Hypertension Flashcards
(64 cards)
1
Q
hypertension
A
- consistent elevation of systemic arterial blood pressure
- complex disease controlled by a combination of genetic and environmental factors
- no specific cause identified for large majority of HTN patients
2
Q
factors that create high blood pressure
A
- blood volume
- peripheral resistance
- cardiac output
3
Q
blood volume and high blood pressure
A
- total amount of blood in vascular system
- volume can change due to disease, drugs, regulatory factors
- more blood = increase pressure
4
Q
How do we increase blood volume?
A
fluids and blood transfusion
5
Q
peripheral resistance and high blood pressure
A
blood traveling around the vasculature at a high rate of speed comes in contact with smooth endothelium of the vessels, where friction slows it down
6
Q
cardiac output and high blood pressure
A
- the volume of blood pumped in a ventricle per minute
- heart rate (# of beats per minute)
- stroke volume: amount of blood pumped by the heart in one contraction
- increase cardiac output, increase blood pressure
HR x SV = CO
7
Q
organs that control BP
A
- brain (emotions)
- kidneys (RAAS)
- chemo/baroreceptors in heart/carotid artery
-hormones (antidiuretic: potent vasoconstrictor)
8
Q
converts angiotensinogen to Angiotensin I
A
renin
9
Q
converts Angiotensin I to Angiotensin II
A
angiotensin converting enzyme
10
Q
primary hypertension
A
no identifiable cause
11
Q
secondary hypertension
A
specific cause can be identified:
- Cushing’s disease
- CKD
- hyperthyroidism
- drugs (corticosteroids, oral contraceptives, decongestants, amphetamines)
12
Q
non-pharmacological management
A
lifestyle changes
- limit alcohol
- restrict sodium consumption
- reduce intake of saturated fat/cholesterol
- increase fresh fruits and vegetables
- increase physical activity
- discontinue use of tobacco products
- reduce sources of stress
- maintain optimal weight
13
Q
diuretics
A
- reduces blood volume
- water excretion in the urine achieved by retaining or excreting electrolytes
14
Q
types of diruetics
A
- potassium wasting
- potassium sparing
15
Q
potassium wasting diuretics
A
thiazide diuretic:
- old
- inexpensive
- safe
- can cause hypokalemia
loop diuretic:
- cause more diuresis than thiazide or potassium-sparing drugs
- not ideal for control of HTN due to adverse effects such as hypokalemia and dehydration
- ototoxic (affect hearing and ears)
- usually used for intermittent fluid off-loading (diuresis)
16
Q
potassium sparing diuretics
A
- hang on to potassium
- produce only modest diuresis
- can cause hyperkalemia
- potassium is our main intra-cellular electrolyte (helps with muscle contraction)
- too much or too little can lead to cardiac conduction abnormalities
- concurrent use of ACE-inhibitors or ARB’s increase the potential for hyperkalemia
- many people control their BP by decreasing sodium and using a salt-substitute that is high in potassium that could lead to hyperkalemia
17
Q
ACE inhibitors
A
- angiotensin converting enzyme inhibitors
- work within the RAAS system
- decrease BP and increase urine volume
- widely used in the treatment of HTN, HF, and myocardial infarction
- blocks the conversion of angiotensin I to angiotensin II (powerful vasoconstrictor)
- end in -pril
18
Q
adverse effects of ACE inhibitors
A
- mild cough, can switch them to an ARB
- postural hypotension
- hyperkalemia
19
Q
side effects of ACE inhibitors
A
- ANGIOEDEMA: caused by pro-inflammatory bradykinins
- swelling of lips, eyes, throat, and other body regions that could lead to throat closure
20
Q
Angiotensin II Receptor Blockers
A
- ARBs
- end in -sartan
- blocks angiotensin II receptors in the smooth muscle
- relatively few side effects (can have hypotension)
- no cough associated with ARBs, much lower risk of angiodedema
- often combined with other anti-HTN drugs
21
Q
beta-blockers
A
- end in -olol
- work by blocking adrenergic receptors (blocks the fight or flight response)
- blockage of B1 receptors in the heart
- decrease HR and heart contractility which decreases cardiac output and lowers systemic blood pressure
- blocks the B1 in the juxtaglomerular apparatus which inhibits the secretion of renin and the formation of angiotensin II
22
Q
adverse effects of beta-blockers
A
- predictable based on inhibition of fight or flight
- slow heart rate
- bronchoconstriction (use with caution in patients with asthma or COPD)
23
Q
calcium channel clockers
A
- block calcium ion channels, which block muscle contraction and relaxes arterial smooth muscle, which lowers peripheral resistance and decreases BP
- rarely used alone
- good for elderly or African American patients who are often less responsive to other anti-HTN drugs
- can increase the effect of statin drugs by messing with liver enzymes (CYP3A4)
24
Q
calcium channel blocker side effects
A
- HYPOTENSION
- dizziness
- peripheral edema
- heartburn
- nausea
- flushing
all due to vasodilation
25
hypertensive crisis
- BP >180/120
- can cause end organ damage
- most common cause is uncontrolled, poorly managed essential HTN
- don't want to drop the BP too fast >> hypotension
26
therapeutic class of hydrochlorothiazide
diuretic
27
pharmacologic class of hydrochlorothiazide
thiazide, potassium wasting diuretic
28
action of hydrochlorothiazide
reduces blood volume through the excretion of water and potassium, reducing blood volume and blood pressure
29
side effects of hydrochlorothiazide
- hypokalemia
- hyponatremia
- hypotension
- dizziness
- dehydration
30
patient considerations for hydrochlorothiazide
- observe for hypokalemia
- increase potassium containing foods
- don't give to patients who don't make urine
31
drug/drug interactions for hydrochlorothiazide
hypokalemia increases the risk of digoxin toxicity
32
trade name for furosemide
Lasix
33
therapeutic class of furoemide
diruetic, antihypertensive
34
pharmacologic class of furosemide
loop diuretic, POTENT potassium-wasting diuretic
35
action of furosemide
- works in the Loop of Henle to promote the excretion of sodium and water, thereby reducing blood volume
- causes potassium wasting
- when given IV, produces rapid diuresis
36
side effects of furosemide
- hypokalemia (check serum potassium levels before giving the drug)
- orthostatic hypotension, dizziness, fainting
- ototoxicity and nephrotoxicity
- hyperglycemia
37
nursing considerations of furosemide
- monitor intake/output
- monitor K+ levels
- monitor blood glucose
- monitor if c/o hearing changes or loss
- use cautiously with other drug that deplete potassium
38
therapeutic class of spironolactone
antihypertensive, reduces edema
39
pharmacologic class of spironolactone
potassium-sparing diuretic, aldosterone antagonist
40
action of spironolactone
- inhibits aldosterone (secreted by adrenal cortex) which increases water and sodium excretion
- commonly used to treat HTN along with other anti-HTN drugs
- slows progression of HF
41
side effects of spironolactone
- hyperkalemia (especially if taken with ACE inhibitors or ARBs)
- gynecomastia
42
nursing considerations of spironolactone
- give with food to increase absorption of drug
- do not give K+ supplements or use salt substitute
- warn male patients about gynecomastia which resolves when drug is discontinued
43
therapeutic class of lisinopril
HTN and heart failure
44
pharmacologic class of lisinopril
ACE inhibitor
45
action of lisionpril
inhibits ACE, which is responsible for converting angiotensin I to angiotensin II which ultimately blocks effects of aldosterone
46
side effects of lisinopril
- usually well tolerated but be alert for sough (possible switch to an ARB) or ANGIOEDEMA
- patients should report coughing, swelling, tongue fullness, difficulty breathing/talking
- HYPERkalemia (use cautiously in patients receiving potassium sparing diuretics)
- hypotension
- can't be used in pregnancy
47
therapeutic class of losartan
drug for hypertension
48
pharmacologic class of losartan
angiotensin II receptor blocker (ARB)
49
action of losartan
vasodilation and reduced blood volume (due to it's effects on blocking aldosterone release)
50
side effects of losartan
- hypoglycemia
- dizziness
- hypotension
51
BB warning for losartan
do not use in pregnancy!! causes fetal injury/death--teratogen
52
nursing consideration for losartan
when given with potassium-sparing diuretics, increased risk for hyperkalemia
53
therapeutic class of metoprolol
drug for HTN and HF
54
pharmacologic class of metoprolol
beta-adrenergic blocker--selective for B1
55
action of metoprolol
reduces sympathetic stimulation of the heart, thus decreasing cardiac workload
56
side effects of metoprolol
- preferred for patients with respiratory disease (due to cardio-selective B1 action)
- hypotension
- bradycardia
- may enhance the hypoglycemic affects of insulin/oral diabetic drugs--watch for hypoglycemia!
57
BB warning for metoprolol
acute withdrawal from drug may make angina worse or cause myocardial infarction
58
nursing considerations for metoprolol
dose should be tapered off over a few weeks
59
contraindications for metoprolol
- heart block
- cardiogenic shock
- hypotension
- overt cardiac failure
- slow heart issues
60
therapeutic class for nifedipine
drug for HTN
61
pharmacologic class for nifedipine
calcium channel blocker
62
action of nifedipine
blocks calcium channels in myocardial and vascular smooth muscle including coronary arteries, which results in coronary artery dilation, less oxygen consumption by heart, an increase in cardiac output, and a fall in BP
63
side effects of nifedipine
dizziness, hypotension, headache
64
nursing considerations of nifedipine
- well tolerated
- give cautiously with other antihypertensive medications
- increases serum levels of digoxin which can lead to bradycardia and digoxin toxicity
- do not take with grapefruit juice
