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Nursing Pharmacology > Module 13 > Flashcards

Module 13 Flashcards

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1
Q

Elevated systemic arterial blood pressure.

A

HTN

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2
Q

Measurement of the force against the walls of your arteries as the heart pumps blood through the body

A

BP

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3
Q

BP is measured with this

A

Sphygmomanometer

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4
Q

When the heart contracts

A

systole

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5
Q

Period of time when the heart fills after a contractoin

A

Diastole

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6
Q 
BP numbers
Normal
Pre-hypertension
Stage 1 HTN
Stage 2 HTN
A

< 120 and <80
120-139 or 80-89
140-159 or 90-99
>160 or >100

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7
Q

HTN of no known cause

The _____ of cases of HTN

A

Primary HTN

Majority of HTN cases

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8
Q

HTN with an identifiable cause.

A

Secondary HTN

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9
Q

What are the different causes of secondary HTN?

A 
Kidney disease
Hyperthyroidism
Pregnancy
Erythropoeitin
Pheochromocytoma
Sleep apnea
Contraceptive use
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10
Q

Tumour on the adrenal gland that causes excess epinephrine release

A

Pheochromocytoma

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11
Q

What are three major factors that influence BP?

A

1 - The amount of water and salt in the body
2 - The condition of your kidneys, NS and blood vessels
3 - Hormone levels in the body

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12
Q

What are risk factors for HTN?

A

Obesity, stress, smoking, high salt, diet, diabetes, African descent

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13
Q

What are certain drugs that are known to cause HTN?

A

NSAIDs, oral contraceptives, and cold medicines that contain pseudoephedrine

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14
Q

If untreated, HTN can cause these, potentially fatal consequences.

A

MI, kidney failure, stroke, retinal damage

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15
Q

Why is HTN called a silent killer?

A

Since many patients may have elevated BP for years before they show any symptoms

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16
Q

How does HTN affect the brain?

A

The brain swells and has multiple areas of hemorrhage

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17
Q

How does HTN affect the kidneys?

A

The vasculature of the kidney is dramatically constricted and the urine output is reduced

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18
Q

How does HTN affect the heart?

A

The heart is dilated (enlarged) and in cardiac failure

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19
Q

What are the determinants of BP?

A

Cardiac output and Peripheral (vascular) resistance

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20
Q

What is cardiac output determined by?

A

Heart rate, heart contractility, blood volume and venous return

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21
Q

An increase in what factors increases cardiac output?

A

HR, heart contractility, blood volume and venous return

22
Q

Determined by arteriolar constriction.

A

Peripheral resistance

23
Q

What are the three systems that our body uses to regulate BP?

A

1 - Sympathetic nervous system
2 - RAAS - renin-angiotensin-aldosterone system
3 - Renal regulation of BP

24
Q

The sympathetic nervous system has a reflex circuit called the ______ _____ that helps keep BP at a set level

A

Baroreceptor reflex

25
Q

Constantly active to help keep body functions in homeostasis.

A

Sympathetic nervous system

26
Q

Consists of the brain stem, receptors on the aortic arch and carotid sinus of the heart, and vascular smooth muscle

A

Baroreceptor reflex

27
Q

If BP is too low, describe the action of the baroreceptor reflex.

A

If BP is perceived to be too low by baroreceptors on the aortic arch and carotid sinus, they relay the information to the brainstem
The brainstem then sends impulses along sympathetic neurons that stimulate the heart to increase CO and cause constriction of smooth muscles on arteries
Blood pressure then increases

28
Q

If BP is perceived as too high by baroreceptors of the aortic arch and carotid sinus, what occurs?

A

Sympathetic activity is decreased, causing decreased CO and vasodilation

29
Q

The activity of baroreceptors can ______ our attempts to lower BP with drugs, since the “set point” in patients with HTN is _____.

A

oppose

high

30
Q

Unlike the baroreceptors reflex, activation of the RAAS may take _____ or _____ to influence BP.

A

hours to days

31
Q

What is the RAAS pathway?

A

Angiotensinogen – Renin –> angiotensin I (inactive) – ACE –> angiotensin II (Active) –> aldosterone + ADH

32
Q

Enzyme that catalyzes the formation of angiotensin I from angiotensinogen

A

Renin

33
Q

Rate-limiting step in RAAS.

A

Renin step

34
Q

Renin is synthesized and secreted by the __________ cells of the kidney into the blood.

A

Juxtaglomerular

35
Q

These all increase renin release.

A

1 - Decreased blood volume
2 - Low BP
3 - Stimulation of beta 1 receptors on juxtaglomerular cells of the kidney

36
Q

Converts inactive angiotensin I into the active angiotensin II.

A

ACE - angiotensin converting enzyme

37
Q

Activated angiotensin II is a potent ________. It binds to its receptor (the __________ on smooth muscle) to produce _________.
Activated angiotensin II also stimulates the release of ________ from the ________ _______. This in turn acts on the kidneys to increase _______ retention, thereby increasing ______ retention.

A

vasoconstrictor
AT1 receptor on smooth muscle
vasoconstriction

aldosterone, adrenal cortex
sodium
water

38
Q

Angiotensin II also acts on the ________ _______ ______ to release ________ ________ (also called _________). This in turn causes ______ retention by the kidneys.

A

posterior pituitary gland
Antidiuretic hormone (aka vasopressin)
causes water retention by the kidney

39
Q

Increased retention of water and sodium from the RAAS system causes an increase in ______ ______, which in turn increases ____.

A

blood volume

CO

40
Q

If blood pressure decreases for a prolonged period of time, the kidney retains ______. This causes an increase in ______ ____, and thus an increase in ____ and thus BP.

A

water
blood volume
CO

41
Q

Decreasing body weight:
There is a _______ relationship between obesity and HTN
Obesity is thought to cause HTN by two mechanisms:
1 - Increased _______ secretion, causing tubular reabsorption of ______ and thus ______ reabsorption and a higher blood volume, higher CO and thus BP
2 - Obese patients also have increased _________ nervous activity

A

direct
insulin, Na+, water reabsorption
sympathetic

42
Q

How does salt affect BP?

A

When salt levels are too high, it causes water to be reabsorbed from the kidney into the blood, causing increased BP.

43
Q

How does exercise affect BP?

A

Regular exercise decreases ECF fluid volume and circulating levels of plasma catecholamines (e.g. epinephrine)

44
Q

The benefits of _______ to BP are seen even in patients that do not restrict their ______ intake or _____ ______ during the training period.

A

exercise
sodium
lose weight

45
Q

Total body ________ levels are inversely correlated with BP.

A

Potassium

46
Q

High potassium diets decrease BP in what ways?

A

Increased sodium excretion
Decreased renin release
Vasodilation (think opposite of action potential so less contraction)

47
Q

Preferred sources of potassium are fresh _____ and ______.

A

fruits and vegetables

48
Q

Patients taking ___ ________ should NOT be on a high potassium diet.

A

Ace inhibitors

49
Q

For the DASH diet, the best results were seen in patients with _______.

A

pre-hypertension

50
Q

How is smoking related to HTN?

A

Smoking acutely elevates BP, but has not been linked to the causal development of HTN

51
Q

How does alcohol affect BP?

A

Excessive alcohol consumption increases BP

Alcohol can decrease responses to anti-hypertensive

Nursing Pharmacology (30 decks)

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