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Pharm EXAM 2 > Chapter 26- hypertension > Flashcards

Chapter 26- hypertension Flashcards

(93 cards)

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1
Q

what is the heart normally labeled as?

A

A pump

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2
Q

what is the function of the heart?

A

delivers o2 and nutrients to the myocardium and tissues

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3
Q

What is the cardiac cycle in 10 steps

A
  1. blood enters from veins -vena cava
  2. into the right atrium
  3. through tricuspid
  4. into the right ventricle
  5. through pulmonary valve and artery
  6. back to the heart through pulmonary veins
  7. into the left atrium
  8. though mitral valve
  9. into the left ventricle
  10. through the aorta and to the body
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4
Q

what is systole

A

contraction of the ventricles – blood going out

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5
Q

what is diastole

A

the heart refills with blood

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6
Q

what is stroke volume

A

amount of blood ejected from the left ventricle during contraction

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7
Q

what is preload

A

the end-diastolic volume, the amount of blood still in the left ventricle

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8
Q

what is afterload

A

resistance to left ventricle ejection, affected by aortic pressure

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9
Q

what is cardiac output and how do we find it

A

amount of blood pumped in a minute, HRxSV

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10
Q

what is contractility

A

ability for the heart to contract

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11
Q

what does the electrical conduction system use

A

electrolytes

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12
Q

what is the conduction pathway of the heart

A

SA node (sets pace)
AV node (receives messages, can slow conduction/filter)
bundle of his (sends messages to right and left bundle)
left/right bundle (sends messages to Purkinje)
Purkinje fibers (causes contraction)

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13
Q

are veins or arteries high-pressure?

A

arteries

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14
Q

why are there valves in veins

A

for low-pressure movement

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15
Q

what is the job of coronary arteries

A

to give oxygen-rich blood to the heart, received during diastole.

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16
Q

how do you find pulse pressure?

A

difference between pressure in the aorta during systole and diastole

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17
Q

what do ECGs and EKGs measure

A

the conduction of the heart

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18
Q

what does the p wave represent

A

atrial depolarization

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19
Q

what does the PR interval represent

A

the atrial impulse from AV to bundle branches

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20
Q

what does the QRS complex represent

A

depolarization of the ventricles

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21
Q

what does the ST segment represent

A

the end of depolarization and the beginning of repolarization

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22
Q

what does the T wave represent

A

repolarization

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23
Q

what will be altered for atrial arrhythmias

A

the p wave

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24
Q

the vasomotor center has two components, baroreceptors and chemoreceptors, what do they do?

A

baro: respond to pressure/stretch changes
chemo: respond to o2, co2, and pH

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25
how does RAAS work
responds to low BP or sodium - the liver releases angiotensinogen - the kidney releases renin - reaction creates angiotensin 1 - lungs release ACE - reaction creates angiotensin 2 - makes adrenal glands make aldosterone - increase reabsorption of sodium, increasing fluid and bp, will decrease potassium levels - aldosterone will also affect kidneys, causing vasoconstriction
26
where and why is ADH secreted, and when will it be inhibited
hypothalamus -concentrated electrolytes, IE low fluid volume -will be inhibited when BP is high
27
how does ADH affect BP
increases BP -retention of water
28
what is autoregulation of blood flow controlled by and what is the main trigger
heart, brain, kidneys nutritional needs of the tissues -ex: decreased o2 and increased co2 in sepsis
29
what does histamine do to BP
dilates the blood vessels, lowering BP
30
what does bradykinin do to BP
is a potent peptide, causing vasodilation
31
what do prostaglandins do to BP
can vasoconstrictor or dilate
32
what is arterial blood pressure, and what are the two main determinants
the force exerted on arterial walls by the blood flow - cardiac output (systolic) -peripheral vascular resistance (diastolic)
33
what is Frank's law
the greater the volume in diastole, the more forceful the contraction, the more blood that the heart will pump -not true for HF
34
what is considered hypotensive and what is the body's response
systolic under 90 -SNS stimulated -adrenal medulla will excrete epinephrine and norepinephrine -RAAS and ADH -kidneys retain fluid and BP is increased
35
the main cause of hypotension
fluid loss
36
what is considered hypertensive and what is the body's response
systolic over 140 diastolic over 90 -renal secretion -fluid loss and decreased circulating volume -decreased CO and decreased arterial BP -BP is lowered
37
difference between primary and secondary HTN
P: In most cases, unknown, hereditary, diet, or lifestyle S: renal, endocrine, or CNS disorders and medications
38
negative effects of HTN
MI, CHF, strokes, renal disease, retinal damage
39
what does synthetic vasopressin treat
diabetes and hypotensive crisis
40
list the levels of hypertension, for diagnosis pt, has to experience levels from 2 readings on 2 occasions
elevated= 120-129 and >80 stage 130-139 and 80-89 stage 2 >140 and >90
41
what are the joint commission goals for BP based on age
<150/90 for people greater than 60 <140/90 for people less than 60 or have DM or chronic kidney disease
42
nonpharmacological management for HTN
-limit alcohol -reduce sodium -reduce fat and cholesterol -increase fruits and veggies -increase aerobic activity -discontinue tobacco -maintain optimum weight -STRESS MANAGEMENT
43
is it better to change an HTN med or increase the dose?
change the medication group
44
how do ace inhibitors work
they inhibit the conversion of angiotensin to angiotensin 2
45
most common ace inhibitors
LISINOPRIL -captopril -enalapril -ramipril
46
what suffix do ace inhibitors have
-pril
47
side effects of Ace inhibitors
TICKY COUGH, HYPERKALEMIA, ANGIOEDEMA -orthostatic hypotension -GI upset -acute renal failure -HA and dizziness
48
black box warning for ace inhibitors
pregnancy
49
who besides pregnant people should not take an ace inhibitor
people with impaired renal function and CHF
50
how do arbs work
selectively bind to angiotensin 2 receptors
51
why would someone take an arb even though its expensive
side effects from ace
52
examples of ARBS
LOSARTAN -valsartan -olmesartan
53
suffix of arbs
-sartan
54
side effects to arbs
ANGIO EDEMA, ACUTE RENAL FAILURE, HYPERKALEMIA -orthostatic hypotension -ha, dizziness -dry mouth -diarrhea
55
who can not take arbs besides pregnant people
hepatic and renal impairment
56
black box for arbs
pregnancy
57
what is the dose for arbs for htn and chf
-once a day for htn -twice a day for chf
58
how do calcium channel blockers work
inhibit the movement of calcium, causing decreased HR and vasodilation
59
common calcium channel blockers
amlodipine, diltiazem, nicardipine, nifedipine
60
suffix of SOME calcium channel blockers
-dipine
61
common side effects of calcium channel blockers
SEXUAL DYSFUNCTION -flushed skin, muscle cramps, peripheral edema -ha, dizziness, hypotension -hepatotoxicity -angioedema
62
who can not take calcium channel blockers
hepatic and renal impairment, CHF/heart block, pregnancy
63
what do calcium channel blockers interact with
macrolide antibiotics and grapefruit juice
64
how do alpha 1 blockers work
inhibit SNS -dilate blood vessels and decrease PVR
65
common alpha one blockers
doxazosin, prazosin, terazosin
66
side effects of alpha one blockers
FIRST DOSE: orthostatic hypotension, dizziness, palpitation, syncopal episode -- FIRST DOSE IS HIGHER -can cause fluid retention -given at bedtime
67
how do alpha two agonists work
inhibit SNS: decreased CO, decreased HR, decreased PVR, decreased BP
68
common alpha two agonists
CLONIDINE -methyldopa and guanfacine
69
side effects of alpha two agonists
FIRST DOSE: orthostatic hypotension, dizziness, palpitation, syncopal episode -- FIRST DOSE IS HIGHER -can cause fluid retention -given at bedtime
70
is clonidine often used
no, it is a last-resort med that needs monitoring
71
how do beta blockers work
decrease HR, contraction, CO, and renin release
72
common beta blockers
atenolol, metoprolol, propranolol
73
suffix for beta blockers
-olol
74
why are beta blockers popular?
-first to be used for pts under 50 -first to be used for selective meds, for pts with asthma, PVD, or DM
75
what do beta blockers treat
HTN, dysrhythmias, HF, MI, glaucoma
76
side effects of beta blockers
hypotension, bradycardia, dizziness, erectile dysfunction
77
black box warning for beta blockers
have to be titrated off, which can cause angina, arrhythmias and MI
78
how do alpha-beta blockers work
the dual effect, works well
79
common alpha-beta blockers
carvedilol, labetalol
80
are diuretics a first-line med
yes, good for mild/moderate HTN
81
how do thiazide diuretics work
block Na reabsorption increase K and H20 secretion
82
most common thiazide diuretic and treatment of HTN
hydrochlorothiazide HCTZ
83
How do potassium-sparing diuretics work
excretion of Na and retention of K -blocks aldosterone
84
common potassium-sparing diuretic
spironolactone
85
what to know about potassium-sparing diuretics
can increase the effects of digoxin can cause hyperkalemia if taking ACE or ARB
86
how do loop diuretics work
Inhibits the reabsorption of Na, Cl, and K in the loop of Henle
87
concerns of loop diuretics
can increase digoxin and cause hypokalemia
87
most common loop diuretic
furosemide --LASIX
88
what can cause a hypertensive emergency
malignant HTN, cerebral hemorrhage, dissecting aortic aneurysm, renal disease
89
symptoms of hypertensive emergency
HA, H/V, visual changes, neuro changes, disorientation, decreased consciousness
90
how do direct-acting vasodilators work
relax smooth muscles in blood vessels
91
common direct-acting vasodilators
hydralazine and nitroprusside (IV only)
92
broad things to monitor for HTN meds
-bradycardia -hypotension and orthostatic (fall risk) -monitor I&O -- diuetics -heart healthy and Na restrictive diet -electrolytes -telemetry monitoring -supplements used -specialty populations

Pharm EXAM 2 (8 decks)

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