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Pharmacology > Hypertension > Flashcards

Flashcards in Hypertension Deck (41):
1

What is stroke volume?

Volume of blood ejected from LV with each contraction

2

What are the factors that influence cardiac output ?

Heart rate
Force of contraction
Blood volume venous return to the heart

3

What are the systems that control blood pressure?

ANS
Renin angiotensin aldosterone system
Endocrine

4

What is the blood pressure for prehypertension And what kind of step care approach is applied to these patients with prehypertension ?

120-139 over 80-89

Life style changes, reducing weight, dietary changes, limiting alcohol, smoking, exercise, reduce stress

*medication therapy if risk factors are present as well like: diabetes, older age, heart failure

5

Stage one blood pressure and treatment ?

140-159 over 90-99

Life style changes ^
Drug therapy:
(Usually single drug therapy)
(First start with beta blocker or diuretic

6

Stage two blood pressure and therapy?

>160/100

Life style changes
Usually drug combination drug therapy

7

Hypertensive crisis blood pressure?

>210/120

8

What are the Goals for stepped Care Approach ?

Reduce morbidity & mortality associated with chronic HTN
Reduce risk of CV disease

9

What is the Thiazide Diuretic prototype drug?

And use/moa?

Hydrochlorothiazide/hydrodiuril

Use: HTN and edema

MOA: blocks Na and Cl in distal tubule
>>> dependent on adequate kidney function

10

Side effects and nursing implications of thiazides diuretics ?

S/E: Electrolyte imbalance (Na,K,Cl)
-hypercalcemia
-Dehydration
-hyperglycemia (careful with diabetics)
-muscle weakness,orthostatic hypotension

NI: monitor bun & creat, I&O, hydrate
Will not work with bad renal function
Usually administered in the morning
Teaching: (orthostatic)-safety & pos. changing
Assess hypercalcemia: fatigue&weakness

11

Loop diuretics

Prototype drug?
Use?
MOA?

Furosemide, Lasix

Use: decrease peripheral edema, associated with CHF, pulm edema, & HTN

MOA: inhibits Na&Cl in loop of henle
-do not need good renal function to work

12

Side effects & nursing implications of Lasix ?

Side effects: fluid loss, orthostatic hypotension, electrolyte imbalance (Na,Cl,K,Mg,Ca,)
Ototoxicity (cn 8) tinnitus-first sign
Hyperglycemia - watch diabetics
Hyperuricemia: increased uric acid (increased risk for gout)
Increased LDL (total cholesterol)

Nursing implications:
Assess bp
K Supplements
IV: works within 5 minutes, lasts up to 2 hrs
--dose (20-40mg over 2 min)
PO: works in 1 hour, lasts up to 8 hours
Careful with other drugs that are ototixic and bp meds

13

Potassium sparing diuretics

Prototype
Use
MOA

Aldactone,spironolactone

Use: adjunct therapy for HTN, edema associated with CHF, cirrhosis

MOA: blocks the action of aldosterone in distal tubules:

-aldosterone antagonist(aldosterone saves Na) so it's decreases Na
-increases Na and water loss
-decreases Ca & Cl
-promotes retention of K & Mg

14

Side effects & nursing implications of aldactone

Side effects:
Hyperkalemia
Electrolyte imbalance (Na,Cl,Ca,)
Promotes retention of K&Mg
Weakness,vomiting,nausea
Menstrual irregularities,impotence,gynecomastia

Nursing:
Assess K
Assess cardiac arrhythmias
Limit foods high in K(bananas)
Avoid K supplements
Patient teaching
Onset: 24-48 hrs
Drug interactions
DOC for Ascites
Can be used for thiazides and loops

15

Osmotic diuretic

Prototype
Use
MOA

Mannitol
Use: (increased cranial pressure)
MOA: increased osmolarity of plasma

16

Mannitol

Side effects & nursing

NV
Fluid/electrolyte imbalance
Headache
Careful with IV-tissue necrosis
Can cause rebound inter cranial pressure

Nursing:
Vitals
Assess fluid& electrolyte
Assess for decrease ICP
may be used in the ED

17

What electrolyte is blocked in order for diuresis to occur?

Na

18

Identify the electrolytes lossed that most likely occurs with loop diuretics

Na Cl K Mg

19

The patient is present with blood pressure of 120/80 with a history of angina and CAD. The most likely therapy would be:

A. Beta blocker
B. Thiazide diuretics & life style changes
C. Life style
D. Alpha 1 blocker

B thiazide diuretic and lifestyle changes

20

Which of the following occur with thiazide diuretics? (Select all)

A. Hypotension
B. Hyperkalemia
C. Hyperglycemia
D. Muscle cramps
E. Hypernatremia

A hypotension
C hyperglycemia
D muscle cramps

21

The patient is prescribed aldactone, and asks what is the best choice for breakfast ?

Low Na and low K

22

ACE inhibitors
(Angiotensin Converting Enzyme)

Prototype Drug
MOA
Use

Catopril, vasotec (pril drugs)

MOA: prevent conversion of angiotensin 1 to angiotensin 2 by blocking ACE

USE: HTN and CHF

23

Side effects & nursing implications of ace inhibitors

Hypotension, dry cough, increased potassium

NI: good for pts to maintain kidneys and good for diabetics
Less orthostatic hypotension
used with asthma pts
Give on empty stomach
Caution with other drugs that cause bp to decrease

24

What is cardiac output

The amount of blood ejected from the LV into the aorta per minute

25

Angiotensin II receptor antagonist

Prototype drug
Use
MOA

Avapro

MOA: blocks the receptors of aII
Uses: HTN

26

Avapro

Side effects
Nursing implications

(Same as ace inhibitors)
Side effects:
Hypotension, dry cough, increased potassium

Nursing:
Good for pts to maintain kidneys
Good for diabetics
Less orthostatic hypotension
Used with asthma pts
Give on empty stomach
Caution with other drugs that cause bp to decrease

27

Beta blockers

Examples of drugs
MOA
Uses

(olol) Atenolol, lopressor (atenolol)

MOA blocks beta 1 receptor
Decrease HR, contractility, renin release

Use: HTN

28

Beta blockers

Side effects
Nursing implications

Bradycardia
Hypotension
Broncho constriction
CNS (insomnia)
Sexual dysfunction

Nursing:
(First line of defense) - these or diuretic--> unless diabetic
* caution with asthma & diabetics
Vitals
Safety
Neuro checks

29

Alpha 1 Blockers

Prototype
MOA
Use
Side effects

Minipress

MOA: blocks alpha 1 stimulation
-vasodilation

Use: HTN
Side effects: hypotension

30

What drug is an alpha 1 & beta blocker ?

Lebetalol

31

Centrally acting agents

Prototype
MOA
Use

Clonidine and methyldopa

MOA: act in brainstem to suppress sympathetic outflow from the brainstem
-inhibits NE

Use: HTN


32

Centrally acting agents
Clonidine/methyldopa

Side effects & nursing

Side effects: hypotension, decreased HR, vasodilation, dry mouth, CNS depression (decreased RR)

Nursing implications: apical pulse, orthostatic hypotension, rebound hypertension when d/c, mouth care, safety, vitals

33

Extra side effects / nursing implications for methyldopa ?

Hepatotoxic and hepatotoxic

CBC and LFT

34

What are the two kinds of Vasodilation agents ?

Direct acting vasodilation & calcium channel blockers

35

Direct Acting Vasodilators

Prototype
MOA
Use

Hydralazine

Moa: promote dilation on arterioles
(Relax,peripheral smooth muscle)

Use: adjunct therapy, for severe HTN

36

Hydralazine
side effects and nursing implications

Side effects: reflex tachycardia, retention of Na and water

NI:
Given with beta blocker to prevent reflex tachycardia

37

Calcium channel blocker

Moa

Prevents the entry of calcium into cardiac cells and vascular smooth muscle -- vasodilation, decrease heart rate, conduction & contractility

38

What does procardia do?

(Calcium channel blocker)

Dilates vascular smooth muscle

39

What does calan/cardizen do?

(Calcium channel blocker)

Dilates vascular smooth muscle and decrease conduction

40

Uses for calcium channel blocker

Decrease bp
Decrease hr
Improve coronary perfusion -- to get more blood to heart

41

Side effects and nursing implications for calcium channel blockers

Side effects:
Hypotension
Bradycardia
Flush,
Orthostatic hypotension
Reflex tachycardia
Dizziness
Constipation

Nursing:
Check apical pulse
Check bp
Safety
Fluids&fiber
Move slowly