Hypertension (M4B) Flashcards
1
Q
hypertension (HTN)
A
persistently elevated BP in arteries
2
Q
modifiable risk factors
A
- smoking
- obesity
- alcohol consumption
- high dietary Na+ intake
- low dietary K+, Ca, Mg
- glucose intolerance
- sedentary lifestyle
- stress
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
4
Q
3 step approach to treating HTN
A
1) lifestyle
2) pharmacology
3) combination drug therapy
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)
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
7
Q
combination drug therapy (step 3 of 3 step approach)
A
continue to add anti-hypertensive meds until goal/results are achieved
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)
9
Q
non-pharm interventions for HTN
A
- compression stockings
- elevate legs
- elevate HOB
10
Q
S&S of HTN
A
- "silent killer" very elevated BP: - SOB - headache - epistaxis - blurred vision - fatigue - tinnitus - profuse sweating - nocturia
11
Q
potential cmplx of HTN
A
- L vent hypertrophy
- MI
- HF
- TIA
- cerebrovascular disease
- renal insufficiency & chronic kidney disease
- retinal hemorrhage
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
13
Q
goals for HTN (planning)
A
- dec BP to therapeutic level
- correct electrolyte imbalances
- prevent falls
- equalize fluid balance
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
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
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
