Chapters 22 & 23

Question 1

Blood fluid coming back into heart. Stretch of ventricles.

Answer 1

Preload

Question 2

Combination of cardiac output and systemic vascular resistance. Minimum pressure to push fluid throughout the body.

Answer 2

blood pressure

Question 3

Persistent systolic bp over 150 and or diastolic over 90

Answer 3

hypertension

Question 4

Amount of pressure against which the heart must work to eject blood during systole.

Answer 4

Afterload (SVR)

Question 5

Cardiac output per minute

Answer 5

4-8L/min

Question 6

Why is HTN called the silent killer

Answer 6

organs are being damaged

Question 7

How do we decrease BP?

Answer 7

dilate the arteries

Question 8

With higher bp how do the arteries react?

Answer 8

shears and damages inside arteries increasing risk of artherosclerosis

Question 9

90% of the cases have this type of htn

Answer 9

Primary or idiopathic (essential HTN)

Question 10

Non-pharm treatments usually used to begin with in patients with HTN

Answer 10

diet, exercise, salt reduction, yoga

Question 11

Peripheral blockers work against SNS

Answer 11

Alpha 1/Beta 1

Question 12

Central agonists work SNS

Answer 12

Alpha 2

Question 13

What adverse effects to the adrenergics do against the SNS

Answer 13

Bradycardia, hypotension-syncope, CNS depression

Question 14

How long could it take for full effects against the adrenergics?

Answer 14

4-6 weeks

Question 15

Alpha 2 agaonists. Most commonly used method is patches.

Answer 15

Clonidine (Catapress)

Question 16

Alpha 1 Blocker. Extended release tablets- caplet will be defecated. Make sure patient understands and knows that medication has been absorbed.

Answer 16

Doxazosin (Cardura)

Prazosin (Minipress)

Question 17

Dual alpha/beta blocker that is used.

Answer 17

Carvedilol (Coreg)

Question 18

Decrease the heart rate and myocardial contractility. Reduce cardiac output and workload

Answer 18

Beta-adrenergic antagonists

Question 19

What do ACE inhibitors block?

Answer 19

bock conversion of angiotensin 1 to 2

Question 20

When are ACE inhibitors given to patients

Answer 20

slow progression of heart failure
given after MI
Can delay progression of kidney failure in diabetes

Question 21

Given PO, well tolerated. ACE Inhibitor meds. (pril meds)

Answer 21

Catopril (capoten)

Lisinopril (zestril)

Question 22

Adverse Effects of ACE Inhibitors.

Answer 22

cough due to bradykinin excess, Hyperkalemia

Question 23

Contraindications of ACE inhibitors

Answer 23

Renal failure pregnance in 2nd and 3rd trimester

Question 24

Prevent angiotensin 2 from activating its target receptors. Have long half lives so can be given PO once daily.

Answer 24

Angiotensin 2 Receptor Blockers (ARB)

Question 25

Report headaches/dizziness due to hypotension. ARB. Given if patient cannot tolerate ACE.

Answer 25

Losartan (Cozaar)

Question 26

Why are ACE inhibitors used more?

Answer 26

Longer on the market so more research cheaper Docs more comfortable with this

Question 27

Potent. Causes hypotension easily. Given PO, IM, IV. Dilates arteries= lower bp. PO encourage to take with meals- increases availability. IV reassess BP in 10 min after admin.

Answer 27

Hydralazine (Apresoline)

Question 28

Nursing responsibilities of direct acting vasodilators?

Answer 28

Don't stop abruptly Check for any swelling Position changes slowly due to potential hypotension/syncope

Question 29

Adverse effects of Direct-Acting Vasodilators

Answer 29

reflex tachycardia (coadminister with Beta-blocker)

Question 30

BP lowers it causes the body to respond through the kidneys to hold on to fluid. What should be given?

Answer 30

diuretics

Question 31

Untreated or poorly controlled HTN- stopping medications "cold turkey"

Answer 31

Hypertensive Emergency (lower bp 20-25%)

Question 32

What med is given in hypertensive emergency?

Answer 32

Sodium nitroprusside (Nitropress)

Question 33

Normal creatinine and potassium lab levels?

Answer 33

Creatinine: 0.5-1.4 Potassium: 3.5-5.2

Question 34

First line agent that is used in htn in African Americans

Answer 34

HCTZ

Question 35

Insufficient blood flow/chest pain

Answer 35

angina

Question 36

Insufficient blood flow to the hart muscle from narrowing of coronary artery may cause....

Answer 36

chest pain

Question 37

When there is obstruction of blood flow to the heart tissue due to blockage

Answer 37

MI

Question 38

Very predictable. Chest pain that occurs with exertion and rest will relieve.

Answer 38

Chronic Stable Angina

Question 39

Occurs when coronary arteries spasm. Caused by vasoconstriction= not necessarily r/t atherosclerosis. Unpredictable.

Answer 39

Vasospastic- Prinzmetal angina

Question 40

Chest pain that is unpredictable, not related to exertion (so happen at rest), rest does not fix. An impending MI.

Answer 40

Unstable angina

Question 41

Dilate veins, reducing the amount of blood returning to the hear. Dilate the coronary arteries, bringing more blood to the myocardium.

Answer 41

Organic nitrates

Question 42

Short-acting nitrate. Sublingual or buccal to terminate acute angina.

Answer 42

Nitroglycerin (Nitro-stat, Nitro-bid)

Question 43

Long acting nitrate. Oral or patch to decrease frequency and severity of episodes.

Answer 43

``` Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Imdur) ```

Question 44

Adverse effects of nitrate medications

Answer 44

flushing of skin headache orthostatic hypotension/syncope

Question 45

Do not take with 24 hours of _______ or other meds that cause hypotension.

Answer 45

Viagra

Question 46

When should we hold Nitrate meds?

Answer 46

If BP is less than 90/60 or HR over 100

Question 47

When is Beta Adrenergic Blockers beneficial

Answer 47

exercise and after MI

Question 48

Beta Blockers Med for prophylaxis of chronic angina

Answer 48

Atenolol (Tenormin) | Metoprolol (Lopressor)

Question 49

Adverse effects of Beta Blockers

Answer 49

Hypotension, fatigue, weakness, dizziness

Question 50

If patient is taking beta blockers and is diabetic what should we monitor?

Answer 50

glucose frequently

Question 51

Ions responsible to cause a cardiac contraction

Answer 51

Potassium (inside cell) Sodium (outside) Calcium (outside)

Question 52

Dilate arterial smooth muscle, reducing blood pressure and decreasing cardiac workload. Some also decrease the heart rate, reducing the workload on the heart, and dilate the coronary arteries.

Answer 52

Calcium Channel Blockers

Question 53

Reducing force of contraction is called.......

Answer 53

negative inotropic effect

Question 54

Ca Channel Blocker. Used to treat HTN and angina. Little to no effect on myocardium itself.

Answer 54

Dihydropyridines (PO) | Amlodipine (Norvasc)

Question 55

Ca Channel Blocker. Longest half-life=30-50 hours= once daily dosing.

Answer 55

Verapamil (Calan)

Question 56

Adverse effects of Ca Channel Blockers.

Answer 56

Dizziness Flushing Hepatotoxicity, Heart Failure (RARE) pulmonary edema (crackles or rhonchi in lungs)

Question 57

Smooth muscle and myocardium. Used to treat HTN, angina and dysrhythmias. Have a negative inotrope effect. Lowers heart rate.

Answer 57

Nondihydropyridines | Diltiazem (Cardizem)