Lecture 6 Flashcards
(82 cards)
1
Q
Dx Hypertension
A
TWO readings of at least 140/90 at TWO appointments
2
Q
Primary Hypertension
A
Most Common
Unknown Etiology
Older People
3
Q
Secondary Hypertension
A
Less Common
Has some cause
Younger People
4
Q
Hypertension Results in
A
End organ damage- heart, kidneys, brain, eyes
5
Q
Stage 1 Hypertension Numbers
A
140-159/90-99
6
Q
Normal Tension Numbers
A
7
Q
Stage 2 Hypertension Numbers
A
160-179/100-109
8
Q
Pre-Hypertension
A
120-139/80-89
9
Q
Hypertensive Emergency
A
>180/>110 AND have symptoms: Confusion Chest Pain Renal Failure Visual Changes
10
Q
Five Types of hypertension drugs
A
Diuretics (Thiazides, Loop) Adrenergic Agents CCB ARB ACEI
11
Q
Thiazides: Mechanism
A
Act on distal Convuluted Tubule
Inhibit Na reabsorption
12
Q
SE of Thiazides
A
Hypokalemia
Hyperuricemia
Xerostomia
Anorexia
13
Q
Loop Diuretics: Mechanism
A
Act on Ascending Loop of Henle
Inhibit Na reabsorption
14
Q
SE of Loop Diuretics
A
Hypokalemia
Hyperuricemia
15
Q
What type of pts use Loop Diuretics
A
Hypertensive pts with CHF
Can cause rapid diuresis
16
Q
Potassium Sparing Diuretics: Mech
A
Spirinolactone and Eplereone - Block Aldosterone Receptor
Amiloride and Triamterene - Block Na channels
17
Q
Potassium Sparing D’s
A
Not as strong as other D’s- used as adjunct
18
Q
SE of K Sparing D’s
A
Hyperkalemia
Arrythmia
19
Q
Adrenergic Meds for Hypertensions: Types
A
A2 agonist
A1 antagonist
B blocker
B1 selective blocker
20
Q
Adrenergic System Responses
A
A1 - Inc BP
A2 - Inhibits NE
B1 - Inc HR and Contraction
B2 - Inc vasoDILATION
21
Q
A2 Agonist: Action
A
Inhibit Epi and NE –>
Vessel Dilation
22
Q
SE of A2 Agonist
A
Drowsiness
Sedation
23
Q
A1 Antagonist: Action
A
Block receptors in arteries and veins–> relax smooth muscle–> Reduce HTN
24
Q
SE of A1 Antagonist
A
Postural Hypotension
25
Disadvantages of Non-selective B blockers and of Selective B1 Blockers
Non selective - reactive airway disease
| Selective - hypotension and bradycardia
26
CCB's: action
Inhibit movement of Ca into cardiac cells --> vasodilation and reduces afterload
27
Uses for CCB's
Hypertension
Arryhthmias
Angina
28
SE's of CCBs
Gingival growth
Excessive hypotension
Nausea/vomiting
Bradycardia
29
ACEI's: Mech
Blocks ACE and thus blocks conversion of Angiotensin I to II
Angiotensin II produces vasoconstriction and stimulates aldosterone release and water retention
30
ACEI's SE's
```
Hypotension
URI
Nausea and vomiting
LICHENOID ORAL LESIONS
Drug interaction w/ NSAID's
```
31
ARB's: Mech
Bind to Angiotensin II receptor and block action
| --> blocks release of aldosterone
32
When is BP an EMERGENCY
>180/110
33
ARB's SE's
```
Fewer than w/ ACEI's
Dizziness, fatigue, insomnia
URI's
Diarrhea
muscle cramping
angioedema
```
34
Meds to take after MI and Stent Placement
Clopidogrel - anti platelet
Felodipine - CCB
Nitroglycerine - vasodilator
35
Stents, when need SBE Prophylaxis?
Only immediately after: 4-12 weeks post placement
36
Types of PCI
Bare Metal Stent
| Drug Eluting Stent
37
Drugs to take with PCI's
Aspirin and Clopidogrel (Plavix)
38
Duration of Platelet Therapy drugs with each stent type
Bare Metal - 1 month, ideally a year
| Drug-Eluting - 6 months, ideally a year
39
With Bare Metal, at 6 weeks, what should you do
Bleeding risk low- continue dual-platelet therapy
High-risk surgery - just continue ASA
If Drug-eluting, defer all high risk procedures for 12 mo.
40
LA recommendation for pts with MI/stent hx
Restrict Epi to 0.04 mg - 2.2 carps
41
Angina
Mismatch of O2 needs of heart and delivery of it to heart
42
Angina: Tx
100% O2
Sublingual Nitroglycerin 0.4mg
Should relieve in 3-5 min - if doesn't, suspect MI!
43
Anti-Angina Drugs
Nitroglycerin
CCB's
B-Blockers
44
NTG Mech
Activate guanylyl cyclase and increase cGMP to cause Vasodilation!
45
NTG SE's
Severe headaches
Flushing, hypotension, light-headedness
Syncope
Localized burning or tingling where places sublingually
46
MI
ischemia leading to myocardial muscle tissue death
47
Disrhythmias associated with MI
Premature ventricular contractions
Ventricular tachycardia
Ventricular fibrillation
Asystole
48
CHF: Mech
Heart is unable to fill/eject blood to meet bodily demands
49
Right Side CHF vs Left Side CHF
Right Side - Systemic Edema
| Left Side- Pulmonary Congestion
50
CHF Classes
1 - symptomatic w/ greater thn normal activity
2 - symptomatic w/ normal activty
3 - symptomatic w/ minimal activity
4 - symptomatic w/out any activity
51
CHF Tx
Digoxin
Diuretics
ACEI's
52
Digoxin
Most common CHF drug
53
Digoxin: Mech
Inc force and strength of contraction of myocardium- allows heart to do more work w/out inc use of O2--> more efficient
54
Digoxin SE's
Narrow therapeutic index
Arryhthmias
Visual changes
Nausea vomiting
55
Digoxin Pts
Check for SE's, minimize Epi, monitor for bradycardia
| Tetracycline and Erythromycin can Inc digoxin levels!!!
56
First line against CHF
ACEI's and ARB's
57
Signs of poor control of CHF
Shortness of breath
Peripheral Edema
Fluctuations in body weight
58
CHF pts
Continue all meds on day of procedure
Obtain cardiology clearance
Minimize BP and HR fluctuation
59
Atrial Fibrillation
Multiple areas in atria depolarize - can lead to rate in the 180s
7x increase risk of CVA
Higher possibility of thrombus formation
60
Acute A Fib Tx
48 hrs- Anticoagulant for 3 weeks, then Cardiovert
61
Stable/Chronic A Fib Tx
CCB and B-Blockers to control rate
| Anticoagulant
62
AntiArrhythmic Agents
Work by depressing parts of the heart that are causing abnormal beating
Dec depolarization velocity, propogation
63
Classes of AntiArrhythmic Agents
I - Na blockers
II - B Blockers
III - K Blockers
IV - Ca Blockers
64
Antiarrythmic agents Caution
Have narrow TI - so only use if arrhythmi is preventing proper heart function
65
Hyperlipidemia
Can cause inc in Chylomicrons
VLDL's
LDL's
66
Hyperlipidemia: Tx
Lifestyle changes
HMG CoA Reductase Inhibitors (statins)
Intestinal absorption inhibitors
Gemfibrozil
67
Statins: Mech and SE's
```
Inhibit HMG CoA Reductase, the rate limiting enzyme in cholesterol synthesis
SE's: GI issues
Muscle pain
Skin rash
Can inc effect of warfarin
```
68
Ezetimibe
Inhibits intestinal absorption of Cholesterol
69
Gemfibrozil
Increases lipolysis of triglycerides and inhibits secretion of VLDL's from liver
70
SE's of Gemfibrozil
```
Gall stones (cholelithiasis)
Taste perversion, hyperglycemia
```
71
Valve disease: Pressure overload problem
Mitral or Aortic Stenosis
72
Valve disease: Volume Overload problem
Mitral or Aortic Regurgitation
73
Heart Murmur: Systole
Aortic and pulmonary stenosis or
| Mitral or tricuspid regurgitatoin
74
Heart Murmur: Diastole
Aortic or pulmonary regurgitation or
| Mitral or tricuspid stenosis
75
Aortic Stenosis
```
Leads to ventricular hypertrophy
Increased risk for MI
Symptoms: Angina
Syncope
Dyspnea
```
76
Aortic Stenosis Prognosis
75% die in 3 years if don't replace valve
77
Aortic Stenosis Mgmt
Heart rate control w/ B Blockers, CCB, Digoxin
| BP Control w/ ACEI and ARB
78
Surgical Tx of Aortic Stenosis
Mechanical valve - last 20-30 years, long-term anticoagulant
| Biologic Valve - last 10-15 years, long-term anticoagulation NOT needed
79
Pacemakers
Used for Sick Sinus Syndrome
Tx for Long-term bradycardia
Can pace atria, ventricles, or both
80
ICD
Provide shocks w/in 15 seconds if sense disrhythmia
| For patients with V fib, increase risk of cardiac death, or advanced CHF
81
Dental treatment for people with Aortic Stenosis
DON'T TREAT - refer to OMS, continue all meds
82
Monopolar Cautery
DON'T EVER USE- can reset ICD
