Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical nutrition 1 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

5 major forms of cardiovascular disease

A
  • hypertension
  • atherosclerosis
  • ischemic heart disease
  • peripheral vascular disease
  • heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 leading causes of death in canada

A
  1. cancer
  2. diseases of the heart
  3. cerebrovascular diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is a major risk factor of hypertension? how can we establish this?

A

Age
prevalence increases with age (higher in males vs females)
and at 65+ equal for male and females, still with a higher prevalence
-> linear relationship

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the leading reason for visits to physicians in canada?

A

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

____ are one of the most expensive drug categories

A

antihypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the lifetime risk for developing hypertension among adults aged 55 to 65 years with normal blood pressure is ___

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which population have the highest rate? lowest rate?

A
  • highest: african-americans (44%)

- lowest: Chinese, Koreans (17%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the 2 phases of the cardiac cycle?

A

systolic (contraction) and diastolic (resting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cardiac output formula

A

stroke volume x heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

peripheral resistance formula

A

(length of vessel x viscosity of the blood)/radius^4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

relationship between vasoconstriction and resistance

A

in vasoconstriction - resistance increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

relationship between vasodilation and resistance

A

in vasodilation - resistance decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mean arterial pressure MAP formula

A

cardiac output x peripheral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the 4 factors regulating blood pressure (MAP)

A
  • sympathetic nervous system
  • renin-angiotensin aldosterone system
  • renal function
  • hormones involved: epinephrine, vasopressin, angiotensin 2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which factors modulate heart rate + direction

A
  • parasympathetic activity decreases HR

- sympathetic activity and epinephrine increase HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

the kidneys sense _____ which causes the release of ____

A

decrease in sodium, extracellular fluid, and arterial blood pressure which causes the release of RENIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

the liver releases ____ which reacts with ____ to make _____

A

angiotensinogen which reacts with renin to make angiotensin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

the lungs produce ____ which reacts with ____ making ____

A

angiotensin-converting enzyme reacts with angiotensin 1 making angiotensin 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

angiotensin 2 positively regulates: (4)

A
  • adrenal cortex
  • vasopressin
  • thirst
  • arteriolar vasoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

adrenal cortex release ___ which stimulates ___. what are the consequences

A

aldosterone stimulates kidneys which results in sodium reabsorption by kidney tubules which osmotically holds more water in ECF -> water conserved and helps correct low ECF volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

effects of vasopressin

A

water reabsorption by kidney tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

____ + ____ + _____ = increase osmolality, increase blood volume and blood pressure

A

water reabsorption + fluid intake + vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the target organ damage related to hypertension

A
  • heart: left ventricle hypertrophy, coronary heart disease, congestive heart failure
  • kidneys: renal failure, proteinuria
  • bigger vessels: peripheral vascular disease/atherosclerosis
  • eyes: retinopathy
  • brain: hemorrhage, stroke, dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do you measure blood pressure

A

sphygmomanometer in mmHg (millimetres of mercury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

causes of hypertension can either be ___ or ___

A

primary/essential or secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are primary/essential/idiopathic causes of HTN

A

they represent 95% of cases

  • unknown etiology
  • interaction from environmental and genetic factors (predisposition)
  • influenced by dietary and behavioural factors (PA, smoking, sleeping)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are secondary causes of HTN

A

they represent 5% of cases

- occurs secondary to another condition such as renal, endocrine, or neurological disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

why do we refer to HTN as the “silent killer”

A

because HTN is typically asymptomatic - you die from HTN due to target organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

which are non-modifiable risk factors of HTN

A
  • age >60y
  • men, postmenopausal women, ethnicity
  • family history of CVD: women <65y or men <55y
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

which are modifiable risk factors of HTN

A
  • smoking
  • sedentary lifestyle
  • abdominal obesity, insulin resistance
  • excess sodium intake
  • poor diet quality
  • stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

why are excessive secretion of vasopressin and angiotensin 2 contributing factors to HTN

A

increased vasoconstriction and fluid retention - high blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

mechanism of smoking on HTN

A

interferes with nitric oxide which impairs endothelial vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

mechanisms of renal disease/atherosclerosis on HTN

A

reduced blood flow -> increased angiotensin 2 -> vasoconstriction + sodium/chloride/water retention -> increase in blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

mechanism of adrenal disorders on HTN

A

adrenal disorders that increase secretion of epinephrine and norepinephrine causes vasoconstriction and increases cardia output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

____ is associated with HTN but the mechanisms are unclear

A

hyperinsulinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the normal range of systolic blood pressure and diastolic blood pressure

A

90-119 mmHg and 60-79 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Blood pressure

A

systolic/diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how does hypertension canada stratify patients?

A

by cardiovascular risk and based on that risk, there are different threshold and targets for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are the 4 stratification categories?

A
  • low risk
  • moderate-to-high risk
  • diabetes mellitus
  • hypertension canada high risk patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

characteristics of a person categorized as “low risk” for hypertension

A
  • person with some HTN

- no target organ damage or cardiovascular risk factors and 10-year global risk inferior to 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

characteristics of a person categorized as “medium-to-high risk” for hypertension

A

multiple cardiovascular risk factors and 10-year global risk 10-14%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

characteristics of a person categorized as “diabetes mellitus” for hypertension

A
  • higher chronic blood glucose

- higher risk at cardiovascular risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

characteristics of a person categorized as “high-risk patient” for hypertension

A
  • > 50y
  • AND with systolic blood pressure between 130-180 mmHG [normal 90-119mmHg]
  • AND with one or more of the following CV risk factors should be considered for intensive BP management:
    . clinical or subclinical cardiovascular disease
    . chronic kidney disease (non-diabetic nephropathy, proteinuria)
    . estimated 10-year global cardiovascular risk >15%
    . age >75y
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

threshold for initiation of antihypertensive therapy and targets for LOW risk patients

A
  • threshold: SBP >160 DBP >100

- treatment: SBD <140 DBP <90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

threshold for initiation of antihypertensive therapy and targets for MODERATE TO HIGH risk patients

A
  • threshold: SBP >140 DBP >90

- treatment: SBD <140 DBP <90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

threshold for initiation of antihypertensive therapy and targets for DIABETIC patients

A
  • threshold: SBP >130 DBP >80

- treatment: SBD <130 DBP <80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

threshold for initiation of antihypertensive therapy and targets for HIGH RISK patients

A
  • threshold: SBP >130

- treatment: SBD <120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

observation made when looking at threshold and treatment between low risk and high risk patients

A

threshold is higher for low risk patients but lower for high risk - you need to start treating high risk patients as soon as possible even if BP is not that high
=> concept of overall risk for cardiovascular diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what is the preferred method for blood pressure measurement

A

Oscillometric (electronic) - patients can do it themselves [having BP measured by doctor can be stressful - influence BP]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

benefits of ambulatory BPM

A

measure BP out of the doctor’s office which could be stressful in itself and influence BP - used when the BP is just at a limit that could be diagnosed as HTN + measures throughout day and night time - more representative of overall BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is the threshold value for diagnosis of HTN for a patient with diabetes?

A

OBPM > 130/80 -> lower threshold value than for a patient with no diabetes [140/90]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is the threshold value for a patient with no diabetes that has a mean office BP lower than 180/110?

A

OBPM >140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is WCHT

A

white coat hypertension - hypertension related to stress of being at the doctors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is the general threshold for diagnosis of HTN

A

> 135/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are the hypertension therapy goals?

A
  • reduce risk of CVD and renal disease

- Lower BP to clinically appropriate level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what does the comprehensive plan for HTN therapy include?

A
  • physical activity
  • weight reduction
  • nutrition therapy
  • moderation in alcohol, relaxation therapy, smoking cesation
  • pharmacological interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are the pharmacological interventions available for treating HTN

A
  • loop diuretics;
  • thiazides;
  • carbonic anhydrase inhibitors;
  • potassium sparing diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what si the basis for HTN therapy?

A

lifestyle modifications, if not sufficient then you add medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what are the dietary factors involved in HTN

A
  • high calories, excess weight, obesity
  • sodium
  • potassium
  • calcium
  • magnesium
  • alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

in adults <55y there is a direct link between ___ and ___

A

excess weight and hypertension
-> 60% of those with excess weight [abdominal obesity more specifically] and normal BP will develop HTN in the next 4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what are the causes of HTN associated with obesity

A
  • insulin resistance/hyperinsulinemia
  • overactivity of sympathetic nervous system with obesity
  • alteration of RAAS [overproduction of aldosterone]
  • leptin increases sympathetic activity [in obesity there is some form of leptin resistance - satiety function isn’t working properly]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is the most potent non-pharmacological approach to treating HTN

A

weight loss - greatest decrease in BP among all of the interventions that are not drugs

63
Q

what is the reduction of BP per 10kg loss

A

5-20mmHg per 10kg loss

64
Q

weight loss is indicated both in ___ and ___ of HTN

A

treatment and prevention

65
Q

all overweight patients should achieve a weight loss of ___ why?

A

5kg -> reduce SBP by 4.4 mmHg and DBP by 3.6mmHg to reduce BP and risk for organ damage

66
Q

what are some weight loss approaches in HTN treatment

A
  • diet education and instruction
  • increase in PA
  • behavior modification
67
Q

weight loss may be more difficult in patient using ____. why?

A

beta-blockers for cardiac disease because these will lower sympathetic activity -> lower metabolism and weight gain

68
Q

what is the relationship between systolic BP and urinary sodium excretion

A

linear relationship

69
Q

measuring serum sodium is a good reflection of sodium intake. True or false?

A

False, when sodium intake increases the RAAS system maintains sodium concentration in a very tight range therefore any excess is excreted which is why sodium excretion is the best method to reflect sodium intake

70
Q

lower sodium intake ____ SBP

A

reduces

71
Q

which population is more responsive to diet lower in sodium

A

hypertensive people although normotensive also see an improvement in SBP
african-american
middle-aged
diabetic, renal disease

72
Q

high sodium intake increases risk of complications in hypertensive patients such as

A

Coronary heart disease death, Cardiovascular disease death and all death

73
Q

when comparing American diet and DASH diet with the same amount of sodium intake, which diet shows a greater reduction in BP when lowering the sodium intake?

A

American diet

74
Q

which is better: American diet with reduced sodium intake or DASH diet with more liberal sodium intake?

A

DASH with more liberal sodium intake -> DASH diet associated BP lines are much lower than the control diet regardless of sodium intake

75
Q

what can explain the heterogeneity observed regarding salt sensitivity

A
  • familial/genetic factors
  • age
  • severity of HTN
  • degree of restriction
  • renin-angiotensin-aldosteron (low renin)
  • sympathetic response (high NE response)
  • duration of trials
76
Q

salt sensitivity is largely influence by ____

A

POTASSIUM: high potassium intake - lower sodium sensitivity

77
Q

good ___ intake is protective against BP

A

potassium

78
Q

if diet is high in ___, higher ___ won’t affect much the increase of BP

A

potassium

sodium

79
Q

dietary sodium DRI

A

adequate intake
14-50: 1500mg Na/day
51-70: 1300mg/day

80
Q

what is the upper limit of sodium

A

2300 mg Na/day for all adults

81
Q

to decrease blood pressure, consider reducing sodium intake towards ____ per day

A

2000 mg Na per day aka 5g of salt

82
Q

80% of average sodium intake is ____

A

processed foods

83
Q

breads are ___ in sodium but are _____

A

lower in sodium but are big contributors because they are eaten in higher amounts

84
Q

choose foods with less than ___ per serving

A

120mg Na

85
Q

choose foods with sodium that have a % daily value of ____

A

5% or less

86
Q

to whom are sodium control diets bets for?

A

hypertensive people and those with renal diseases

87
Q

overall, reducing sodium intake:

A
  • reduces BP in most cases
  • prevents HTN
  • has an additive effect to antihypertensive medications -> lower doses and better control
  • reduces risks of complications
88
Q

relationship between potassium intake and BP

A
  • inverse relationship
  • decrease in mean blood pressure
  • decreased prevalence in HTN with higher K intake
89
Q

what are the mechanisms involved in potassium decreasing BP?

A
  • natriuresis [sodium secretion in urine]
  • suppressed renin
  • attenuates vascular contraction -> vasodialtion
  • may reduce sympathetic activity and angiotensin
90
Q

higher sodium intake favours ___

A

potassium excretion

91
Q

our kidneys and RAS system are programmed to ____ [basis of our physiology]

A

conserve sodium and excrete potassium if in excess

92
Q

recommended daily dietary intake of potassium

A

> 60mmol (2300mg) -> associated with decreased risk of stroke mortality (+50mmol reduced BP)

93
Q

potassium supplementation above daily dietary intake of 60mmol/day os recommended as a treatment for hypertension. true or false

A

false - emphasize fruit and vegetable + dairy intake which will allow for sufficient potassium intake

94
Q

what are the risk factors for hyperkalemia

A
  • patients using RAAS inhibitors
  • patients receiving other drugs causing hyperkalamia [retention of K]
  • chronic kidney disease
  • baseline serum potassium >4.5mmol/L
95
Q

___ intake is inversely associated with BP

A

calcium

96
Q

what are the mechanisms of increased calcium itnake

A
  • increased sodium excretion
  • increased sensitivity to nitric oxide -> vasodilation
  • reduced production of superoxyde and prostanoids (vasoconstrictors)
97
Q

calcium supplementing above daily recommended dietary intake is not recommended as a treatment for ___

A

hypertension

98
Q

relationship between magnesium and BP

A

inverse relationship

99
Q

mechanism of magnesium on BP

A

relates to vascular structure and function: regulates vascular reactivity and contractility

100
Q

what are the recommendations for magnesium intake

A

increase dietary intake to reach DRI (menL 420mg/d; women 320mg/d)

101
Q

alcohol intake has an immediate _____ effect but followed by ____ in the next 10-15h

A

vasovagal (decrease BP)

elevated BP

102
Q

effect of moderate alcohol consumption

A

does not raise BP and has cardioprotective effects

103
Q

recommendations for alcohol consumption

A
  • limit to 2 drink per day for men

- limit to 1 drink per day for women

104
Q

what are the routine lab tests done for assessment fo HTN

A
  • urinalysis to see excretion of electrolytes
  • blood chemistry (K+, Na+, creatinine)
  • fasting blood glucose or Arc1 [hemoglobin Arc1 - marker for longer term blood glucose]
  • serum lipid profile [stratification of HTN - overall cardiovascular risk]
105
Q

how is hypertension assessed

A
  • routine lab testing
  • electrocardiogram (ECG)
  • target organ damage
  • cardiovascular risk score
  • physical activity
106
Q

which are the possible nutrition diagnoses for HTN

A
  • excessive energy intake
  • excessive or inappropriate intake of fats
  • excessive sodium intake
  • inadequate calcium, fibre, potassium, or magnesium intake [inverse relationship with those nutrients and HTN]
  • overweight/obesity
  • food and nutrition knowledge deficit
107
Q

which are the health behaviour recommendations for treatment of HTN

A
  • weight reduction [BP decreased by 5-10mmHg/10kg loss]
  • eating healthier [DASH-like]
  • being more physically active
  • moderation in alcohol intake [abstain or limit to <2/day]
  • relaxation therapies
  • smoking cessation
108
Q

what are the recommendations for exercise and hypertension

A
  • accumulation of moderate PA of 30-60min/day on most days IN ADDITION to daily activities
  • higher intensities are NOT more effective at reducing BP
  • for HTN up to 160/99 mmHg: resistance exercise does not negatively impact BP
  • recommend gradual increase to 30-60min/day of moderate intensity
109
Q

what does DASH diet stand for

A

dietary approach to stop hypertension diet

110
Q

what is the rational behind the DASH diet

A

negative correlations between blood pressure and certain nutrients intake (potassium, calcium, magnesium, fibres and proteins) therefore you increase intake in these
> combine a diet that contains a lot of fruits and vegetables, whole grains, low fat dairy, restriction on total fat, saturated fats, dietary cholesterol, and salt

111
Q

what are the results/benefits of the DASH diet

A
  • average reduction of 5.5 mmHg SBP and 3 mmGh DBP more in DASH vs control
  • further decrease in hypertensive subjects
  • half of the DASH effects were observed for the high F&V diet vs control
112
Q

what is the carbohydrate goal in the DASH diet

A

55%

113
Q

what is the protein goal in the DASH diet

A

18%

114
Q

what is the total fat goal in the DASH diet

A

27%

115
Q

what is the saturated fat goal in the DASH diet

A

6%

116
Q

what is the sodium goal in the DASH diet

A

2300mg

117
Q

what is the potassium goal in the DASH diet

A

4700mg

118
Q

what is the calcium goal in the DASH diet

A

1250mg

119
Q

what is the magnesium goal in the DASH diet

A

500mg

120
Q

what is the fiber goal in the DASH diet

A

30g

121
Q

which foods are major sources of energy and fiber

A

whole wheat bread and rolls, whole wheat pasta, English muffin, pita bread, bagel, cereals, oatmeal, brown rice, unsalted pretzels and popcorn

122
Q

rich sources of potassium magnesium and fiber (vegetables)

A

broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes

123
Q

important source of potassium magnesium and fibre (fruits)

A

apples, apricots, bananas. dates, grapes, oranges, grapefruit, mangoes, melons, peaches, pineapple, strawberries

124
Q

major sources of calcium and protein

A

fat free or low fat milk or buttermilk, fat free, low fat or reduced fat cheese, fat free or Low fat regular frozen yogurt

125
Q

rich sources of protein and magnesium

A

select only lean, trim away visible fats, broil, roast, poach, remove skin from poultry

126
Q

rich sources of energy, magnesium, protein, and fiber

A

almonds, hazelnuts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentos, split peas

127
Q

27% of calories as fat including fat in or added to foods which include

A

soft margarine, vegetable oil (canola, corn, olive, safflower), low fat mayo, light salad dressing

128
Q

sweets should be low in fat. examples

A

fruit flavoured gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar

129
Q

what is the main difference between DASH and mediterranean diet

A

Medi diet is low in dairy

130
Q

observations of healthy diets similar to DASH-sodium diets rich in CHO, rich in protein, rich in UFA

A

all diets reduced BP, LDL-C and cardiovascular risk

diets high in protein and unsaturated FA further decreased blood pressure in hypertensive individuals

131
Q

comparing typical DASH-diet vs. higher-fat/low CHO DASH diet

A
  • similar decrease in blood pressure
  • decrease triglycerides and large and medium VLDL particle concentrations
  • did not decrease LDL-c but increased LDL peak particle diameter [LDL particle size increased - less atherogenic, less cholesterol esters in larger LDL particles]
    => depends on type of fat
132
Q

Benefits of DASH diet

A

improves:

  • BP
  • LDL
  • VLDL
  • TG
133
Q

examples of antihypertensive drugs

A
  • thiazide diuretics
  • distal tubular diuretics
  • angiotensin converting enzyme (ACE) inhibitors
  • angiotensin 2 receptor blockers (ARB)
  • calcium channel blockers (CCB)
  • beta blockers
  • single pill combination (SPC) [combine 2 different medications that act through different mechanisms of action aka ACE inhibitor with calcium blocker]
134
Q

what is the mechanism of diuretic treatments

A

> more urine produced

  • decreased reabsorption of Na and K
  • production of osmotic diuresis
  • increased excretion of Na and K
  • inhibit action of aldosterone
135
Q

about loop diuretics

A
  • excrete more potassium, diet should be providing alot of potassium + supplementation
  • i.e. furosemide
  • most prescribed drug
  • side effects: hypokalemia, hyperglycemia [pb of insulin secretion]
136
Q

about thiazides diuretics

A
  • potassium excretion
  • hydrochlorothiazide
  • side effects: hypokalemia, hyperglycemia
137
Q

for both loop and thiazides, what is the dietary approach

A
  • provide potassium rich foods

- provide potassium supplements

138
Q

about potassium sparing diuretic

A
  • spironolactone, triamterene, amiloride
  • avoid excess dietary potassium and supplements
  • avoid salt substitutes [potassium chloride]
  • avoid excess water consumption
  • take with food
  • avoid natural licorice
139
Q

why should one avoid natural licorice

A

natural licorice interacts with medication
it comes from root and contains an acid that acts by stimulating cortisol production. effect on creating a state of production of aldosterone
-> plays against antihypertensive medication

140
Q

about ACE inhibitors

A
  • ramipril
  • inhibits conversion of angiotensin 1 to angiotensin 2 -> decrease vasoconstriction, vasopressin, inhibits aldosterone release
  • side effects/interactions: hypotension, dry cough, side effects are more prevalent in African Americans, avoid salt substitutes, avoid natural licorice
141
Q

about angiotensin 2 receptors blockers (ARB)

A
  • valsartan, losartan
  • usually used when ACEi are not tolerated
  • block angiotensin 2 receptor and therefore decrease its activity -> vasodilation, reduced vasopressin and aldosterone
  • side effects/interactions: hyperkalemia, avoid salt substitutes and natural licorice, caution with grapefruit for Losartan
142
Q

why should one be cautious when eating grapefruit whilst taking losartan (ARB) or felodipine (CCB)

A

it contains a molecule that can interact with cytochrome P4-50 involved in drug metabolism
P4-50 is slightly inhibited by grapefruit molecule and drug will be found in higher levels in blood than what is normally expected

143
Q

about calcium channel blockers

A
  • amlodipine
  • affect the movement of calcium through calcium channels causing blood vessel relaxation, especially large vessels
  • side effects/interaction: deem, avoid natural licorice, limit caffeine/alcohol, avoid grapefruit with felodipine
144
Q

what si the contraindication associated with calcium channel blockers

A

heart failure

145
Q

about beta blockers

A
  • propanolol
  • block adrenergic beta-receptors in the heart (B1) -> decrease rate and cardiac output
  • prescribed fro treating heart problems
  • side effects/interactions: dizziness, fatigue, bradycardia, hallucinations, avoid natural licorice
146
Q

to whom are beta-blockers recommended for

A

not recommended as initial therapy in those over 60y

147
Q

why is fasting glucose monitored when using beta-blockers

A

the symptoms experienced by beta-blockers could mask some symptoms of hypoglycaemia (dizziness, fatigue)

148
Q

where is the drug metabolized and excreted

A

liver and kidney

149
Q

with all HTN drug avoid ____

A

natural licorice because it contains glycyrrhinic acid

150
Q

why should one consider the nutritional status of patient taking medication

A

low albumin may increase drug effect because of more free drug in the blood

151
Q

which physiological status should be considered before medication use

A

pregnancy, lactation, presence of disease

152
Q

when patient has diabetes, which drug do you prescribe

A
  • with complications: ACEi or ARB

- without complications: ACEi ARB CCB or diuretics

153
Q

when patient has coronary artery disease, which drug do you prescribe

A

ACEi or ARB

beta-blockers or CCB for stable angina

154
Q

when patient has heart failure, which drug do you prescribe

A

ACEi or ARB + beta-blockers

AVOID CCB

Clinical nutrition 1 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions