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NUR 325 Funds of Pathopharm > Week 2 Hypertension > Flashcards

Week 2 Hypertension Flashcards

1
Q

RAAS System

A

Liver ——> Kidney —-> Lungs —-> Adrenal glands
|. |. |. |vasoconstrict
Angiotensinogen +renin->A1+ ACE —>A2 > Aldosterone+ADH
Released. |
⬆️ Na (cells)
⬇️ K+ (urine)
|
⬆️ BP

**RAAS regulates BP by ⬆️ Na+ resorption into cells, ⬆️ BP

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2
Q

Other mechanisms of affecting BP

A
  • Arterial baroreceptors (altering HR)

- Vascular auto regulation (regulates MAP)

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3
Q

Blood Pressure Categories

A

Normal <120 AND. <80
Elevated 120-129. AND <80
Stage 1 130-139. OR. 80-89
Stage 2 140 or higher. OR 90 or higher
HTN crisis 180 or higher AND/OR. 120 or higher

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4
Q

Primary HTN vs Secondary HTN

A 
Primary 
- NO known cause 
- Idiopathic 
- Excess salt, abnormal arteries, ⬆️ blood volume,
  genetic disorders, stress

Secondary

  • KNOWN causes
  • Treat underlying cause
  • Health conditions, certain meds (BC, histamines, steroids, amphetamines), recreational drugs (cocaine), pregnancy, HTT
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5
Q

RISK FACTORS for Primary HTN

A

R - Race, male AA
I - Increase Na+ and alcohol intake
S - Smoking/stress
K - K+ and Vit. D intake low

F - Family Hx
A - Advanced age
C - Cholesterol high 
T - Too much caffeine 
O - Obese 
R - Restricting Activity
S - Sleep apnea
  • Insulin resistance (pre-diabetes)
  • Men prior to 55
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6
Q

Long-term Effects of HTN

A

C - Cardiovascular (CHF, hypertrophy, atherosclerosis)
A - brAin (stroke, aneurysm, hemorrhage)
K - Kidneys (renal failure - end stage kidney dz)
E - Eyes (retinal changes, retinopathy, blindness)
E - lower Extremities (gangrene)

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7
Q

Hypertensive crisis
—> 1. Hypertensive urgency
—> 2. Hypertensive emergency

A

Hypertensive crisis: >180 SBP AND/OR >120 DBP

Hypertensive urgency:
——No S/S, causes -> anxiety, pain
——Gradually reduce BP hours to days

Hypertensive emergency:
——Symptoms of organ damage: headache, blurry vision
——Stroke, brain hemorrhage, angina, Acute Coronary
Syndrome, heart dysfunction
——Lower BP in min to hours (IV meds)

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8
Q

Diuretics

A

General MOA: ⬆️ UO, ⬇️ volume, ⬇️ PVR

*Potassium sparing (Spironolactone)

  • Potassium wasting
    - > Thiazide (hydrochlorothiazide)
    - > Loop (furosemide)
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9
Q

Potassium Sparing Diuretics

A

spironolACTONE

MOA:
- Block Aldosterone (Na+ & H2O retention)
= Na+ & H2O released into urine
= Potassium retention
* Bc it blocks aldosterone, aldosterone normally keeps Na+
& releases K+. This does the opposite.

Indications:
- HTN

Adverse Reactions:
- HYPERkalemia
- Endocrine effects (deep voice, impotence, irreg menstrual
cycles, gynecomastia, hirsutism)

Nursing Considerations:

  • Combo w/ other HTN drugs & diuretics
  • Small amt of diuresis & HoTN effect
  • potassium Sparing -> Spironolactone
  • SpironolactONE blocks AldosterONE
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10
Q

Thiazide Diuretics

A

hydrochloroTHIAZIDE

MOA:
- Distal convoluted tubule
- Inhibits resorption of Na+/K+/Chloride (goes into urine)
= ⬇️ CO & PVR

Indications:
- HTN (1st line)

Adverse Reactions:

  • Hypokalemia (low K+)
  • Worse w/ renal insufficiency
  • Hyperuricemia (watch out in GOUT pts)
  • Elevate glucose, cholesterol, and TG
  • Orthostatic HoTN

Nursing Considerations:
- Monitor K+ levels.
- Can give K+ supplements.
- Encourage foods rich in K+ —> avocados, spinach,
watermelon, bananas, beans, sweet potatoes, and beats.

  • potassium WASTING —> excrete more K+ into urine —>
    Hypokalemia —> eat foods higher in K+
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11
Q

Loop Diuretics

A

furoSEMIDE

MOA:
- Inhibits the kidneys ability to reabsorb Na+ in the LOOP OF
HENLE (Makes kidneys put more Na+ in the urine)
- ⬇️ fluid in blood vessels -> ⬇️ CO
- Profound Diuresis possible (used for fluid overload)
- POTENT

Indications:

  • HTN
  • Fluid overload

Adverse Reactions:

  • Hypokalemia (potassium follows with Na+ into urine)
  • Hyponatremia
  • Dehydration
  • HoTN
  • Ototoxicity - push IVF slowly

Nursing Considerations:

  • Monitor K+ levels
  • KCL supplements
  • potassium WASTING —> excrete more K+ into urine —>
    Hypokalemia —> eat foods higher in K+
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12
Q

Normal Potassium Levels

A

3.5 - 5

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13
Q

Sympatholytics

A

General MOA: SNS blockers (SNS normally vasoconstricts, when it is blocked, it dilates)

alpha-adrenergic blockers (doxazosin, -zosin)
Centrally acting alpha 2 agonists (clonidine, -(o)idine)
Beta adrenergic blockers (beta blockers, -olol)

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14
Q

Beta adrenergic blockers

Beta blockers

A

metoprOLOL (selective, B1)
propranOLOL (non-selective, B1 & B2)
carvediLOL (a & b, B1 & B2)

MOA:

  • ⬆️ Nitric oxide = vasodilation response
  • Blocks B1 receptors (heart) = ⬇️ HR & contractility
  • Blocks norepinephrine & epinephrine from SNS

Indications:
- HTN

Adverse Reactions:

  • Bradycardia
  • HoTN
  • Mask hypoglycemia (prevents tachycardia) -> be careful DM
  • Fatigue/lethargy

Nursing Considerations:

  • WEAN when discontinuing
  • Rebound HTN
  • Propanolol -> caution w/ asthma
  • HOLD & call HCP if: BP <60, SBP <100
* The 5 Bs:
B - Blood sugar masking/Bottomed out blood sugar 
B - Bradycardia & heart Blocks
B - Breathing problems 
B - Bad for HF pts
B - Blood pressure lowered
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15
Q

Alpha-2 Adrenergic Agonist

A

clonIDINE

MOA:

  • ⬇️ sympathetic outflow = ⬇️ stimulation of adrenergic receptors (alpha and beta)
  • ⬇️ BP

Indications:
- HTN, not 1st line

Adverse reactions:

  • Drowsiness (common). QHS.
  • Rebound HTN
  • May worsen w/ pre-existing liver disease

Nursing considerations:
- Rebound HTN

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16
Q

Selective Alpha 1 Blockers

A

doxaZOSIN

MOA:

  • Selective alpha 1 blockade
  • Venous AND arterial dilation

Indications:
- HTN, not 1st line

Adverse reactions:

  • HoTN
  • Dizziness

Nursing considerations:
- HoTN

17
Q

RAAS Blockers

A 
ACE inhibitors (-pril)
ARBs (-spartan) 
Renin inhibitor (-kiren)
18
Q

ACE inhibitors

A

captoPRIL, lisinoPRIL

MOA:
- Safe 1st line therapy
- Blocks ACE
= inhibits A2 (vasoconstrictor) production -> ⬆️ dilation
= inhibits aldosterone (⬆️ Na, ⬇️K) ->
⬇️ Na absorption, ⬇️ H2O retention

Indications:

  • HTN - slows progression of L ventricular hypertrophy
  • DM - renal protective effects

Adverse reactions:

  • 1st dose HoTN
  • Cough
  • Dizziness
  • Rash
  • Angioedema: AA

Nursing considerations:

  • 🚫 PREGNANT WOMEN (teratogenic!!)
  • renal insufficiency -> caution
  • captopril -> neutropenia -> monitor WBC
  • hyperkalemia
  • combo w/ thiazide diuretics

** ACE - angioedema, cough, electrolyte imbalance (⬆️ K+)

19
Q

ARBs

Angiotensin Receptor Blockers

A

loSARTAN

MOA:

  • Blocks A2 AFTER formed
  • Vasodilation
  • ⬆️ Na+ & H2O excretion

Indications:

  • HTN
  • HF (⬇️ stress on heart)
  • Stroke progression
  • Many others

Adverse reactions:

  • Well tolerated
  • Angioedema, mild

Nursing considerations:

  • 🚫 PREGNANT WOMEN
  • Caution w/ renal problems
20
Q

Can ACEi and ARBs be taken together?

A

NO

21
Q

Renin inhibitor

A

aliskIREN

MOA:
- Direct inhibition of renin (does opposite of renin)
- Induces vasodilation, ⬇️ blood volume, ⬇️ SNS, inhibits
cardiac & vascular hypertrophy

Indications:

  • HTN
  • HF

Adverse reactions:

  • Well tolerated
  • GI discomfort
  • W/ ACEi: hyperkalemia, especially w/ DM pts

Nursing considerations:

  • Several weeks to see effect
  • 🚫 PREGNANT
22
Q

Calcium Channel Blockers

A

nifeDIPINE, nicarDIPINE, verapAMIL, diltiaZEM

MOA:

  • Blocks Ca++ access to cells
  • ⬇️ contractility
  • ⬇️ conductivity of heart

Indications:

  • Heart rhythm disorders (Diltiazem & verapamil)
  • HTN
  • Chest pain
  • refractive HTN/HTN emergency (Nicardipine)

Adverse reactions:

  • Orthostatic HoTN
  • Peripheral edema

Nursing considerations:

  • Best for ELDERLY & AA
  • Diuretics can be given for peripheral edema
23
Q

Vasodilators

A

HydralaZINE

MOA:

  • Work directly on arterial & venous smooth muscles
  • Cause relaxation
  • ⬇️ PVR

Indications:
- HTN

Adverse reactions:

  • HoTN
  • Dizziness
  • Headache
  • Tachycardia
  • Edema
  • Dyspnea
  • GI upset

Nursing considerations:

  • HoTN
  • Combo w/ other Anti-HTN meds

NUR 325 Funds of Pathopharm (10 decks)

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