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Nursing Semester 2 > Monica - Week 9 - Exam 3 > Flashcards

Monica - Week 9 - Exam 3 Flashcards

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1
Q

what are three characteristics of hypertension?

A
  • damages arterial blood vessel
  • asymtomatic for years
  • risk factor for MI, CVA, HF, RF, PVD
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2
Q

____% of adults with HTN can be treated with _______ and also may require _____________

A

46; lifestyle changes; drug therapy

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3
Q

only _____% follow treatment

A

20

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4
Q

up to ___% fail to fill prescriptions

A

25

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5
Q

why do those people fail to fill prescriptions?

A
  • don’t want to believe it
  • think they don’t need it
  • feel fine (asymptomatic)
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6
Q

what are the 4 non-modifiable risk factors?

A
  • family history
  • age
  • gender
  • ethnicity
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7
Q

what is the percentage of HTN d/t genetics?

A

30 - 40; specific genes predispose to HTN

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8
Q

what occurs with age r/t HTN?

A

blood vessels lose elasticity with ↑ age

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9
Q

what are 3 characteristics of HTN r/t gender?

A
  • 56% of women and 59% of men
  • before middle ages, more common in males
  • age > 65 more common in females
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10
Q

what are 3 characteristics of HTN r/t ethnicity? Who is more sensitive?

A
  • African Americans more salt-sensitive
  • develop HTN at a younger age
  • need more aggressive therapy
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11
Q

why are African Americans more salt sensitive?

A

they have a gene that makes them more sensitive to salt

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12
Q

what are 6 modifiable risk factors of HTN?

A
  • lack of physical activity (obesity, ↑ strain on ♥, ↑ triglycerides, ↑ risk of diabetes)
  • dietary (↑ cholesterol, ↑ salt)
  • nicotine (↑ risk for damaged arteries)
  • stress- socioeconomic status
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13
Q

what is considered “normal” blood pressure?

A

SBP < 120 and DBP < 80

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14
Q

what is elevated blood pressure?

A

SBP 120 - 129 and DBP < 80

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15
Q

what is high blood pressure stage 1?

A

SBP 130 - 139 OR DBP 80 - 89

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16
Q

what is high blood pressure stage 2?

A

SBP 140 or higher OR DBP > 90

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17
Q

what is hypertensive crisis?

A

SBP > 180 and/or DBP > 120

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18
Q

what is the percentage of primary hypertension?

A

90 - 95% of cases

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19
Q

what is primary hypertension?

A

BP ↑ without identified cause

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20
Q

what are the contributing factors to primary hypertension?

A

↑ Na intake, ↑ BMI, DM, Smoking, Excessive alcohol intake, hyperaldosteronism, family history

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21
Q

what is the percentage of secondary hypertension?

A

5 - 10 % of cases

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22
Q

what is secondary hypertension? An example?

A

underlying cause can be identified and corrected. Ex. HTN pregnancy .

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23
Q

what is a complication of HTN?

A

target-organ damage

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24
Q

what systems are affected in target organ damage?

A

heart, brain, peripheral vascular disease, nephrosclerosis, and retinal damage.

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25
Q

which specific disease are caused d/t heart target organ damage?

A
  • coronary artery disease

- left ventricular hypertrophy

26
Q

what occurs during target organ damage of the brain?

A

plaque formation in carotid arteries → TIA o? r stroke

27
Q

what occurs during target organ damage r/t peripheral vascular disease?

A

intermittent claudation (s/sx) → ischemic leg pain with activity (rest = no pain)

28
Q

what occurs during nephrosclerosis?

A

atrophy of tubules and destruction of glomeruli = ↓ kidney function

29
Q

what occurs during retinal damage?

A

blurred vision and vision loss

30
Q

what can occur with athrosclerosis?

A

hemorrhage

31
Q

what is the process map of short term mechanism regulation of BP for DECREASED BP?

A
  • baroreceptors sense a ↓ BP
  • SNS is activated
  • ↑ HR, ↑ cardiac contractility, vasocontriction
32
Q

what is the process map of short term mechanismm regulation of BP for INCREASE BP?

A
  • baroreceptors sense a ↑ BP
  • inhibitor signals go to brain stem
  • ↓ HR, ↓ force of contraction, vasodilation
33
Q

what occurs to baroreceptors with those with HTN?

A

overtime baroreceptors recognize ↑ BP as “normal”

34
Q

what is the long term regulation of BP?

A

RAAS (renin-angiotensin-aldosterone systems)

35
Q

what 3 things occur during RAAS?

A
  • Na+ and H2O retention
  • ↑ ECF volume
  • vasoconstriction of the arteries
36
Q

what things occur with the long term presence of angiotensin II?

A
  • hypertrophy of the myocardial cells (causes enlarge ♥)
  • collagen deposits (scar-like tissues)
  • cardiac remodeling (↑ risk of morbid/mortal of ♥ failure)
  • accelerates deposition of fatty plagues
  • ↑ risk of MI and CVA
37
Q

what are 4 first line hypertension agents?

A
  • thiazide diuretics
  • calcium-channel blockers
  • angiotensin-converting enzyme (ACE) inhibitors
  • angiotensin- receptor blockers (ARBs)
38
Q

what are 5 second line hypertension agents?

A
  • diuretics
  • beta-blockers
  • alpha-blockers
  • centrally alpha-agonists
  • direct vasodilators
39
Q

what is the drug for ACE inhibitors?

A

lisinopril - there are 10 in this category that end in “pril”

40
Q

how does lisinopril work? (5 mechanisms)

A
  • inhibits conversion of Angio I → Angio II
  • ↓ systemic vascular resistance
  • ↓ aldosterone secretion (no Na+/H2O retention/retention of K+)
  • slows down progression of cardiac remodeling
  • reduces glomerular filtration pressure (“renoprotective/cardioprotective”)
41
Q

what are the AE of lisinopril?

A

dry cough, ED, orthostatic hypotension, possible hyperkalemia

42
Q

what are special considerations for lisinopril?

A

metabolized and excreted by kidneys → dose adjustments for renal impairment

43
Q

what is the drug for angiotensin II receptor blockers?

A

losartan - there are 8 drugs in this category that end in “tan”

44
Q

how does losartan work? (3 mechanisms)

A
  • blocks Ag II receptors in arterioles (no vasoconstrict)
  • block Ag II receptors in adrenal gland (no aldost/no absorption of Na+/H2O)
  • blocks Ag II receptors in heart (prevent ♥ remodeling)
45
Q

losartan is used in _________ __________

A

diabetic nephropathy

46
Q

what are the AEs of losartan?

A

hypotension, hyperkalemia, and hypoglycemia

***DOESNT PRODUCE DRY COUGH

47
Q

what are special considerations for losartan?

A
  • doses are adjusted for kidney pts

- be aware of K+ sparing products/supplements

48
Q

what is the main alpha-1 blocker drug?

A

doxazosin

49
Q

where does doxazosin work?

A
  • alpha 1 receptors located in arterial and venous smooth muscle, GI, GU
  • blocks alpha-1 receptor from binding with norepinephrine
50
Q

how does doxazosin work? (3 mechanisms)

A
  • alpha-1 activation —> vasoconstriction
  • blocking alpha-1 receptors in post-synapse —> decreased peripheral resistance and BP
  • prevents contractions of bladder neck and urethra (urine flow—>BPH)
51
Q

what are the AEs of doxazosin?

A

dizziness, HA, decreased libido, and sexual dysfunction (noncompliance occurs d/g this)
- first does orthostatic hypotension within first 24 hours; recommend take first dose at bed time to minimize chance of OH—> dizzy, fainting, syncope

52
Q

what is the main drug of alpha-2 agonist?

A

clonidine

53
Q

how does clonidine work?

A
  • CNA action to decrease sympathetic activity

- lack of norepinephrine production —> reduced BO

54
Q

what are the AEs with clonidine?

A

dry mouth, drowsiness, withdrawal phenomenon

55
Q

what occurs to when clonidine is discontinued abruptly?

A

rebound hypertension - increased BP more than it was at patient’s baseline

56
Q

clonidine is used as treatment for _____ ________

A

resistant HTN - when other first line drugs aren’t working

57
Q

what is the main drug of vasodilators?

A

hydralazine

58
Q

when is hydralazine used?

A

for moderate to severe HTN with diuretic - usually PRN IV form

59
Q

how does hydralazine work? (2 mechanisms)

A
  • dilate blood vessels
  • relax arteriolar smooth muscle which reduces peripheral resistance causing a hypotension effect (compensate by beating faster)
60
Q

what is the AE of hydralazine?

A

tachycardia

other possible: edema, orthostatic hypotension

61
Q

what are the 8 collaborative care and lifestyle modifications that can be made?

A
  • Diet: DASH (Dietary Approach to Stop HTN)
  • decreasing Na+ intake (<2300 mg/day, ideal 1500mg/day; decrease by 1000mg/day)
  • weight reduction (ideal weight)
  • increase physical activity (90-150mins/week)
  • alcohol moderation (2 for men, 1 for women)
  • avoid tobacco products (nicotine= vasoconstriction)
  • psychosocial factors
    _ compliance with drug therapy
62
Q

T/F: HTN has no cure, has to be managed. If you change your lifestyle, no need for pharmacotherapy

A

TRUE

Nursing Semester 2 (21 decks)

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