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Flashcards in HTN Deck (43):
1

HTN drug types

Diuretics, beta blockers, ace inhibitors, ARBs, CCBs

2

Five related factors in HTN

Cardiac Output, blood volume, peripheral resistance, artery elasticity, blood viscosity

3

Framingham Heart Study

1948: it was started in Massachusetts in 1948. pt between 30 and 62 yr. they try id. Factors, they tracked their htn through life. In 1972, the 2nd generation, that group was much more diverse. The latest group is way more diverse. The latest group are the grandchildren from the first group. They study the heart’s left ventricle

4

Pulse pressure

Systolic minus diastolic. It represents the force that the heart generates each time it contracts.

5

Blood pressure (definition)

Blood pressure is the force exerted on the walls of an artery by the pulsing blood under pressure from the heart.

6

Systolic pressure

The contraction of the heart forces the blood under high pressure into the aorta. The peak of maximum pressure when ejection occurs is the systolic pressure.

7

Diastolic pressure

When the ventricles relax, the blood remaining in the arteries exerts a minimum or diastolic pressure.

8

Factors Influencing Blood Pressure.

Age, stress, ethnicity, gender, daily variation, medications, activity and weight.

9

Diuretics drug names

Furosemide (Lasix), spironolactone (Aldactone), metolazone, polythiazide, benzthiazide.

10

Diuretics action

Lowers blood pressure by reducing resorption of sodium and water by the kidneys, thus lowering circulating fluid volume.

11

Beta-adrenergic blockers drug names

(if it finishes in "lol" is beta-adrenergic blocker) Atenolol (Tenormin), nadolol (Corgard), timolol maleate (Blocadren), propranolol (Inderal).

12

Beta-adrenergic blockers action

Combines with beta-adrenergic receptors in the heart, arteries, and arterioles to block response to sympathetic nerve impulses; reduces heart rate and thus cardiac output.tbu

13

Vasodilators drug names

Hydralazine hydrochloride (Apresoline), minoxidil (Loniten).

14

Vasodilators action

Acts on arteriolar smooth muscle to cause relaxation and reduce peripheral vascular resistance.

15

Calcium channel blocker names

(ends in pine) Diltiazem (Cardizem, Dilacor XR), verapamil hydrochloride (Calan SR), nifedipine (Procardia), nicardipine (Cardene).

16

Calcium channel blocker action

Reduces peripheral vascular resistance by systemic vasodilation.

17

Angiotensin-converting enzyme (ACE) inhibitors names

(ends in pirl) Captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), benazepril (Lotensin).

18

Angiotensin-converting enzyme (ACE) inhibitors action

Lowers blood pressure by blocking the conversion of angiotensin I to angiotensin II, preventing vasoconstriction; reduces aldosterone production and fluid retention, lowering circulating fluid volume.

19

Angiotensin-II receptor blockers names

(ends in tan) Losartan (Cozaar), olmesartan (Benicar).

20

Angiotensin-II receptor blockers action

Lowers blood pressure by blocking the binding of angiotensin II, which prevents vasoconstriction.

21

Normal BP values

Systolic:

22

Pre HTN values

Systolic: 120-139. Diastolic: 80-89

23

Stage 1 HTN values

Systolic: 140-159. Diastolic: 90-99

24

Stage 2 HTNvalues

Systolic: ≥160. Diastolic: ≥100

25

BP definition equation

Cardiac output x peripheral recistance

26

Classifying Hypertension

Persistent SBP ≥ 140, ≥ DBP 90 or current use of anti-HTN meds in the adult patient. One high reading does not mean the pt is hypertensive

27

Measuring BP. (7 tips)

1. Abstain from smoking, caffeine, exercise 30 minutes prior to BP.
2. Rest quietly for 5 minutes
3. Patient: seated, feet on floor, arm at heart level. Place arm on a hard surface. Palm up. Pt can’t talk.
4. Appropriate sized cuff
5. At least 2 measurements,1 minute apart, averaged together & recorded
6. Evaluation of “white coat” hypertension
7. Pt with hx of disease (breat cancer, lymph cancer or other) it is not recommended to take BP in that side

28

Isolated Systolic Hypertension

SBP ≥140 coupled with an average DBP ≤ 90

29

Primary Hypertension (etiology)

Formerly: Essential or Idiopathic Hypertension (same as primary HTN)
No identified cause
90-95% of cases
Risk factors: Age, African-American, obesity, smokers, excessive ETOH, stress, DM, high lipid levels, sedentary lifestyle.

30

Secondary Hypertension (Etiology)

Results from specific cause or condition. Typically renal related.

31

RAAS mechanism

Renin + angiotensinogen = angiotensin 1 + ACE = Angiotensin 2 = vaso constriction + aldosterone secretion (sodium retention) =

32

Vascular endothelium dysfunction

decrease vasodilator response to nitric oxide
increase endothelin levels result in “prolonged & pronounced” vasoconstriction

33

Nitric Oxide (definition for vascular system)

Is a powerful vasodilator

34

Gerontological Considerations

-Loss of tissue elasticity
-Increase stiffness of myocardium & PVR
-Blunting of baroreceptor reflex, decrease renal function, renin response to sodium & water depletion
-Increase likelihood of auscultatory gap, increase sensitivity to BP changes

35

TOD

Target Organ Damage

36

Dash Diet (food amounts)

Grains: 6 - 12
Fruits: 4-6
Veggies: 4-6
Dairy: 2-4
Meats: 2
Nuts: 3-6 a week
Fats and sweets: 2-4

37

Diagnostic Studies

Accurate BP monitoring
Physical exam
Target organ focus
UA, BUN/creatinine, creatinine clearance
Electrolytes (especially potassium)
Fasting blood glucose
Lipid profile, EKG

38

Diuretics overall goal

Decreasing circulating volume by increasing urine output

39

Diuretics major uses

Treat hypertension
Remove edema fluids
Prevent renal failure

40

Diuretics side effects

Fluid volume deficit, A/B imbalance & electrolyte imbalance

41

Which diuretics inhibit reabsorption of Na, Cl, K, resulting in osmotic water loss

hydrochlorothiazide (HCTZ) and furosemide (Lasix)

42

Which diuretic spares potassium

Aldactone

43

Caution with K+ sparing diuretics:

not given with K supplements or with another K sparing diuretic if patients also taking ACEI’s