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NUR 325 > Hypertension > Flashcards

Hypertension Flashcards

Exam 1

1
Q

What types of medications are used to treat hypertension?

A

Diuretics, Sympathetic nervous system blockers, beta blockers, calcium channel blockers, and vasodilators

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2
Q

What are the three types of Diuretics?

A

Potassium-sparing
Thiazide (thiazide-like)
Loop

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3
Q

What is the mechanism of action in general diuretics?

A

Increase urinary output, decrease circulating volume, and decrease arterial resistance

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4
Q

What medication is the 1st line management of mild hypertension?

A

Thiazide diuretics- Hydrochlorothiazide

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5
Q

What is the mechanism of action of Hydrochlorothiazide?

A

Works on the distal convoluted tubule to inhibit resorption of sodium/potassium/chloride and decrease cardiac output. Results in water loss. Also relaxes arterioles and decreases peripheral vascular resistance.

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6
Q

What are the side effects of Hydrochlorothiazide?

A

Electrolyte and metabolic disturbances- HYPOKALEMIA
Orthostatic hypotension
May worsen renal insufficiency
Hyperuricemia (elevated uric acid)
Can elevate levels of glucose, cholesterol, and triglycerides

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7
Q

What nursing actions should we perform when a patient receives Hydrochlorothiazide?

A

Monitor potassium levels
Can give potassium supplements
Encourage food rich in potassium (avocado, spinach, bananas, sweet potatoes)

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8
Q

What medication is a loop diuretic?

A

Furosemide (lasix)

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9
Q

What is the mechanism of action for loop diuretics?

A

Inhibits the kidneys ability to reabsorb sodium in the LOOP OF HENLE. Makes kidneys put more sodium in the urine. Water follows the sodium = increased urine output.

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10
Q

What are the side effects of Furosemide?

A

HYPOKALEMIA and other electrolyte abnormalities
Dehydration
Hypotension
Ototoxicity- difficulty hearing, usually transient with furosemide

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11
Q

What are some nursing considerations for a patient receiving Furosemide?

A

Monitor potassium levels
Patients typically receive KCL supplements with their Lasix dose

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12
Q

What is the normal range for potassium?

A

3.5 - 5.0

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13
Q

Why is hypokalemia so important to monitor for?

A

Potassium works on the heart and can cause rhythm problems

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14
Q

What medication is a potassium-sparing diuretic (aldosterone agonist)?

A

Spironolactone

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15
Q

What is the mechanism of action for spironolactone?

A

Blocks the action of aldosterone (sodium and water retention) = potassium retention and excretion of sodium and water

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16
Q

Why is Spironolactone given?

A

Usually given in combination with other hypertensives/diuretics to get more effect with a lower chance of hypokalemia. Only provides small amount of diuresis and hypotensive effect

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17
Q

What are side effects associated with Spironolactone?

A

Can see HYPERkalemia
Endocrine effects: deepened voice, impotence, irregular menstrual cycles, gynecomastia, hirustism

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18
Q

What are the three types of Sympatholytics?

A
  1. Alpha-adrenergic blockers
  2. Centrally acting alpha 2 agonists
  3. Beta adrenergic blockers
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19
Q

What is the mechanism of action of Sympatholytics?

A

Decrease blood pressure by decreasing PERIPHERAL VASCULAR RESISTANCE. Sympathetic nervous system BLOCKERS- decreased vasoconstriction

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20
Q

What are the two types of beta adrenergic blockers (beta-blockers)?

A

Beta 1 receptors and Beta 2 receptors

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21
Q

Where are Beta 1 receptors located?

A

In the hear (called cardioselective beta receptors)

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22
Q

Where are Beta 2 receptors located?

A

In the lungs

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23
Q

What 3 medications are beta blockers?

A

Metoprolol, propanolol, and carvedilol

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24
Q

What is the suffix for beta blockers?

A

-OLOL

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25
Q

What kind of beta blocker is propanalol?

A

non-selective beta blocker

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26
Q

What kind of beta blocker is carvedilol?

A

Alpha and beta blockers

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27
Q

What is the mechanism of action for beta blockers?

A

Increases nitric oxide to cause a vasodilation response. Blocks stimulation of beta-1 receptors to decrease heart rate and contractility.

28
Q

What are the side effects of beta blockers?

A

Fatigue/lethargy
Bradycardia
Hypotension
Can mask hypoglycemia

29
Q

What are nursing considerations with a patient receiving beta-blockers?

A

Wean when discontinuing
Possibility of rebound hypertension if discontinued abruptly
If it is a non-selective beta blocker, do not use in patients with asthma or other breathing conditions
Recognize the risk for hypotension and/or bradycardia.
Hold and contact provider if HR is less than 60 or a systolic BP less than 100

30
Q

Why are alpha-2 adrenergic agonist (centrally acting sympatholytic) typically not the first-line treatment?

A

High side-effect profile

31
Q

What medication is an alpha-2 adrenergic agonist?

A

Clonidine

32
Q

What is the mechanism action of Clonidine?

A

Decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (both alpha AND beta receptors). Main outcome: decreased blood pressure.

33
Q

What is a nursing consideration for a patient receiving Clonidine?

A

Do NOT abruptly discontinue- risk for rebound hypertension

34
Q

What are potential side effects of Clonidine?

A

Drowsiness (most common)
Rebound hypertension
May worsen pre-existing liver disease

35
Q

What medication is a selective alpha-1 blocker?

A

Doxazosin

36
Q

What is the mechanism action of Doxazosin?

A

Selective alpha-1 blockade
Venous AND arterial dilation

37
Q

What are side effects of Doxazosin?

A

Hypotension
Dizziness

38
Q

What are the 3 types of RAAS blockers?

A

1 ACE inhibitors
2 ARBs
3 Renin inhibitor

39
Q

What medication is safe and efficacious first-line therapy for hypertension and heart failure?

A

ACE inhibitors

40
Q

What is the suffix for ACE inhibitors?

A

-PRIL

41
Q

What medications are ACE inhibitors?

A

Captopril and Lisinopril

42
Q

What is the mechanism of action of Captopril and Lisinopril?

A

Blocks angiotensin-converting enzyme (ACE). Inhibits production of Angiotensin-2 (powerful vasoconstrictor). Inhibits aldosterone secretion and leads to less water retention

43
Q

Why is Captopril and Lisinopril the drug of choice for Diabetes Mellitus?

A

Has some renal protective effects

44
Q

What are side effects of Captopril and Lisinopril?

A

First dose hypotension
Dry, non-productive, PERSISTENT cough
Dizziness
Rash
Serious: ANGIOEDEMA

45
Q

Why is Captopril and Lisinopril not appropriate for pregnant women?

A

Teratogenic

46
Q

What nursing considerations do we need to think about when a patient is on Captopril or Lisinopril?

A

Renal insufficiency- use cautiously in patients with a history of renal disease
Captopril can cause neutropenia- monitor WBC
Risk of hyperkalemia- especially if on K supplements

47
Q

What medication are ACE-inhibitors often given in conjunction with?

A

Thiazide diuretics

48
Q

What medication is an angiotensin receptor blocker (ARBs)?

A

Losartan

49
Q

What is the suffix for angiotensin receptor blockers (ARBs)?

A

-sartan

50
Q

What is the mechanism of action for Losartan?

A

Blocks the action of angiotensin 2 AFTER it has formed. Causes vasodilation and increased sodium and water retention.

51
Q

What are indications for Losartan?

A

Hypertension
Heart failure
Stroke progression
Many more

52
Q

What are side effects of Losartan?

A

Well tolerated
Some risk of angioedema
Use cautiously in patients with renal problems

53
Q

What is very important for women when taking ARBs (Losartan)?

A

Requires the use of contraception if of childbearing age. Do not use if pregnant.

54
Q

What medication is ARBs never given with?

A

ACE inhibitors

55
Q

What medication is a renin inhibitor?

A

Aliskiren

56
Q

What is the mechanism of action of Aliskiren?

A

Direct inhibition of renin.

57
Q

What are side effects of Aliskiren?

A

Relatively well tolerated
GI discomfort
When given with ACE inhibitors, watch for hyperkalemia, especially in patients with diabetes

58
Q

What nursing considerations do we need to take with patients taking Aliskiren?

A

Takes several weeks to see full effect
Do NOT take when pregnant

59
Q

What medications are calcium channel blockers?

A

Nifedipine, amlodipine, nicardipine, verapamil, and diltiazem.

60
Q

What two calcium channel blocker medications are more common to work on rhythm disturbances, not hypertension?

A

Verapamil and diltiazem

61
Q

What is the mechanism of action of calcium channel blockers?

A

Blocks calcium access to cells causing decreased contractility and decreased conductivity of the heart and decreases the demand for oxygen

62
Q

What are side effects of calcium channel blockers?

A

Orthostatic hypotension
Peripheral edema

63
Q

What are nursing considerations for patients currently taking calcium channel blockers?

A

Often best for elderly and African Americans
Diuretics can be given for peripheral edema

64
Q

What medication is a vasodilator?

A

Hydralazine

65
Q

What is the mechanism of action of Hydralazine?

A

Vasodilators work directly on arterial and venous smooth muscles and cause relaxation.
Direct vasodilation causes decreased systemic and peripheral vascular resistance

66
Q

What are side effects of Hydralazine?

A

HYPOTENSION
Dizziness, headache, tachycardia, edema, dyspnea, GI upset

NUR 325 (7 decks)

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