Exam 2 Flashcards
What class of drug is typically given for first line monotherapy to tx HTN?
diuretics
Why would diuretics be taken with other anti-hypertensive medications?
they will have enhanced effects
Diuretics work by decreasing what 2 things?
- blood volume
- arterial resistance
What type of beta blocker is best for diabetics? Why?
- B1 - cardioselective is preferred : s/s of hypoglycemia are masked but does not induce hypoglycemia
- non selective beta blockers can cause hypoglycemia in DM pts and the s/s are masked
Which type of CCB works on the heart?
What is the prototype?
- dipines : work on blood vessels only
- nifedipine
Why might a diabetic patient who does not have hypertension be prescribed an ACE inhibitor?
- it helps protect the kidney from diabetic nephropathy
- by dec angiotensin 2 the efferent arterioles are able to vasodilate –> lowering the pressure in the glomerulus –> slows the progression of kidney disease / problems
What is angioedema?
What do we give to treat it?
What causes it?
- a potentially life threatening hypersensitivity reaction
- give epi
- an increase in bradykinins from ACE inhibitors or ARBs can cause this –> it can happen at any point in drug therapy
What are the goals of anti angina drugs? (2)
- dec O2 demand of the heart : dec HR, contractility, preload or after load
- inc O2 delivery to heart : relax / dilate coronary arteries
When do the coronary arteries receive blood?
- during diastole / filling
Stable Angina
- triggered by :
- ___ is the underlying cause
- tx :
- triggered by : activity
- CAD (coronary artery disease)
- tx : dec O2 demand of the heart
Variant Angina
- What is it?
- triggers/timing?
- tx :
- coronary artery vasospasm
- occurs at anytime : rest or activity
- tx : inc O2 supply with relaxation and dilation of coronary arteries
Unstable Angina :
- emergency?
- tx ?
- yes : medical emergency
- tx as MI until proven otherwise
Why is PO short acting nitro not prescribed?
- completely metabolized by the liver and will have no effect on the heart : we do give long acting : isosorbide mononitrate or dinitrate
What edu should be given about storing SL nitro at home?
- dark container
- not in bathroom or humid area
- do not dump out into hand and pour back into bottle (dump into cap)
What edu should be given about nitro administration via patch?
- pt
- nurse / administrator who is not the pt
Pt
- remove patch at night to have drug free pd so tolerance does not develop
- rotate sites
Nurse
- wear gloves so your skin does to absorb the medication
- wipe off area before applying defib patches –> can cause burns
How is acute chest pain treated in the ED? (6)
- SL nitro x3 then IV
- IV BB (CCB is 2nd choice)
- supplemental O2
- IV morphine –> dec preload and after load
- ACE inhibitor : dec mortality in pts with Left vent dysfunction / HF
- anti platelet and anticoagulation therapy
What are underlying cxs of HF? (7)
- chronic HTN
- MI
- Valvular heart disease
- coronary artery disease
- congenital heart disease
- dysrhythmias
- aging
Right ventricular hypertrophy causes a back up of pressure into the ___ ___. Which causes __ (3 different things).
- back of up pressure into the peripheral veins
- cx : vein distention, edema in LE, ascites
Left ventricular hypertrophy causes a back up of pressure into the ___ ___. Which causes __ (3 different things).
- pressure backs up into the lungs
- cx : pulmonary HTN, pulmonary edema, wet lungs
The goal of HF tx is to inc force of ___ and dec ___ to reduce O2 consumption.
- need to increase the force of contraction
- need to dec HR
HF pts who take a diuretic may alter their daily doses using a ___ ___ that is based on ___ ___.
- sliding scale
- daily weight
When should diuretics be administered? (time of day)
- early so you aren’t peeing all night –> fall risk
Blocking angiotensin does what 3 things?
- cx vasodilation
- prevent Na and H2O retention
- prevents cardiac remodeling
Blocking aldosterone does what 2 things?
- inhibit Na and H2O retention
- prevent cardiac remodeling
