CH 26: Hypertension

Question 1

homeostasis resulting from increased blood pressure in the cardiovascular system

Answer 1

vasodilation
decreased stroke volume
decreased HR
decreased CO
blood pressure back to normal

Question 2

homeostasis resulting from increased blood pressure in the kidneys

Answer 2

increased urine output
decreased blood volume
blood pressure returns to normal

Question 3

primary HTN

Answer 3

no identifiable cause

Question 4

secondary HTN caused by:

Answer 4

 Diseases: for example, Cushing’s, hyperthyroid, CKD
 Drugs: corticosteroids, contraceptives, alcohol, amphetamines,
caffeine, decongestants,
Many times there are no symptoms

Question 5

4 organs most affected by prolonged HTN or uncontrolled HTN

Answer 5

 Heart
 Brain
 Kidneys
 Retina

Question 6

consequences of HTN

Answer 6

 Heart must work harder
o Excessive workload can ultimately cause heart to fail = heart
failure (HF)
 Damage to the blood vessels
o Can result in transient ischemic attacks and strokes
 Damage to the arteries of the kidneys
o Can result in CKD
 Damage to the vessels in the retina
o Can result in rupture or occlusion = visual impairment and
blindness
 If HTN continues, damage to the organs and tissues can be irreversible

Question 7

lifestyle recommendations for HTN

Answer 7

 Limit intake of alcohol.
 Restrict sodium consumption and increase potassium intake.
 Reduce intake of saturated fat and cholesterol and increase
consumption of fresh fruits and vegetables.
 Increase physical activity.
 Discontinue use of tobacco products.
 Reduce sources of stress and learn to implement coping strategies.
 Maintain optimal weight.

Question 8

goal of pharmacotherapy for HTN

Answer 8

reduce morbidity and mortality

Question 9

Alpha2 Agonists action

Answer 9

Decrease SNS impulses to heart and arterioles = vasodilation

Question 10

Alpha 1 Blockers action

Answer 10

inhibit SNS action on arterioles = vasodilation

Question 11

direct vasodilators

Answer 11

Act on smooth muscle of arterioles = vasodilation

Question 12

calcium channel blockers

Answer 12

Block calcium ion channels in arteries causing vasodilation

Question 13

Angiotensin receptor blockers

Answer 13

Prevent angiotensin II from reaching the receptors = vasodilation

Question 14

ACE inhibitors (angiotensin-converting enzyme)

Answer 14

Block formation of angiotensin II = vasodilation AND block aldosterone secretion = decrease fluid volume

Question 15

diuretics

Answer 15

Increase urine output = decrease fluid volume

Question 16

Beta blockers

Answer 16

Decrease heart rate and myocardial contractility = reduce CO

Question 17

treatment begins at systolic greater than 120 with:

Answer 17

non-pharmacologic changes

Question 18

drug treatment starts with systolic greater than

Answer 18

130

Question 19

therapeutic effects of lisinopril (ACE inhibitors)

Answer 19

Block formation of angiotensin II = vasodilation AND block
aldosterone secretion = decrease fluid volume

Question 19

adverse effects of lisinopril (ACE inhibitors)

Answer 19

Headache,
dizziness,
orthostatic hypotension,
rash,
cough
Angioedema,
acute renal failure,
first-dose phenomenon,
fetal toxicity,
hyperkalemia

Question 20

monitoring for lisinopril (ACE INHIBITORS)

Answer 20

Persistant cough
Postural hypotension– first dose phenomenon
Hyperkalemia with potassium sparing diurectics
Monitor labs for glucose,
eletrolytes, AST, ALT, BUN, creatinine
Potassium!

Question 21

safety for lisinopril (ACE inhibitors)

Answer 21

angioedema - emergency!
No use during pregnancy
NSAIDs can reduce the effect
Alcohol may increase hypotension
Can lead to lithium toxicity

Question 22

adverse effects of losartan (ARBs)

Answer 22

Headache,
dizziness,
orthostatic
hypotension,
diarrhea,
fatigue,
upper respiratory tract infection
Angioedema,
acute renal
failure,
first-dose phenomenon,
fetal toxicity,
hyperkalemia,
nephrotoxicity
(aliskiren)

Question 23

safety and monitoring for losartan (ARBs)

Answer 23

Hypoglycemia
UTIs
anemia
Dizziness and fainting after first couple of doses
Fetal injury and death when taken with pregnancy

Question 24

therapeutic effects of nifedipine (selective CCB) and diltiazem (non-selective CCB)

Answer 24

Block calcium ion channels in arteries causing vasodilation Nifedipine: decrease HTN and angina

Question 25

adverse effects of nifedipine (selective CCB) and diltiazem (non-selective CCB)

Answer 25

Flushed skin, headache, dizziness, peripheral edema, lightheadedness, nausea, constipation, fatigue, sexual dysfunction Hepatotoxicity, MI, HF, confusion, mood changes, angioedema

Question 26

safety and monitoring of nifedipine (selective CCB) and diltiazem (non-selective CCB)

Answer 26

monitor for digoxin toxicity do not crush or divide alcohol increases vasodilation and can lead to syncope

Question 27

therapeutic effects of atenolol (beta blocker)

Answer 27

Decrease heart rate and myocardial contractility = reduce cardiac output Reduced blood pressure Reduce angina Heart failure, MI Migraines

Question 28

adverse effects of atenolol (beta blocker)

Answer 28

Fatigue, insomnia, drowsiness, impotence or decreased libido, bradycardia, confusion Agranulocytosis, laryngospasm, Stevens-Johnson syndrome, anaphylaxis; if the drug is abruptly withdrawn, palpitations, rebound HTN, dysrhythmias, MI

Question 29

safety and monitoring for atenolol (beta blocker)

Answer 29

Broncho-constriction Fatigue and intolerance Caution in patients with asthma or HF Do not stop abruptly! Can result in rebound hypertension and MI

Question 30

therapeutic effects of doxazosin (alpha 1 - alpha blockers)

Answer 30

Inhibit SNS activation in arterioles = vasodilation Lower blood pressure Bph symptoms

Question 31

adverse effects of doxazosin (alpha 1 - alpha blockers)

Answer 31

Orthostatic hypotension, dizziness, headache, fatigue First-dose phenomenon, tachycardia, dyspnea

Question 32

safety and monitoring of doxazosin (alpha 1 - alpha blockers)

Answer 32

Orthostatic hypotension HYPOTENSION Sedation and dizziness Hemolytic anemia, leukopenia, thrombo- cytopenia, lupus. Caution with erectile dysfunction drug = low bp NSAIDs can decrease effect

Question 33

therapeutic effects of clonidine (alpha 2 adrenergic blockers)

Answer 33

Decrease SNS impulses to heart and arterioles = vasodilation

Question 34

adverse effects of clonidine (alpha 2 adrenergic blockers)

Answer 34

Peripheral edema, sedation, depression, headache, dry mouth, decreased libido Hepatotoxicity, hemolytic anemia, granulocytopenia

Question 35

therapeutic effects of hydralazine (direct acting vasodilators)

Answer 35

Act on the smooth muscle of arterioles = vasodilation Not first choice due to side effects

Question 36

adverse effects of hydralazine (direct acting vasodilators)

Answer 36

Orthostatic hypotension, fluid retention, headache, palpitations Lupus-like reaction (hydralazine), severe hypotension, MI, dysrhythmias, shock

Question 37

safety and monitoring of hydralazine (direct acting vasodilators)

Answer 37

Reflex tachycardia** Sodium and water retention Can develop tolerance over time DO NOT STOP ABRUPTLY Severe hypotension with other anti-hypertensives

Question 38

swelling around the lips, eyes, throat, and other body regions.

Answer 38

angioedema

Question 39

compensatory response to the sudden decrease in blood pressure caused by the drug.

Answer 39

reflex tachycardia