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N232 > Hypertension (M4B) > Flashcards

Hypertension (M4B) Flashcards

1
Q

hypertension (HTN)

A

persistently elevated BP in arteries

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2
Q

modifiable risk factors

A
  • smoking
  • obesity
  • alcohol consumption
  • high dietary Na+ intake
  • low dietary K+, Ca, Mg
  • glucose intolerance
  • sedentary lifestyle
  • stress
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3
Q

non-modifiable risk factors

A
  • family Hx
  • men greater than women before age 55; women greater than men after 55
  • African descent
  • Indigenous descent
  • immigration-related change in socioeconomic status & culture
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4
Q

3 step approach to treating HTN

A

1) lifestyle
2) pharmacology
3) combination drug therapy

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5
Q

lifestyle modifications (step 1 of 3 step approach)

A
  • smoking cessation
  • dec ETOH usage
  • dec Na+ intake
  • diet/weight loss (DASH diet)
  • exercise (lightweights/aerobic)
  • blood glucose control w/ DM
  • set goals (pt education)
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6
Q

pharmacology used (step 2 of 3 step approach)

A
  • diuretics
  • ACE inhibitors
  • angiotensin II receptor blocker
  • Ca channel blockers
  • vasodilators
  • beta blockers
  • start with 1 drug at a low dose and inc if necessary
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7
Q

combination drug therapy (step 3 of 3 step approach)

A

continue to add anti-hypertensive meds until goal/results are achieved

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8
Q

what to monitor in a pt with HTN?

A
  • VS: BP, HR, RR, O2 sat
  • fluid balance
  • pt weight
  • electrolytes (S&S of high/low levels)
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9
Q

non-pharm interventions for HTN

A
  • compression stockings
  • elevate legs
  • elevate HOB
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10
Q

S&S of HTN

A 
- "silent killer"
very elevated BP: 
- SOB 
- headache
- epistaxis 
- blurred vision
- fatigue
- tinnitus
- profuse sweating
- nocturia
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11
Q

potential cmplx of HTN

A
  • L vent hypertrophy
  • MI
  • HF
  • TIA
  • cerebrovascular disease
  • renal insufficiency & chronic kidney disease
  • retinal hemorrhage
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12
Q

diagnosing HTN when pt visits

A
  • if BP > 140/90: take 2 or more readings, eliminate the 1st reading and average the other 2
  • Hx/Px (risk factors, reason for inc BP, target organ damage)
  • repeat visit within 1 mo to reassess (review lifestyle changes)
  • on 2nd visit, BP >140/90 w/ target organ damage –> pharm Tx begins
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13
Q

goals for HTN (planning)

A
  • dec BP to therapeutic level
  • correct electrolyte imbalances
  • prevent falls
  • equalize fluid balance
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14
Q

hypertensive emergency

A
  • systolic BP > 180 and/or diastolic > 120
  • acute, life-threatening
  • not lower than 140/90
  • reduce MAP by 20-25% within 1st hr
  • close monitoring of IV (check BP every 5 mins)
  • continue to bring down BP
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15
Q

hypertensive urgency

A
  • BP elevated but no evidence of progressing target organ damage
  • may present w/ headache, epistaxis, anxiety
  • lower BP within few hrs
  • give quicker-acting oral meds to dec BP
  • bring BP to normal range within 24-48 hrs
  • close monitoring of BP every 5 mins
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16
Q

Dx tests for HTN

A
  • blood biochemistry (Na+, K+, CR, GFR)
  • HgA1C (fasting glucose; underlying DM)
  • fasting lipid lvls (total, HDL, LDL, non-HDL, triglycerides, cholesterol)
  • urinalysis
  • 12-lead ECG
  • echocardiogram
  • angiogram (any concerns in arteries/heart)
17
Q

electrocardiogram (ECG)

A
  • records electrical impulses that stimulate heart to contract
  • used to evaluate arrhythmias, conduction defects, MIs, hypertrophy, pericardial disease
  • shows 12 different view of electrical impulses happening in heart
  • tells on possible lead where damage on heart muscle
18
Q

cardiac stress test

A
  • noninvasive study where heart stressed in some way (ex. treadmill)
  • electrodes on body to see conduction of heart
  • O2 sat monitor on finger & BP cuff
  • sees how well heart tolerates when there’s an inc in demand
  • unable to meet demands –> pt shows S&S (ex. angina, fatigue, dec BP)
19
Q

echocardiogram

A
  • US taken of heart
  • shows integrity of valves
  • how well atrium and ventricles pumping, EF
  • possible structural issues of heart
20
Q

coronary angiogram

A
  • invasive procedure
  • insert cather into radial a. or femoral a. and inject dye
  • take series of x-rays to see flow of dye in vessels
  • detects blockages, bulges, and location
  • stent to revascularize area
  • usually for chest pain (active cell death)
21
Q

pharmacological interventions - 1st line of Tx

A

diuretics

22
Q

diuretics prescribed for HTN

A
  • furosemide
  • hydrochloride thiazide (HTCZ)
  • spironolactone
23
Q

furosemide

A
  • loop diuretic
  • dec vol
  • blocks reabsorption of Na+ and H2O in kidneys –> diuresis
  • PO, IV, IM
  • K+ wasting diuretic
  • monitor BP, Na+, K+ lvls
  • don’t give if pt dehydrated (can cause severe dehydration)
24
Q

hydrochloride thiazide (HCTZ)

A
  • thiazide diuretic
  • dec blood vol
  • promotes urine production
  • inc excretion of Na+ and H2O by inhibiting Na+ reabsorption in distal tubule
  • promotes excretion of Cl, K, Mg, and HCO3-
  • max diuresis lower than loop diuretics
  • monitor BP, Na+, K+ lvls
25
Q

spironolactone

A
  • K+ sparing medication (diuretic)
  • inhibits Na+ reabsorption in kidneys while saving K+ and H+ ions in distal tubules
  • inc in urine production
  • dec K+ excretion
  • monitor Na+, K+ and H+ lvls
  • monitor for S&S of dehydration & hypotension
26
Q

beta blockers

A
  • block stimulation beta1 receptors in heart (responsible for flight and flight response) –> dec contractility & HR
  • can be selective and non-selective
  • rarely used d/t SE
  • ex. metoprolol
27
Q

metoprolol

A
  • beta blocker
  • dec HR & contractility
  • used to treat HTN, HF, MI & migraines
  • never give to pt in 3rd deg heart block
  • check drug guide when safe to give med/hold med
  • check for trends in assessments
  • assess BP and HR (apex for 1 min)
28
Q

angiotensin converting enzyme (ACE inhibitor)

A
  • blocks conversion of angiotensin I to angiotensin II
  • angiotensin II causes vasoconstriction
  • causes systemic vasodilation
  • also used for pts w/ HF and MI
  • ex. ramipril
29
Q

ramipril

A
  • ACE inhibitor
  • monitor K+ and Na+ levels
  • SE: dry, hacky cough
30
Q

angiotensin II receptor blockers (ARBs)

A
  • blocks vasoconstrictor and aldosterone-producing effects of angiotensin II @ receptor sites
  • ex. candesartan
31
Q

candesartan

A
  • ARBs
  • watch for BP
  • SE: hypotension, elevated K+, dry cough
  • can use for HF
32
Q

Ca+ channel blockers

A
  • inhibits transportation of Ca+ into myocardial and vascular SM cells
  • results in inhibition of excitation and contraction coupling and subsequent contraction –> systemic vasodilation –> dec BP & angina
  • ex. Diltiazem
33
Q

diltiazem

A
  • Ca+ channel blocker
  • assess BP & HR (note rhythm)
  • SE: hypotension, worsening HF
  • don’t give with grapefruit juice
34
Q

vasodilators (hydralazine)

A
  • IV
  • direct acting peripheral arteriole dilator
  • massive vasodilation
  • for hypertensive crisis/emergency situation
  • SE: hypotension & reflex tachycardia
35
Q

antihypertensive medications

A
  • diuretics
  • beta blockers
  • ACE inhibitors
  • ARBs
  • Ca+ channel blockers
  • vasodilators

N232 (5 decks)

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