Ch.44-46

Question 1

Essential hypertension

Answer 1

is the most common type, affecting 90% of persons with high blood pressure.

Question 2

Ten percent of hypertension cases are related to renal and endocrine disorders and are classified as

Answer 2

Secondary hypertension

Question 3

Prehypertension

Answer 3

is the second category, defined as a systolic blood pressure (SBP) 120 to 139 and a diastolic blood pressure (DBP) 80 to 89.

Question 4

Stage 1 hypertension

Answer 4

falls between 140/90 and 159/99

Question 5

stage 2 hypertension

Answer 5

160/100 or greater

Question 6

According to the JNC 7

Answer 6

if the blood pressure is greater than 20/10 mm Hg above goal, a drug regimen should be started.

Question 7

Diuretics

Answer 7

promote sodium depletion, which decreases extracellular fluid volume (ECFV). Diuretics are effective as first-line drugs for treating mild hypertension.

Question 8

Hydrochlorothiazide

Answer 8

is the most frequently prescribed diuretic for controlling mild hypertension. It can be used alone for recently diagnosed or mild hypertension or with other antihypertensive drugs.

Question 9

Thiazide diuretics should not be used for clients with renal insufficiency

Answer 9

(creatinine clearance less than 30 mL/min).

Question 10

Diuretics are not used if hypertension is the result of renin-angiotensin-aldosterone system involvement,

Answer 10

because they tend to elevate the serum renin level.

Question 11

The sympatholytics comprise five groups of drugs:

Answer 11

(1) beta-adrenergic blockers, (2) centrally acting alpha2 agonists, (3) alpha-adrenergic blockers, (4) adrenergic neuron blockers (peripherally acting sympatholytics), and (5) alpha1- and beta1-adrenergic blockers.

Question 12

Beta-adrenergic blockers, frequently called beta blockers,

Answer 12

are used as antihypertensive drugs or in combination with a diuretic. Beta blockers are also used as antianginals and antidysrhythmics

Question 13

Beta blockers

Answer 13

educe heart rate, contractility, and renin release. There is a greater hypotensive response in clients with higher renin levels.

Question 14

Nonselective beta blockers such as propranolol (Inderal)

Answer 14

inhibit beta1 (heart) and beta2 (bronchial) receptors.

Question 15

Cardioselective beta blockers are preferred

Answer 15

because they act mainly on the beta1 rather than the beta2 receptors and bronchoconstriction is less likely to occur.

Question 16

cardioselective beta blockers that block beta1 receptors

Answer 16

Acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), and metoprolol
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(Lopressor)

Question 17

Noncardioselective beta blockers inhibit

Answer 17

the liver’s ability to convert glycogen to glucose in response to hypoglycemia.

Question 18

Centrally acting alpha2 agonists

Answer 18

They stimulate the alpha2 receptors, which in turn decreases sympathetic activity; increases vagus activity; decreases cardiac output; and decreases serum epinephrine, norepinephrine, and renin release.

Question 19

Centrally acting alpha2 agonists

Answer 19

methyldopa, clonidine, guanabenz, and guanfacine

Question 20

alpha blockers

Answer 20

blocks the alpha-adrenergic receptors,resulting in vasodilation and decreased blood pressure.

Question 21

Alpha blockers are useful in treating hypertension

Answer 21

in clients with lipid abnormalities.

Question 22

alpha blockers

Answer 22

They decrease the very-low-density lipoproteins (VLDL) and the low-density lipoproteins (LDL) that are responsible for the buildup of fatty plaques in the arteries (atherosclerosis)

Question 23

The selective alpha1-adrenergic blockers

Answer 23

—prazosin, terazosin, and doxazosin—are used mainly to reduce blood pressure and can be used to treat benign prostatic hypertrophy (BPH).

Question 24

The more potent alpha blockers—phentolamine and phenoxybenzamine

Answer 24

are used primarily for hypertensive crisis and severe hypertension resulting from catecholamine-secreting tumors of the adrenal medulla (pheochromocytomas).

Question 25

alpha1 and beta1 adrenergic

Answer 25

blocks both the alpha1 and beta1 receptors.Blocking the alpha1 receptor causes vasodilation, decreasing resistance to blood flow.

Question 26

Direct-Acting Arteriolar Vasodilators

Answer 26

Vasodilators are potent antihypertensive drugs. Direct-acting vasodilators act by relaxing the smooth muscles of the blood vessels, mainly the arteries, causing vasodilation. Vasodilators promote an increase in blood flow to the brain and kidneys. With vasodilation, the blood pressure decreases and sodium and water are retained, resulting in peripheral edema. Diuretics can be given with a direct- acting vasodilator to decrease the edema.

Question 27

Two of the direct-acting vasodilators,

Answer 27

hydralazine and minoxidil, are used for moderate to severe (dose-related) hypertension.

Question 28

Angiotensin-Converting Enzyme (Ace) Inhibitors

Answer 28

Drugs in this group inhibit ACE, which in turn inhibits the formation of angiotensin II (vasoconstrictor) and blocks the release of aldosterone. Aldosterone promotes sodium retention and potassium excretion. When aldosterone is blocked, sodium is excreted along with water, and potassium is retained. ACE inhibitors cause little change in cardiac output or heart rate,
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and they lower peripheral resistance

Question 29

These 10 ACE inhibitors include

Answer 29

benazepril (Lotensin), captopril (Capoten), enalapril maleate (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)

Question 30

Angiotensin II Receptor Blockers (ARBs)

Answer 30

antihypertensive drugs. These agents are similar to ACE inhibitors in that they prevent the release of aldosterone (sodium-retaining hormone). They act on the renin-angiotensin-aldosterone system (RAAS). The difference between ARBs and ACE inhibitors is that ARBs block angiotensin II from the AT1 receptors found in many tissues, whereas ACE inhibitors inhibit the angiotensin-converting enzyme in the formation of angiotensin II. The ARBs cause vasodilation and decrease peripheral resistance. They do not cause the constant, irritated cough ACE inhibitors can. Like ACE inhibitors, ARBs should not be taken during pregnancy.

Question 31

examples of ARBs

Answer 31

Losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), candesartan cilexetil (Atacand), eprosartan (Teveten), olmesartan medoxomil (Benicar), and telmisartan (Micardis)

Question 32

Calcium Channel Blockers

Answer 32

Slow calcium channels are found in the myocardium (heart muscle) and vascular smooth muscle (VSM) cells. Free calcium increases muscle contractility, peripheral resistance, and blood pressure. Calcium channel blockers, also called calcium antagonists and calcium blockers, block the calcium channel in the VSM, promoting vasodilation

Question 33

calcium blockers in 3 groups:

Answer 33

diphenylalkylamine (verapamil), benzothiazepines (diltiazem), and dihydropyridine (amlodipine and others)

Question 34

Verapamil (Calan)

Answer 34

is used to treat chronic hypertension, angina pectoris, and cardiac dysrhythmias. Verapamil and diltiazem act on the arterioles and the heart. The dihydropyridines are the largest group of calcium channel blockers and consist of seven drugs; six of these are used to control hypertension.

Question 35

Nifedipine (Procardia)

Answer 35

was the first drug in this group. Nifedipine decreases blood pressure in older adults and in those with low serum renin values. Nifedipine and verapamil are potent calcium blockers. Nifedipine, in its immediate-release form (10- and 20-mg capsules), has been associated with an increased incidence of sudden cardiac death, especially when prescribed for outpatients at high doses.

Question 36

Amlodipine (Norvasc)

Answer 36

ike other calcium blockers, is highly protein-bound. It is gradually absorbed via the GI tract. Because the half-life of amlodipine is longer than other calcium blockers, it is taken once a day.