Flashcards in Medically compromised Deck (79)
percentage of US population with HTN in 2000? (According to National Health and Nutrition examination survey)
Definition of htn (according to JNC 7)?
Percentage of Americans over 65 with HTN
which blood pressure continues to rise throughout life?
When does the other one level or fall off?
systolic: continues to rise throughout life
diastolic: levels off or falls around age 50
two types of hypertension? Percentage of patients with each?
90% of patients have primary (essential) hypertension- no identifiable cause
10% of patients have secondary hypertension- identifiable cause (sleep apnea, drug induced, kidney disease, primary aldosteronism, renovascular disease, thyroid…etc.
Hypertension that older adults often get? What causes it?
Isolated systolic HTN. central arterial stiffness, loss of elasticity.
constitutes an important risk factor for cardiovascular disease.
Blood pressures above _____ are associated with increased risk of cardiovascular disease.
Definition of systolic and diastolic pressure?
systolic pressure: pressure at the peak of ventricular contraction
diastolic pressure: total resting resistance in the arterial system after passage of the pulsating force produced by contraction of the left ventricle.
mean arterial pressure:
systolic minus diastolic pressure
sum of the diastolic pressure plus one-third the pulse pressure
According to JNC 8, at what level should BP medication be administered?
for >60 with no diabetes or CKD, >150/90. For 140/90
One of which four HTN medications should be used initially on non-blacks?
thiazide, ACE inhib, angiotensin receptor blocker, Ca channel blocker
One of which two HTN medications should be used initially on black patients?
thiazide or Ca Channel blocker
One of which two HTN medications should be used initially on CKD patients (all races)?
ACE inhib or angiotensin receptor blocker
Which two HTN medications should not be used in combination?
ACE inhib and angiotensin receptor blocker
Three most commonly prescribed HTN meds in 2013?
1. Lisinopril (Prinivil or Zestril) ACE inhib
2. Norvasc (Amlodipine besylate (Ca Channel blocker)
How do ACE inihibs work?
inhibit angiotensin-converting enzyme (a component of the blood pressure-regulating renin-angiotensin system),that turns angiotensin 1 into angiotensin 2, thereby decreasing the tension of blood vessels and blood volume, thus lowering blood pressure.
Three common ACE inhibitors?
How does the renin-angiotensin-aldosterone system work?
Renin is released by the kidney, which produces antiogensin, which signals the adrenal gland to produce aldosterone, which increases blood pressure.
How do ARB's work?
They block Angiotensin II receptors, which causes vasodilation, and slows the production of aldosterone.
5 common ARB's?
Eprosartan (tevoten), candesartan (atacand), losartan (cozaar), valsartan(diovan), irbesartan (avapro)
What is an ARB?
An angiotensin II Receptor Antagonist (or Angiotensin receptor blocker).
What is Norvasc?
The most popular calcium channel blocker (amlodipine besylate)
How do calcium channel blockers work (3)?
The prevent the opening of calcium channels, which in smooth muscle causes vasodilation, in cardiac muscle reduces force of contraction, and they slow down electrical activity of the heart, slowing the heartbeat.
How does hydrochlorothiazide work?
Acts on the kidneys to reduce sodium reabsorption in the distal tubule, thus inhibiting the kidney's abilities to retain water and reducing the volume of blood.
Three common uses for beta blockers?
Preventing cardiac arrhythmias, preventing a second MI after a first one has occured, and treating HTN.
How do Beta blockers work on HTN?
beta blockers block the action of catecholamines on beta adrenergic receptors, thus decreasing the heart rate.
Also Blockade of the sympathetic nervous system on renin release leads to reduced aldosterone via the renin-angiotensin-aldosterone system, with a resultant decrease in blood pressure due to decreased sodium and water retention.
Difference between nonselective and cardioselective beta blockers?
Nonselective (blockades beta one and beta two receptors) increase in BP possible don't use more than .036 epi
Cardioselective (blockades only beta 1 receptors) can use epi normally
Two big beta blockers?
What is INR? What is the range for healthy? for those with A fib?
Derivative of prothrombin time (measures how fast someone clots) .8-1.2 for healthy, 2-3 target for A Fib