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Clinical Nutrition 1 > Hypertension 2 > Flashcards

Hypertension 2 Flashcards

1
Q

How much PA to reduce BP in HTN?

A
  • moderate PA of 30-60 min/d (4-7days/week)

- in addition to daily activities

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2
Q

Would you promote high intensity activities to reduce BP?

A

No

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3
Q

Tips for a patient to increase PA

A
  • needs to be a GRADUAL increase to 30-60 min/d
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4
Q

For stage 1 HTN, how does resistant training impact BP?

A

Does not impact negatively

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5
Q

Nutrition Assessment HTN

A
  • identify dietary factors and patterns (contributing to increase BP)
  • evaluate need for weight control
  • prioritise methods to meet DASH dietary goals
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6
Q

Nutrition Diagnosis HTN

A
  • excessive energy intake
  • excessive/inappropriate intake of fats
  • excessive sodium intake
  • inadequate calcium, fiber, potassium, or magnesium intake
  • overweight/obesity
  • food & nutrition knowledge deficit
  • physical inactivity
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7
Q

Nutrition Intervention HTN

A

Comprehensive approach that addresses multiple lifestyle factors:

  • DASH
  • Weight loss
  • Low Sodium
  • Alcohol in moderation
  • Potassium, calcium, magnesium
  • Physical activity
  • Smoking cessation
  • Stress management
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8
Q

DASH diet rich in

A

F and V, legumes, low-fat dairy, high K, Mg, Ca, fibre; poor T fat, SDA and dietary cholesterol

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9
Q

Benefits of DASH diet according to studies

A
  • average reduction of 5.5mmHg SBP and 3.0mmHg DBP

- further decrease in HTN subjects of 11.4mmHg/5.5mmHg

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10
Q

DASH stands for

A

Dietary
Approach to
STOP
Hypertension

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11
Q 
For a 2,100 kcal diet, how much 
- sodium
- potassium
- calcium
- magnesium
- fiber 
in a DASH diet
A
  • 2300 mg sodium
  • 4700mg potassium
  • 1250 mg calcium
  • 500mg magnesium
  • 30g fiber
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12
Q

What % of Total fat, saturated fat, protein, carb in a DASH diet

A
  • Total fat = 27% (includes 6% sat fat)
  • Protein = 18%
  • Carbohydrate = 55%
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13
Q

Which diet is most beneficial:

HTN or Mediterranean

A

DASH

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14
Q

When would you recommend 1500mg Na to HTN patient?

A

If he has refractory HTN (= BP not controlled)

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15
Q

How much NA do you recommend to a HTN patient?

A

3000mg

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16
Q

DASH diet improves

A

BP
LDL
VLDL
TG

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17
Q

DASH diet implies increasing what? and reducing what?

A

Increasing: potassium, magnesium, calcium, fiber

Reducing saturated FA and sodium

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18
Q

A patient has a blood pressure of 130 (SBP) what is his risk?

A

HTN high risk

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19
Q

Antihypertensive drugs examples

A
  • thiazide diuretics
  • distal tubular diuretics
  • angiotensin converting enzyme inhibitors
  • ANG2 receptor blockers
  • calcium channel blockers
  • beta blockers
  • single pill combination
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20
Q

First drug to treat HTN in adult without complications

A

Thiazide/ thiazide-like diuretic

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21
Q

SBP and DBP goal in most HTN pt without diabetes?

A

SBP < 140 mmHg

DBP < 90 mmHg

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22
Q

SBP and DBP goal in HTN pt with diabetes?

A

SBP < 130 mmHg

DBP < 80 mmHg

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23
Q

SBP and DBP in high-risk HTN pt

A

SBP < 120 mmHg

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24
Q

Drug treatment considerations

A
  • Location and drug metabolism and excretion
  • Drug/nutrient interactions
  • Drug/ drug interaction
  • Nutritional status
  • Physiological status
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25
Q

Drug/nutrient interaction example

A

natural liquorice (glycyrrhinic acid)

26
Q

Drug tx for patient with :

- diabetes (+complications)

A

ACEi or ARB

27
Q

Drug tx for patient with :

- diabetes (+ no complications)

A

ACEi or ARB or CCB or diuretics

28
Q

Drug tx for patient with :

- coronary artery disease

A

ACEi or ARB

29
Q

Drug tx for patient with :

- heart failure

A

ACEi or ARB + beta blockers

30
Q

Drug tx for patient with :

- coronary artery disease (+ stable angina)

A

beta blockers or CCB

31
Q

Loop diuretics generic name

A

furosemide (Lasix)

32
Q

Thiazides generic name

A

hydrochlorothiazide (Apo-Hydro)

33
Q

Potassium sparing generic name

A

spironolactone (Aldactone), triamterene, amiloride

34
Q

ACE inhibitors generic name

A

ramipril (Altace)

35
Q

ANG2 receptor blockers (ARB) generic name

A

Valsartan (Diovan)

Losartan (Cozaar)

36
Q

Calcium channel blockers generic name

A

Amlodipine (Norvasc)

37
Q

Beta-blockers generic name

A

Propanolol (Inderal), atenolol, metoprolol

38
Q

Low albumin affects drug effect how?

A

Increases drug effect because of more free drug in the blood

39
Q

2 types of diuretics

A
  • loop and thiazides

- K-sparing

40
Q

Loop and thiazides mechanism

A
  • decreased reabsorption of Na and K
  • production of osmotic diuresis
  • increased excretion of Na and K (and H+)
41
Q

K-sparing mechanism

A

inhibit action of aldosterone

42
Q

Loop and thiazides provided with

A
  • potassium rich food

- potassium supplements (side effects)

43
Q

WIth potassium sparing diuretics avoid

A

excess dietary potassium and supplements, avoid salt substitues, excess water consumption, natural liquorice

44
Q

Side effects of loop diuretics

A 
hypokalemia 
hyperglycemia 
anorexia
nausea/vomiting
constipation
45
Q

SIde effects of thiazides

A 
hypokalemia 
hyperglycemia 
anorexia
malaise
muscle weakness
46
Q

Side effects of potassium supplements

A

irritates mucosal lining, increased risk for ulceration, nausea/vomiting/diarrhea

47
Q

Mechanism of ACE inhibitors

A
  • inhibit conversion of ANG1 to ANG2

- decrease vasoconstriction, vasopressin, inhibit aldosterone release

48
Q

Side effects of ACE inhibitors

A

hypotension (older patients)
dry cough
may worsen renal function

49
Q

With ACE inhibitors avoid

A

salt substitutes

natural licorice

50
Q

Side effects of ACE inhibitors are increased in

A

African Americans

51
Q

When are ANG2 receptor blockers used

A

when ACEi are not tolerated

52
Q

Mechanism of ANG2 receptor blockers

A

Block ANG2 receptor and decrease its activity –> vasodilation, reduced vasopressin and aldosterone

53
Q

Side effects ANG2 receptor blockers

A

hyperkalemia, nausea, dizziness

54
Q

With ANG2 receptor blockers avoid

A

salt substitutes
natural licorice
grapefruit

55
Q

Mechanism of calcium channel blockers

A

affect movement of Ca through Ca channels causing blood vessel relaxation

56
Q

Side effects calcium channel blockers

A

edema, náuseas, heartburn

57
Q

With calcium channel blockers avoid:

A

natural liquorice
caffeine
alcohol
grapefruit

58
Q

Contraindication of calcium channel blockers with

A

heart failure

59
Q

Beta-blockers mechanism

A

block adrenergic beta-receptors in heart –> decrease rate and cardiac output

60
Q

Side effects beta-blockers

A

nausea/vomiting, constipation/diarrhea, bloating, masks symptoms of hypoglycaemia, dizziness, fatigue, CHF, hallucination, insomnia

61
Q

Beta-blockers not recommended if

A
  • diabetes mellitus

- initial therapy if >60y

Clinical Nutrition 1 (13 decks)

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