Hypertension Flashcards
Erythropoietin
replacement that increases RBC production. We give this to patients with severe anemia.
Amphetamines, cocaine, binge drinking, corticosteroidsoids, Estrogen, Decongestants, MOA inhibitors increase or decrease your bp?
increase
Difference between risk group A, B, C
1: No risk factors 2: has at least one risk factor; not including DM 3: Target organ damage/clinical cardiovascular disease and/or DM
if patient has stage 1 bp (140-159/90-99), what treatment options are there for risk group A, B, C?
1: lifestyle changes for 1 year to see if that helps 2: lifestyle changes for 6 months to see if that helps 3: drug therapy
If patient has stage 2 or 3 bp (160+/100+), what treatment options are there for risk group A, B, C?
1: Drug therapy 2: Drug therapy 3: Drug therapy
Clinical manifestations of HTN
Tinnitus, HA, Morning HA, Dizziness
Papilledema
Target organ damage
Type of antihypertensive med for Black people
Thiazide-type diuretic or CCB or ACE I or ARB
HTN Diet, What do you decrease, increase & limit?
Decrease in fat, sodium, sugar. Increase in Calcium, Potassium, Magnesium Limit Alcohol
DASH Diet: Grains & grain products consist of?
Carbs & fiber
DASH Diet: Vegetable & Fruits consist of?
Potassium, magnesium & fiber
DASH Diet: Low-Fat/Fat free milk products consist of?
Calcium, protein, potassium & magnesium
DASH Diet: Meats, poultry & Fish products consist of?
Protein & magnesium
DASH Diet: Nuts, seeds & beans products consist of?
Magnesium, potassium, protein & fiber
If male >65 yr old patient is trying to control his HTN, how many drinks should he have? <65? Women at any age?
1 drink a day; 2 drinks a day; 1 drink a day
Side effect of ALL antihypertensive meds?
hypotension. Don’t stand still for extended periods of time. Get OOB slowly
5 main antihypertensive drugs
Thiazide Diuretics, BB, ACE inhibitors, CCB, Angiotensin II receptor blockers (ARB)
Pharmacological management of HTN?
start with one antihypertensive at a low dose, If that doesn’t work increase dose or add a 2nd, if that doesn’t work then increase dose if that’s not effective then add another med.
Why are ACE inhibitors the med of choice for diabetics?
because they delay the progression to end-stage renal disease
ACE inhibitors end in?
pril
Vasotec (enalapril), Zestril (lisinopril), Accupril (quinapril), Quinapril (accupril), Altace (ramipril) are what type of antihypertensive
Ace inhibitors
Ace inhibitor side effects
a chronic dry couch which require stopping of drug, taste alterations, dizziness, skin rashes, Angioedema, sleep problems, tachycardia, hyperkalemia ( SO WATCH K+ LEVELS!)
ARBS do what to arteries?
dilates them
What medication decreases the effectiveness of Ace inhibitors?
NSAIDS
What people may experience angioedema with Ace inhibitors?
Smokers & African Americans
Ace inhibitors decrease BP and they are also used for…
post MI, Left ventricular hypertrophy, HF, renal disease, asymptomatic, atherosclerosis, protenuia/ESRF, DM, Raynauds
How do ARBs effect preload & afterload??
it decreases them
ARB’s end in?
sartan
Losartan (Cozaar), Candesartan (Atacand), Irbesartan (Avapro), Valsartan (Diovan) are what type of antihypertensive?
ARB
What other medication is often used with ARBs?
often used with a diuretic or they come as combination pills with HCTZ in them.
ARBs are used to decrease BP and are also used….
post MI, left ventricular hypertrophis, HF, renal disease, proteinuria/ESRF, DM
What do you need to watch for with patients taking ARBS?
have kidney function tests done regularly & electrolytes
Atenolol (Tenormin), Metoprolol (Lopressor, Toprol), Propranolol (Inderal), Nadolol (Corgard), Acebutolol (Sectral) are what type of antihypertensive?
BB
BB decrease BP and are also used…….
MI, Afib, tachy dysrhythmias, angina, HF, tachycardia, anxiety, hyperthyroidism, migraines (Timolol & Propranolol)
BB what should you teach patient about BB
it can exacerbate Raynauds, check pulse, use carefully with COPD & DM, don’t use in young
Beta 1 cells consist of
cardiac cells
Beta 2 cells consist of
smooth muscle in bronchi and blood vessels & convert glycogen to glucose in the liver & muscles
nonselective beta cells do what
block both beta 1 & beta 2 cells
When beta 1 & beta 2 are blocked, what will happen? Lungs? Blood Glucose levels?
Broncoconstriction and decreased glucose levels
Nonselective bb should be used cautiously with whom?
Asthma/Diabetics
Nadolol (Corgard) & Propranolol (Inderal) are what type of antihypertensive?
Nonselective BB
“BETA BLOCKER” side effects
Bradycardia, Exacerbates HF, Tired, Appetite loss, Bad dreams, Low state depression, Only occasionally able to preform, Contractility decreased, Knowledge deficit, Exacerbates asthma, Really nauseated
what should you warn a patient about with BB?
lethargy, impotence, fatigue
CCB side effects “A-G”
Abundant N&V, Bradycardia, Constipation, Dizziness, Edema, Falling sperm count, Gingival overgrowth. (Dihydropyridine CCB can worsen nephropathy)
CCB is used for
systemic & pulmonary HTN, angina, arrhythmias, left ventricular hypertrophy, peripheral artery disease, asymptomatic atherosclerosis angina, cerebral vasospasm
Dihydropyridine CCB end in? and what do they do?
“-dipine”. They decrease vascular resistance & arterial pressure.
Amlodipine (Norvasc), Nicardipine (Cardene), Nifedipine (Procardia) are which kinds of antihypertensive?? and what are they used fo r?
Dihydropyridine CCB; only used for angina & HTN
Which Dihydropyridine CCB is only used for HTN?
Felodipine (Plendil)
Nondihydropyridine CCB’s are used only for?
Angina
Diltiazem (Cardizem) & Verapamil (Calan, Isoptin) are what kind of antihypertensive and what are they used for?
Nondihydropyridine and they are used only for angina
Nondihydropyridine do what?
They decrease the force of the heart contraction and reduce the oxygen demand and decrease vasospasm
What should you teach a patient with CCB?
report dizziness, grapefruit juice increases blood drug levels and pharmacologic effects, Erythromycin may increase antihypertensive effect
Thiazide Diuretics are used to decrease BP and are used with…
elderly with isolated systolic increase in BP, CHF
Thiazaide Diuretics increase renal secretion of what?
Na, K+, & Mg
Thiazide treatment can cause what?
gout
With gout, you should avoid what and increase what?
avoid foods high in purines (Red meat, alcohol, fish, beans) and increase fruits and veggies. Eat radishes before any gouty meal, eat raw cucumber, vit c, drink lots of water
Chlorothiazide (Diuril), Hydroclorothiazide (Esidrix, HCTZ) Metolazone (Zaroxolyn) are what type of antihypertensive?
Thiazide diuretic
Thiazide side effects
hypokalemia, increased LDL, decreased HDL, gout, hyperlipidemia, hypercalcemia, hyponatremia
What should you watch for with a patient on a thiazide diuretic?
check cholesterol, increase K+ consumption, med can decrease insulin secretion & decrease insulin sensitivity
