Flashcards in Chapters 22 & 23 Deck (57):
Blood fluid coming back into heart. Stretch of ventricles.
Combination of cardiac output and systemic vascular resistance. Minimum pressure to push fluid throughout the body.
Persistent systolic bp over 150 and or diastolic over 90
Amount of pressure against which the heart must work to eject blood during systole.
Cardiac output per minute
Why is HTN called the silent killer
organs are being damaged
How do we decrease BP?
dilate the arteries
With higher bp how do the arteries react?
shears and damages inside arteries increasing risk of artherosclerosis
90% of the cases have this type of htn
Primary or idiopathic (essential HTN)
Non-pharm treatments usually used to begin with in patients with HTN
diet, exercise, salt reduction, yoga
Peripheral blockers work against SNS
Alpha 1/Beta 1
Central agonists work SNS
What adverse effects to the adrenergics do against the SNS
Bradycardia, hypotension-syncope, CNS depression
How long could it take for full effects against the adrenergics?
Alpha 2 agaonists. Most commonly used method is patches.
Alpha 1 Blocker. Extended release tablets- caplet will be defecated. Make sure patient understands and knows that medication has been absorbed.
Dual alpha/beta blocker that is used.
Decrease the heart rate and myocardial contractility. Reduce cardiac output and workload
What do ACE inhibitors block?
bock conversion of angiotensin 1 to 2
When are ACE inhibitors given to patients
slow progression of heart failure
given after MI
Can delay progression of kidney failure in diabetes
Given PO, well tolerated. ACE Inhibitor meds. (pril meds)
Adverse Effects of ACE Inhibitors.
cough due to bradykinin excess, Hyperkalemia
Contraindications of ACE inhibitors
Renal failure pregnance in 2nd and 3rd trimester
Prevent angiotensin 2 from activating its target receptors. Have long half lives so can be given PO once daily.
Angiotensin 2 Receptor Blockers (ARB)
Report headaches/dizziness due to hypotension. ARB. Given if patient cannot tolerate ACE.
Why are ACE inhibitors used more?
Longer on the market so more research
Docs more comfortable with this
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.
Nursing responsibilities of direct acting vasodilators?
Don't stop abruptly
Check for any swelling
Position changes slowly due to potential hypotension/syncope
Adverse effects of Direct-Acting Vasodilators
reflex tachycardia (coadminister with Beta-blocker)
BP lowers it causes the body to respond through the kidneys to hold on to fluid. What should be given?
Untreated or poorly controlled HTN- stopping medications "cold turkey"
Hypertensive Emergency (lower bp 20-25%)
What med is given in hypertensive emergency?
Sodium nitroprusside (Nitropress)
Normal creatinine and potassium lab levels?
First line agent that is used in htn in African Americans
Insufficient blood flow/chest pain
Insufficient blood flow to the hart muscle from narrowing of coronary artery may cause....
When there is obstruction of blood flow to the heart tissue due to blockage
Very predictable. Chest pain that occurs with exertion and rest will relieve.
Chronic Stable Angina
Occurs when coronary arteries spasm. Caused by vasoconstriction= not necessarily r/t atherosclerosis. Unpredictable.
Vasospastic- Prinzmetal angina
Chest pain that is unpredictable, not related to exertion (so happen at rest), rest does not fix. An impending MI.
Dilate veins, reducing the amount of blood returning to the hear. Dilate the coronary arteries, bringing more blood to the myocardium.
Short-acting nitrate. Sublingual or buccal to terminate acute angina.
Nitroglycerin (Nitro-stat, Nitro-bid)
Long acting nitrate. Oral or patch to decrease frequency and severity of episodes.
Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)
Adverse effects of nitrate medications
flushing of skin
Do not take with 24 hours of _______ or other meds that cause hypotension.
When should we hold Nitrate meds?
If BP is less than 90/60 or HR over 100
When is Beta Adrenergic Blockers beneficial
exercise and after MI
Beta Blockers Med for prophylaxis of chronic angina
Adverse effects of Beta Blockers
Hypotension, fatigue, weakness, dizziness
If patient is taking beta blockers and is diabetic what should we monitor?
Ions responsible to cause a cardiac contraction
Potassium (inside cell)
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.
Calcium Channel Blockers
Reducing force of contraction is called.......
negative inotropic effect
Ca Channel Blocker. Used to treat HTN and angina. Little to no effect on myocardium itself.
Ca Channel Blocker. Longest half-life=30-50 hours= once daily dosing.
Adverse effects of Ca Channel Blockers.
Hepatotoxicity, Heart Failure (RARE)
pulmonary edema (crackles or rhonchi in lungs)