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NURS200 > HTN > Flashcards

HTN Flashcards

1
Q

What is the FIRST medication response to HTN?

A

Diuretics

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2
Q

The biggest ways to lower BP with diet

A

Reduce sodium intake

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3
Q

how do diuretics work

A

Block the reabsorption of sodium, forcing it’s excretion

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4
Q

Lasix acts where

A

Loop of henle

Site of GREATEST sodium reabsorption

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5
Q

Thiazides act where

A

Acts on distal convoluted tubule

More moderate diuresis

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6
Q

Reason for diuretics given in HF

A

Decrease fluid bulidiup

drop in wt, edema, better breathingetc.

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7
Q

Big concerns when giving lasix

A

HOTN
Electrolyte depletion

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8
Q

Calcium channe lblockers

A

Prevent ca from entery muscel cells causing contraction

Limits/slows muscle contraction

  • some block channels of arterioles and relax sooth muscel, decreasing BP
  • Some decrease heart contractility and wt

NOT useful in HF, because they decrease heart rate and contractility

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9
Q

ACE inhibitors

A

Block the formation of angiotensin 2
Causing dilation
Blocks the reabsorption of sodium, causing fluid excretion

BP decreases

Prevents ace converting enzyme from converting ang 1 to 2

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10
Q

RAAS system

A

Renin
Angiotensin 1
ACE converting enzyme
Angiotensin 2 (Vasoconstrictor)
- Causes vasocontriction
Stimulates release of aldosterone
- Causing reabsorption of sodium
Stimulates ADH, increasing fluid retention

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11
Q

Angiotensin receptor blockers

A

Do not effect angiotensin formation
Instead, attatch to receptors that cause reaction of ADH stimulation and Aldosterone stimulation

Therefore, same effect as ACE inhibs

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12
Q

Beta Blockers

A

Selective/Non selective

Blocks the beta-anergics recetpors

Slows HR

Used w/ caution in HF

Blocks production of Renin

Decreases Blood pressure

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13
Q

When Beta 1 recepots ar eblocked

A

Heart rate is slowed - negative chronotrope

and contractility is decreased - negative inotrope

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14
Q

chronotrope

A

Heart rate

Negative chronotrope = Slows HR
Positive Chronotrope = Increases HR

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15
Q

Inotrope

A

Contractility

Negative inotrope = decreased contractility

Positive inotrope = Increased Contractility

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16
Q

Most common CVD

A

HTN

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17
Q

Primary/essential

A
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18
Q

BP is effected by 3 factors

A

Cardiac Output
Volume (More = higher BP)
Peripheral resistance - increasing resistance by narrowing BV

Pharmacotherapy for HTN always focuses on reducing one of these factors

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19
Q

HTN risk factors

A

Risk factors for HTN include:
Diet
Exercise
Age
Smoking
Genetic factors which may alter renal function, and secretion of hormones that regulate blood pressure (angiotensin II, aldosterone, ADH)

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20
Q

Normal BP regulation

A

Blood pressure is regulated through homeostatic mechanisms

If blood pressure increases, nervous and endocrine mechanisms become active that reduce blood pressure:

CO is decreased

arterioles dialet

Kidneys increase urine output

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21
Q

Vasomotor centre

A

Regulates activity of SNS
Baroreceptors/chemoreceopters alter CO

21
Q

Complications of HTN

A

As blood pressure increases, heart must work harder to eject blood into circulation contributing to the following
Ventricular hypertrophy
Angina, MI, CVA, peripheral vascular disease
Heart failure
Kidney failure
Blindness

22
Q

Local mediator of vascular tone

A

Vasoconstrictors (ang 2, endothelin)
Vasodialtors
-Nitorc oxide, prostoglandins

23
Q

Minute to minute BP regulation

A

Vasomotor center
Local mediators of vascular tone

24
Dayu to day regulation of BP
Aldosterone ADH alter Blood volume
25
Guidelines for management of HTN
First approach is lifestyle mod If BP does not change, druags are added - Diuretics, ACE inhibitors, Angiotensin II receptor blockers, calcium channel blockers, beta-blockers (Sometimes need more than one)
26
HTN diet
Low alcohol low Sodium
27
Non pharm treatments for HTN
Exercise WT reduction Diet Stress reduction Smoking cessaiton
28
Diet for HTN
Dietary Approaches to Stop Hypertension The DASH eating plan includes whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium, and magnesium, as well as protein and fiber. Eating foods lower in salt and sodium also can reduce blood pressure.
29
Alcohol Consumption reccomendation
Should be limited to 2 drinks or fewer per day. Should not exceed 9 drinks per week for women 14 for men.
30
Why are diuretics often first choice
Bc of few side effects
31
Adverse effects of diuretics
Electrolyte depletion Fall risk
32
3 categories of Ca channel blockers
Areteiole selective durgs Cardioselective drugs (ie. diltiazem) Non-selective drugs (ie. Verapamil)
33
Adverse effects of Ca channel blockers
Adverse effects Dizziness, flushing, hypotension Reflex tachycardia (with nifedipine) Peripheral edema (Bc vasodilation and lower BP) Dysrhythmias Exacerbation of heart failure why? they have a negative inotropic effect (reducing the heart's strength of contraction) and can slow heart rate
34
Reflex tachycardia
When BP drops suddenly HR increases
35
Prototype Drug Nifedipine (Adalat) (2 of 2)
A Ca channel blocker Used for HTN and Chronic stable or variant angina Selectively blocks calcium channels in myocardial and vascular smooth muscle,(including the coronary arteries) causing vasodilation which reduces resistance and blood pressure Adverse effects HOTN, flushing, headaches, dizziness, peripheral edema, Hepatotoxicity Paradoxical angina Severe hypotension Exacerbation of heart failure
36
Nursing considerations for pts recieving calcium channel blockers
Obtain complete health history including allergies and drug history Obtain baseline vital signs, and ECG Assess for pulmonary and peripheral edema Assess neurological status and level of consciousness (LOC) Planning Patient to exhibit reduced systolic and diastolic blood pressure
37
Nursing interventions (What to monitor) for Ca Channel blockers
Monitor : BP HR (Reflex tachycardia) Signs of Ortho HOTN Signs of HF (Fluid overload0 Monitor wt I&O Liver function Kidney functions
38
Ace inhibs adverse effects
Persistant cough HOTN Hyperkalemia Angioedema (Hypersensitivity rxn) -constricts airway
39
What to monitor for pts on ACE inhibs
Obtain complete health history including allergies and drug history Obtain baseline ECG and vital signs Assess neurological status and level of consciousness (LOC) Obtain blood and urine samples for laboratory testing Monitor Potassium and Sodium
40
Interventions ACE Inhib
When giving the first dose, monitor for first dose phenomenon syncope Pbserve for hypersensitivity Monitor
41
INterventions for Ace inhibi
Dizziness S/S of bruising (Can effect platlets) Monitor for persistant cough Monitor electrolyte levels Monitor liver and kidney function
42
Prototype: Enalapril (Vasotec)
ACE inhib Has prolonged half life which permits administration once or twice a day. uses
43
Adrenregic antogonists
Block Alpha 1 receptors resulting in vasodialtion Can cause Nausea, tachycardia, palpitations
44
Beta adrenergic antagonist
Indicated for Hypertension, dysrhythmias, angina Mech of action Decrease CO and HR Mask signs of Hypoglycemia Nonspecficic can also act on resp system causing bronchioconstriction Take BG regularal
44
Direct acting vasodialtors
Pretty severe adverse effects, only indicated for severe HTN Relax arteriol smooth muscle causing vasodialtion Causing reflex tachycardia
45
Prototype Drug Hydralazine (Apresoline) (1 of 2)
Used in HTN emergencies Moderate to severe hypertension Hypertensive emergencies Acute heart failure Causes Causes peripheral vasodilation of arterioles, reducing peripheral resistance and pressure Adverse effects Lupus-lke syndromes
45
What should nurses monitor for vasodilatlors
BP, carefully with titration Dizziness and LOC
45
If a drug ends in Lol
Beta Blocker
46
If it ends in pril
Ace inhibitor
47

NURS200 (30 decks)

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