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NUR 325 > Alterations in Cardio System > Flashcards

Alterations in Cardio System Flashcards

1
Q

Renin Angiotensin Aldosterone System (RAAS)

A

In response to low BP or low serum sodium levels.

Used to regulate BP and extra cellular volume.

Also activated by renal perfusion.

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2
Q

Elevated Blood Pressure Level

A

120-129 and <80

Encourage diet changes

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3
Q

Stage 1 HTN

A

130-139 or 80-89

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4
Q

Stage 2 HTN

A

140+ or 90+

Intro to meds

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5
Q

Crisis HTN

A

180+ and/or 120+

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6
Q

Primary HTN

A

Idiopathic-no known cause

Most common

Absence of underlying disease process

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7
Q

Risk Factors for HTN

A

Smoking, excessive sodium intake, obesity, 60+ years old, family hx, sedentary lifestyle, insulin resistance

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8
Q

Secondary HTN

A

KNOWN cause related to underlying condition

Treat underlying cause
- renal disorder
- adrenocorticol tumors
- adrenomedullary tumors
- drugs
- pregnancy, hormonal therapy

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9
Q

S/SX of HTN

A

Asymptomatic, none

Look for signs of end organ damage
-headache
-chest pain
-red face
-visual changes
-weakness in extremities
-increased temp

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10
Q

Hypertensive Crisis

A

rapidly progressive HTN in which SBP>180 and/or DBP>120

more common with primary HTN

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11
Q

HTN Urgency

A

no s/sx of end organ damage

BP > 180/120

Treat by gradually lowering BP (hrs to days)

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12
Q

HTN Emergency

A

s/sx evident of end organ damage, more intense, uncontrolled

treat by aggressively lowering BP (min to hrs)

IV therapy-faster administration

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13
Q

Diuretics

A

Potassium Sparing (mild)
Thiazide (mild)
Loop (moderate to profound)

MOA: blocks Na and Cl reabsorption, increase urinary output, decrease arterial resistance, decrease circulatory volume

water fluid pills

first line.

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14
Q

Hydrochlorothiazide

A

Thiazide Diuretic

MOA: works on distal convoluted tubule to inhibit reabsorption of Na/Cl to decrease cardiac output and relax arterioles

SE: electrolyte and metabolic imbalances, HYPOkalemia, orthostatic hypotension, may worsen renal insufficiency, can elevate glucose and cholesterol levels

NA: monitor K levels, K supplements and K rich foods

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15
Q

furosemide

A

LOOP Diuretic

MOA: inhibit kidneys ability to absorb Na in the LOOP OF HENLE, more peeing out

SE: HYPOkalemia, dehydration, HYPOtension, Ototoxicity (hearing loss)

NA: monitor K levels, KCl supplements, notify HCP of low urine output, push slow thru IV

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16
Q

spironolactone

A

Potassium Sparing Diuretic

MOA: blocks action of aldosterone, potassium retention and excretion of Na and water

SE: HYPERkalemia, deepened voice, hirsutism, gynecomastia, irregular periods

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17
Q

Sympatholytics

A

BETA BLOCKERS
Alpha adrenic blockers
Centrally acting alpha 2 agonists
Beta adrenic blockers

Impact SNS
Decreases vasoconstriction and peripheral vascular resistance

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18
Q

Metoprolol (selective)
Propranolol (nonselective)
Carvedilol (alpha and beta)

A

Beta Adrenergic Blocker

BETA 1: heart
BETA 2: lungs

MOA: increase nitric acid, blocks stimulation of beta 1 receptors, decreases BP AND HR

SE: fatigue/lethargy, bradycardia, HYPOtension, can mask HYPOglycemia

NA: wean when discontinuing, possibility of rebound HTN, don’t use with patients with asthma or breathing problems (COPD), HOLD if SBP<100 or HR<60

19
Q

clonidine

A

Alpha 2 Adrenergic Antagonist

MOA: decreases SNS outflow and stimulation of alpha and beta receptors

SE: drowsiness, rebound HTN, can worsen preexisting liver disease

NA: advise to take at night, don’t abruptly discontinue

20
Q

doxazosin

A

Selective Alpha 1 Beta Blocker

MOA: selective alpha 1 blockage, venous and arterial dilation

SE: HYPOtension, dizziness

21
Q

RAAS Blockers

A

ACE inhibitor
ARBs
Renin inhibitor

22
Q

Captopril
Lisinopril

A

ACE inhibitor

1st line

MOA: blocks angiotensin-converting enzyme, inhibits production of angiotensin 2 and aldosterone secretion

Drug of choice for diabetic patients

SE: first dose HYPOtension, dry persistent nonproductive cough, dizziness, rash, angioedema

DO NOT TAKE IF PREGNANT

NA: be cautious with renal disease patients, neutropenia, risk of HYPERkalemia

23
Q

losartan

A

Angiotensin Receptor Blocker

MOA: blocks action of angiotensin 2 after formation, causing vasodilation, increased Na and water retention

SE: well tolerated, some risk of angioedema

DO NOT USE IF PREGNANT

24
Q

aliskiren

A

Renin Inhibitor

MOA: direct inhibition of renin, induces vasodilation, decreases blood volume, inhibits cardiac and vascular hypertrophy

SE: relatively well tolerated, GI discomfort, watch for HYPERkalemia if given with ACEi

NA: takes several weeks to see effect

DO NOT TAKE IF PREGNANT

25
Q

Calcium Channel Blockers

A

nifedipine
nicardipine
verapamil
diltiazem

26
Q

nifedipine
nicardipine
verapamil
diltiazem

A

Calcium Channel Blockers

MOA: blocks Ca access to cells, decreases contractility and conductivity of heart, decreases 02 demand, vasodilation of smooth muscles

SE: bradycardia, headache, orthostatic hypotension, GI discomfort, peripheral edema

*cardiac rhythm problems, chest pain

NA: best for elderly and AA

27
Q

hydralazine

A

vasodilator

MOA: causes relaxation directly on arterial and venous smooth muscles, decreases peripheral resistance

SE: HYPOtension, dizziness, headache, tachycardia, dyspnea, GI discomfort

28
Q

Cholesterol

A

essential part of phospholipid layer in all cell membranes

highly insoluble

Exogenous- 25%
Endogenous- 75% (more impactful)

manufactured by liver

HMG CoA reductase- pathway liver uses to create cholesterol

29
Q

Lipoproteins

A

combo of lipids (cholesterol and triglycerides) and proteins

HDL (good)
LDL (bad): stick to artery walls and creates plaque buildup
VLDL

30
Q

Hypercholesterolemia

A

also called hyperlipidemia/dyslipidemia

too much cholesterol in blood stream

31
Q

Total Cholesterol Score

A

HDL + LDL + triglyceride / 5

32
Q

Familial Hypercholesterolemia

A

defect in LDL receptors in liver cells

liver cannot efficiently remove LDL from blood serum

33
Q

LDL:HDL

A

Male <5.0
Female <4.5

34
Q

Risks of Hyperlipidemia

A

Diet (high saturated fats)
Age
Family Hx
HTN
Diabetes
Physical inactivity

35
Q

Atherosclerotic Plaque

A

built up cholesterol (LDL) on blood vessels, vasodilation problem

36
Q

Atherosclerosis

A

elevated LDL cholesterol leads to thickening/hardening of arterial walls

plaque formation: injury to endothelium layers of vessels, increased permeability of LDL molecules into vessels

NA: decrease cholesterol (LDL), increase HDL, meds, weight control, exercise, smoking cessation

37
Q

Effects of atherosclerosis

A

99% blockage- angina

fatigue, inability to complete common tasks, stroke, heart attach, ischemic heart disease

38
Q

HMG-CoA Inhibitors

A

atorvastatin
simvastatin
rosuvastatin

drugs that treat HDL and prevent fatal atherosclerosic cardiovascular events associated with high cholesterol

39
Q

atorvastatin
simvastatin
rosuvastatin

A

first line

MOA: stops liver from making endogenous cholesterol

*familial hypercholesterolemia patients won’t respond due to LDL defect

prevents strokes and heart attacks,
decreases diabilities from stroke,
reduces total mortality with hx of ASCVD event

SE: myopathy, Rhabdomyolysis, acute kidney failure, heptotoxicity

NA: taken at night, drug interactions, avoid alcohol

40
Q

Cholesterol production in liver is highest at what time of day?

A

Night.

41
Q

ezetimibe

A

Cholesterol Absorption Inhibitor

MOA: blocks absorption of cholesterol in jejunum

2nd line

NA: fasted lipid panel, creatine kinase (CK) level monitoring, consider secondary causes

42
Q

Creutzfeldt Jacob Disease

A

Mad cow disease from PRION microbes

43
Q

Normal Potassium Level

A

3.5-5.0

NUR 325 (14 decks)

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