week two Flashcards
RAAS
renin angiotensin aldosterone system
regulates long term BP and extracellular volume
angiotensionogen
released by liver in response to LOW BP and sodium level
RAAS steps
low fluid stimulates kidney to release renin
renin causes liver to convert angiotensinogen to angiotensin I
angiotensin I travels to lung and ACE converts it to agiotensin II
angiotensin II acts on adrenal glands to release aldosterone
angiotensin II is a vasocontrictor
arterial baroreceptors
receptors in carotid sinus, aorta, left ventricle, sense BP and alter by changing heart rate
vascular autoregulation
maintains normal perfusion
regulates based on MAP
alters resistance in arterioles
primary hypertension
no known cause, absence of underlying disease
primary hypertension risk factors
smoking, sodium, sedentary, hyperlipidemia, stress, obesity
secondary htn
known cause
renal disorder, tumors, drug induced
long term htn outcomes
increased left ventricular work
end stage renal disease
stroke
eye issues
gangrene
hypertensive crisis
rapidly progressing htn >180, >120
hypertensive urgency
no signs of end organ damage
>180/120
gradually reduce
hypertensive emergency
end organ damage, headache, blurry vision. Use iv meds to lower BP quicly
types of meds to treat htn
diuretics
sympathetic NS blocker
beta blocker
calcium channel blocker
vasodilator
types of diuretics
potassium sparing (mild)
thiazide (mild)
loop (moderate to profound)
diuretic MOA
increase urinary output and decrease circulating volume
thiazide diuretics
hydrochlorothiazide, metolazone
works on distal convoluted tubule to inhibit reabsorption or sodium/potassium and chloride, water loss
relaxes arterioles, decreased vascular resistance
side effect of thiazide diuretics
electrolyte disturbance, hypokalemia
orthostatic hypotension,n
nursing action of thiazide diuretics
monitor K levels, give supplements, encourage K rich foods
loop diuretics
furosemide, bumetanide, torsemide
MOA: inhibit kidneys ability to reabsorb sodium, makes urine more salty, more urine out
PO or IV
loop diabetic side effect
hypokalemia
dehydration, hypotension
nursing considerations for loop diuretics
monitor K levels, usually recieve supplement
hypokalemia
low K level, normal 3.5-5
potassium sparing diuretics
spironalactone, triamterene
MOA: block action of aldosterone
only given PO, usually given with otherss
side effects of potassium sparing diuretics (aldosterone antagonist)
endocrine effects
sympatholytics
alpha adrenergic blockers
centrally acting alpha2agonists
beta andrenergic blockers
what are sympatholytics
sympathetic nervous system blockers, usually vasocontstricts
(DECREASE PERIPHERAL VASCULAR RESISTANCE)
beta adrenergic blockers
metoprolol, propranolol, carvedilol
block beta 1 and 2 receptors
PO/IV
increases vasodilatoin response and blocks dilation of beta 1 receptors
beta blocker side effects
fatigue
hypotension
bradycardia
beta blocker nursing considerations
must be weaned, rebound htn, don’t use with breathing conditions
RISK FOR LOW BP and slow HR
alpha 2 adrenergic agonist
clonidine, methyldopa
decrease sympathetic outlow, decreased receptor stimulation
side effects of alpha 2 adrenergic agonist
drowsiness, rebound htn
selective alpha 1 blockers
doxazosin, selective alpha 1 blockade
side effects of selective alpha 1 blockers
low bp, dizzy
ACE inhibitors
captopril, lisinopril, enlapril, benazepril, ramipril
blocks ACE, inhibits production of angiotensin 2
ace inhibitor side effects
hypotension, cough, dizzy, angioedema
NOT FOR USE IN PREGNANCY
nursing considerations for ace inhibitors
renal insufficiency, captopril can cause neutropenia
risk of hyperkalemia
angiotensin receptor blockers
losartan, eprosartan, valsartan, olmesartan
indications for angiotensin receptor blockers
htn, heart failure, stroke progression
side effects of angiotensin receptor blockers
angioedema, cannot use if pregnant
ONLY GIVEN PO
renin inhibitor
aliskiren
inhibition of renin, induces vasodilation
calcium channel blockers
nifedipine, amlodipine, nicardipine, verapamil, diltiazem
calcium channel blocker info
can also treat heart rhythm disorders
PO or IV
orthostatic hypotension
vasodilators
hydralazine
vasodilator MOA
work on arterial and venous smooth muscle to cause relazation
PO or IV
