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316 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

hypertension

A
  • consistent elevation of systemic arterial blood pressure
  • complex disease controlled by a combination of genetic and environmental factors
  • no specific cause identified for large majority of HTN patients
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2
Q

factors that create high blood pressure

A
  • blood volume
  • peripheral resistance
  • cardiac output
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3
Q

blood volume and high blood pressure

A
  • total amount of blood in vascular system
  • volume can change due to disease, drugs, regulatory factors
  • more blood = increase pressure
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4
Q

How do we increase blood volume?

A

fluids and blood transfusion

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5
Q

peripheral resistance and high blood pressure

A

blood traveling around the vasculature at a high rate of speed comes in contact with smooth endothelium of the vessels, where friction slows it down

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6
Q

cardiac output and high blood pressure

A
  • the volume of blood pumped in a ventricle per minute
  • heart rate (# of beats per minute)
  • stroke volume: amount of blood pumped by the heart in one contraction
  • increase cardiac output, increase blood pressure
    HR x SV = CO
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7
Q

organs that control BP

A
  • brain (emotions)
  • kidneys (RAAS)
  • chemo/baroreceptors in heart/carotid artery
    -hormones (antidiuretic: potent vasoconstrictor)
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8
Q

converts angiotensinogen to Angiotensin I

A

renin

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9
Q

converts Angiotensin I to Angiotensin II

A

angiotensin converting enzyme

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10
Q

primary hypertension

A

no identifiable cause

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11
Q

secondary hypertension

A

specific cause can be identified:
- Cushing’s disease
- CKD
- hyperthyroidism
- drugs (corticosteroids, oral contraceptives, decongestants, amphetamines)

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12
Q

non-pharmacological management

A

lifestyle changes
- limit alcohol
- restrict sodium consumption
- reduce intake of saturated fat/cholesterol
- increase fresh fruits and vegetables
- increase physical activity
- discontinue use of tobacco products
- reduce sources of stress
- maintain optimal weight

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13
Q

diuretics

A
  • reduces blood volume
  • water excretion in the urine achieved by retaining or excreting electrolytes
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14
Q

types of diruetics

A
  • potassium wasting
  • potassium sparing
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15
Q

potassium wasting diuretics

A

thiazide diuretic:
- old
- inexpensive
- safe
- can cause hypokalemia

loop diuretic:
- cause more diuresis than thiazide or potassium-sparing drugs
- not ideal for control of HTN due to adverse effects such as hypokalemia and dehydration
- ototoxic (affect hearing and ears)
- usually used for intermittent fluid off-loading (diuresis)

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16
Q

potassium sparing diuretics

A
  • hang on to potassium
  • produce only modest diuresis
  • can cause hyperkalemia
  • potassium is our main intra-cellular electrolyte (helps with muscle contraction)
  • too much or too little can lead to cardiac conduction abnormalities
  • concurrent use of ACE-inhibitors or ARB’s increase the potential for hyperkalemia
  • many people control their BP by decreasing sodium and using a salt-substitute that is high in potassium that could lead to hyperkalemia
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17
Q

ACE inhibitors

A
  • angiotensin converting enzyme inhibitors
  • work within the RAAS system
  • decrease BP and increase urine volume
  • widely used in the treatment of HTN, HF, and myocardial infarction
  • blocks the conversion of angiotensin I to angiotensin II (powerful vasoconstrictor)
  • end in -pril
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18
Q

adverse effects of ACE inhibitors

A
  • mild cough, can switch them to an ARB
  • postural hypotension
  • hyperkalemia
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19
Q

side effects of ACE inhibitors

A
  • ANGIOEDEMA: caused by pro-inflammatory bradykinins
  • swelling of lips, eyes, throat, and other body regions that could lead to throat closure
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20
Q

Angiotensin II Receptor Blockers

A
  • ARBs
  • end in -sartan
  • blocks angiotensin II receptors in the smooth muscle
  • relatively few side effects (can have hypotension)
  • no cough associated with ARBs, much lower risk of angiodedema
  • often combined with other anti-HTN drugs
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21
Q

beta-blockers

A
  • end in -olol
  • work by blocking adrenergic receptors (blocks the fight or flight response)
  • blockage of B1 receptors in the heart
  • decrease HR and heart contractility which decreases cardiac output and lowers systemic blood pressure
  • blocks the B1 in the juxtaglomerular apparatus which inhibits the secretion of renin and the formation of angiotensin II
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22
Q

adverse effects of beta-blockers

A
  • predictable based on inhibition of fight or flight
  • slow heart rate
  • bronchoconstriction (use with caution in patients with asthma or COPD)
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23
Q

calcium channel clockers

A
  • block calcium ion channels, which block muscle contraction and relaxes arterial smooth muscle, which lowers peripheral resistance and decreases BP
  • rarely used alone
  • good for elderly or African American patients who are often less responsive to other anti-HTN drugs
  • can increase the effect of statin drugs by messing with liver enzymes (CYP3A4)
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24
Q

calcium channel blocker side effects

A
  • HYPOTENSION
  • dizziness
  • peripheral edema
  • heartburn
  • nausea
  • flushing

all due to vasodilation

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25
Q

hypertensive crisis

A
  • BP >180/120
  • can cause end organ damage
  • most common cause is uncontrolled, poorly managed essential HTN
  • don’t want to drop the BP too fast&raquo_space; hypotension
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26
Q

therapeutic class of hydrochlorothiazide

A

diuretic

27
Q

pharmacologic class of hydrochlorothiazide

A

thiazide, potassium wasting diuretic

28
Q

action of hydrochlorothiazide

A

reduces blood volume through the excretion of water and potassium, reducing blood volume and blood pressure

29
Q

side effects of hydrochlorothiazide

A
  • hypokalemia
  • hyponatremia
  • hypotension
  • dizziness
  • dehydration
30
Q

patient considerations for hydrochlorothiazide

A
  • observe for hypokalemia
  • increase potassium containing foods
  • don’t give to patients who don’t make urine
31
Q

drug/drug interactions for hydrochlorothiazide

A

hypokalemia increases the risk of digoxin toxicity

32
Q

trade name for furosemide

A

Lasix

33
Q

therapeutic class of furoemide

A

diruetic, antihypertensive

34
Q

pharmacologic class of furosemide

A

loop diuretic, POTENT potassium-wasting diuretic

35
Q

action of furosemide

A
  • works in the Loop of Henle to promote the excretion of sodium and water, thereby reducing blood volume
  • causes potassium wasting
  • when given IV, produces rapid diuresis
36
Q

side effects of furosemide

A
  • hypokalemia (check serum potassium levels before giving the drug)
  • orthostatic hypotension, dizziness, fainting
  • ototoxicity and nephrotoxicity
  • hyperglycemia
37
Q

nursing considerations of furosemide

A
  • monitor intake/output
  • monitor K+ levels
  • monitor blood glucose
  • monitor if c/o hearing changes or loss
  • use cautiously with other drug that deplete potassium
38
Q

therapeutic class of spironolactone

A

antihypertensive, reduces edema

39
Q

pharmacologic class of spironolactone

A

potassium-sparing diuretic, aldosterone antagonist

40
Q

action of spironolactone

A
  • inhibits aldosterone (secreted by adrenal cortex) which increases water and sodium excretion
  • commonly used to treat HTN along with other anti-HTN drugs
  • slows progression of HF
41
Q

side effects of spironolactone

A
  • hyperkalemia (especially if taken with ACE inhibitors or ARBs)
  • gynecomastia
42
Q

nursing considerations of spironolactone

A
  • give with food to increase absorption of drug
  • do not give K+ supplements or use salt substitute
  • warn male patients about gynecomastia which resolves when drug is discontinued
43
Q

therapeutic class of lisinopril

A

HTN and heart failure

44
Q

pharmacologic class of lisinopril

A

ACE inhibitor

45
Q

action of lisionpril

A

inhibits ACE, which is responsible for converting angiotensin I to angiotensin II which ultimately blocks effects of aldosterone

46
Q

side effects of lisinopril

A
  • usually well tolerated but be alert for sough (possible switch to an ARB) or ANGIOEDEMA
  • patients should report coughing, swelling, tongue fullness, difficulty breathing/talking
  • HYPERkalemia (use cautiously in patients receiving potassium sparing diuretics)
  • hypotension
  • can’t be used in pregnancy
47
Q

therapeutic class of losartan

A

drug for hypertension

48
Q

pharmacologic class of losartan

A

angiotensin II receptor blocker (ARB)

49
Q

action of losartan

A

vasodilation and reduced blood volume (due to it’s effects on blocking aldosterone release)

50
Q

side effects of losartan

A
  • hypoglycemia
  • dizziness
  • hypotension
51
Q

BB warning for losartan

A

do not use in pregnancy!! causes fetal injury/death–teratogen

52
Q

nursing consideration for losartan

A

when given with potassium-sparing diuretics, increased risk for hyperkalemia

53
Q

therapeutic class of metoprolol

A

drug for HTN and HF

54
Q

pharmacologic class of metoprolol

A

beta-adrenergic blocker–selective for B1

55
Q

action of metoprolol

A

reduces sympathetic stimulation of the heart, thus decreasing cardiac workload

56
Q

side effects of metoprolol

A
  • preferred for patients with respiratory disease (due to cardio-selective B1 action)
  • hypotension
  • bradycardia
  • may enhance the hypoglycemic affects of insulin/oral diabetic drugs–watch for hypoglycemia!
57
Q

BB warning for metoprolol

A

acute withdrawal from drug may make angina worse or cause myocardial infarction

58
Q

nursing considerations for metoprolol

A

dose should be tapered off over a few weeks

59
Q

contraindications for metoprolol

A
  • heart block
  • cardiogenic shock
  • hypotension
  • overt cardiac failure
  • slow heart issues
60
Q

therapeutic class for nifedipine

A

drug for HTN

61
Q

pharmacologic class for nifedipine

A

calcium channel blocker

62
Q

action of nifedipine

A

blocks calcium channels in myocardial and vascular smooth muscle including coronary arteries, which results in coronary artery dilation, less oxygen consumption by heart, an increase in cardiac output, and a fall in BP

63
Q

side effects of nifedipine

A

dizziness, hypotension, headache

64
Q

nursing considerations of nifedipine

A
  • well tolerated
  • give cautiously with other antihypertensive medications
  • increases serum levels of digoxin which can lead to bradycardia and digoxin toxicity
  • do not take with grapefruit juice

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