR, force of contraction, and rate of AV conduction
Can cause
Hypotension
Bradycardia
HF symptoms (coughing, SOB, edema, fatigue)
Drowsiness, depression

28
Q

Vasodilators

A

Decrease SVR (systemic vascular resistance)

Reduce afterload

reserved for hospitalized patients, need IV access

29
Q

Nitroglycerin

A

Vasodilator

Used to treat angina

Rapid onset: 2-5 min
Sublingual tabs, IV, translingual spray

Slow onset: 20-60 min
Transdermal patch
Nitro ointments
XR capsules

SE:

  • Hypotension
  • Tachycardia
  • Dizziness
  • HA
  • Syncope
30
Q

Angiotensin inhibitors

A

ACE inhibitors or ARB

ACE inhibitors: prevent angiotensin vasoconstriction–>reduces afterload

ARB: Vasodilation and inc. sodium/water excretion–> reduces preload

31
Q

ARBs

A

Blocks action of Angiotensin 2

ex.
Valsartan
Losartan
Olmesartan

Can cause

  • Angioedema
  • Fetal harm
  • Renal damage

doesn’t cause hyperkalemia or cough

32
Q

Which ARB is the only sartan approved for MI, stroke, CVD in patients not able to take ACE inhibitors?

A

Telmisartan

33
Q

Which ARB is the only sartans approved for HF?

A

Valsartan, Cadesartan

Inc. L ventricular ejection fraction

34
Q

Which ARB is the only sartan approved for nephropathy in hypertensive patients with DM2?

A

Losartan

Irbesartan

35
Q

Ace inhibitors (PRILS)

A

Captopril
Lisinopril
Enalapril
Quinapril

Lower peripheral vasc. resistance WITHOUT increasing: CO, HR, contractility

Indicated for HTN, HF, post MI

can cause: 
Postural hypotension
Angioedema
nonproductive cough
Hyperkalemia
36
Q

Fosinopril (Monopril)

A

Decrease peripheral and arterial resistance and pulmonary capillary pressure.

Increases exercise tolerance and CO

May cause First dose effect

Watch for Hyperkalemia, Hypotension, N/V, cough

37
Q

Calcium channel blockers (Very Nice Drugs)

A

Blocks movement of calcium into cells

ex.
Verapamil
Nifedipine
Diltiazem

Reduces afterload by inc. vasodilation-> which lowers SVR and BP.

Lowers HR and contractility

Side effects:
Hypotension
Bradycardia
AV block
HA
GI distress
peripheral edema
38
Q

Hypertensive crisis

A

Severe abrupt increase in DBP (over 140)
Rate more important than actual value

Often occurs in pt w/ hx of HTN that failed to comply w/ meds or have been underdosed

Hypertensive emergency: 
-evidence of acute target organ damage
\: Hypertensive encephalopathy, cerebral hemorrhage
-Acute renal failure
-MI
HF w/ pulmonary edema
39
Q

Hospitalization for hypertensive crisis

A

Critical care unit

IV drug therapy titrated to MAP—slowly decrease

MAP=(SBP + 2(DBP))/3

Monitor cardiac and renal function

neuro checks

determine cause

education to avoid future crises

Med surg exam 3 (9 decks)

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