Week 7: Vascular Perfusion: Bleeding/Clotting, Anemia Hypertension Flashcards
1
Q
what is the difference between homeostasis and allostasis?
A
homeostasis: think BALANCE or stability of the systems that maintain life
pH
con. of different ions in the ECF (Na, Ca)
osmolality of ECF
glucose levels
arterial O2 tension
Allostasis -under stress defence mechanisms
adaptation to changing external and internal environment
arterial BP
HR
body core temp
con of circulating hormones
sleep-wake cycle
energy metabolism
2
Q
what does hemodynamics consist of?
A
systemic circulation:
arteries supply tissues with nutrients and O2 rich blood
veins return blood to pulmonary circulation
Left atrium and left ventricle to aorta = back to right atrium and right ventricle
pulmonary circulation:
right atrium and right ventricle pulmonary artery to lungs - pulmonary veins to Left atrium and left ventricle
re O2 and returned to systemic circulation
3
Q
what is CO = HR x SV?
A
cardiac output = heart rate times stroke volume
ex. 60 bpm x o.1 L/beat = 6 L/minute
4
Q
what is cardiac preload?
A
this is when the volume of blood returned to the heart pre systole - which exerts pressure on the ventricle walls
description: filling force applied to the heart
when the heart stretches it generates more force to effectively pump the increased load - Frank Starling mechanism (has limits)
increased preload - increased O2 demand of the myocardium, but is more O2 efficient than increasing HR
5
Q
what is cardiac after load?
A
description: the pressure the ventricle must overcome to eject blood into the arteries
when contraction - LV must generate more pressure than aortic diastolic pressure
pressure must be great enough to overcome peripheral resistance
reduced after load with vasodilators is a useful therapy for failing heart
increased after load can decrease stroke volume
6
Q
what does perfusion connect to?
A
pain
cognition
elimination
gas exchange
mobility
nutrition
patient education
inflammation
intracranial regulation
stress and coping
7
Q
true or false regarding how the body clots:
Perfusion is needed to sustain life, supply oxygen and nutrients to tissues.
When we have an injury, the body must a way stop losing blood while still maintaining perfusion to the tissues. This is a controlled process called hemostasis.
In order to form clots we only need platelets in the blood to work together to form the mature and functional fibrin clot
Platelets (thrombocytes) are blood cells made in the bone marrow and stored in the spleen.
The liver does not make most of the clotting factors.
A
false; third one - clotting factors as well
last one: the liver does
8
Q
where does stem cells originate from?
A
bone marrow
9
Q
what falls under stem cell?
A
erythroblast, myeloblast, mono blast, lymphoblast, megakaryoblast
10
Q
what does megakaryoblast develop into?
A
megakaryoblast - megakaryocytes - thrombocytes (platelets)
11
Q
what are the two pathways that fall under clotting cascade?
A
intrinsic and extrinsic
12
Q
explain extrinsic pathway?
A
External cellular injury (trauma, laceration)
Collagen exposed in the vessels activates clotting.
Bacteria or inflammation can also trigger clotting
Generally Protective
13
Q
explain intrinsic pathway?
A
No trauma: Internal conditions trigger clotting.
Venous stasis, lack of blood flow, plaques in vessels, too many clotting factors
Less protective, often problematic
14
Q
what are some labs used to measure blood clotting?
A
Activated partial thromboplastin time (aPTT)
International normalized ratio (INR)
Prothrombin time (PT)
Platelet count
15
Q
what is Activated partial thromboplastin time (aPTT)?
A
purpose:
Assessment of intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII
normal values:
25-35 sec
16
Q
explain International normalized ratio (INR)
A
purpose:
Standardized way of reporting PT- compares PT with a control value
normal values
0.8-1.2
17
Q
prothrombin time (PT)
A
purpose
Assessment of extrinsic coagulation(blood going from solid to semi solid) by measurement of factors I, II, V, VII and X
normal values
11-16 sec
18
Q
platelet count
A
purpose
Count of number of circulating platelets
normal values
150X109/L to 400x109/L
19
Q
what falls under problem clots: Virchow’s Triad
A
Blood Stasis
Hypercoagulability
Endothelial injury
- risk factors clot formation are associated with these parts of the triad.
20
Q
true of false: A clot of this type is called a thrombus. A thrombus will trigger inflammation. A piece of the clot that breaks off and travels around the body is called an embolus.
A
true
21
Q
true or false: deep vein thrombosis is a problem clots
A
true
22
Q
select all that is true about DVT:
Thrombus forms in the deep veins
May be asymptomatic
Common symptoms include:
Calf or groin pain on affected side
Sudden onset unilateral edema Increased warmth
Redness (rubour) to affected limb
A
all true
23
Q
how do you diagnosis for DVT?
A
Physical assessment, confirm with venous duplex ultrasonography
24
Q
what is superficial vein thrombosis?
A
Usually superficial leg veins- close to the skin surface
* Tenderness, rubour, warmth, pain, inflammation and induration along the vein
* Vein appears as a palpable cord
* Edema rarely occurs
* If left untreated, DVT can occur
25
true or false: DVT is a risk for pulmonary embolism - clot breaks off and blocks blood flow in lungs: emergency
TRUE
26
what is a life threatening complication of VTE?
pulmonary embolism!!!
Blockage of pulmonary artery by air, fat, tumor tissue or a thrombus
Lodges in blood vessel obstructs perfusion of alveoli
30% mortality in untreated clients
Diagnosis plus anticoagulant therapy mortality rate is 6-8%
27
what could be possibly happening in the life threatening complication of VTE : pulmonary embolism ?
cutting the circulation into your lungs causes to have difficulty breathing, and short of breath
28
Anemia Critical Values : Hgb often looked at clinically
how much is the value in men and women?
<135 in men, <120 in women
29
Anemia Critical Values L
Do men and women share the same general signs and symptoms?
yes they do share the same general signs and symptoms
30
True or False. With Anemia Critical Values : S & S influenced by severity more than etiology.
true
31
Do we look at age, and underlying health in when we are looking at anemia critical values.
yes we do.
32
is this true, in terms of hematocrit M 42- 52 % , F 37-47% , is this the correct value ?
yes it is the correct value
33
Define the signs and symptoms within the value
Hct > 30- 35%
Hct 25-30%
Hct 20-25%
Hct 15-20%
Hct < 15 %
no symptoms
fatigue, malaise
SOBOE, dyspnea
light- headed, confusion
death, MI, etc.
34
what is the normal range of hgb for male and female ?
M 140 - 180
F 120- 160
35
what are the two types of anemia we covered in class ?
anemia due to decreased production of RBC
anemia due to blood loss ( acute and chronic )
36
what are the characteristics of anemia due to decreased production of RBC
and what are the characteristics of anemia due to blood loss ( acute & chronic )
anemia due to decreased production of RBC
1. Iron deficiency anemia
2. Vitamin B12 deficiency anemia
3. Folic Acid deficiency anemia
Anemia due to blood loss ( acute & chronic )
1. bleeding
37
what does iron essential for?
involved in the procces of making hemoglobin
38
when we don't have enough iron/ we have iron deficiency anemia what do we call that ?
microcytic
39
where is iron store in our body ?
liver and muscle tissue
40
define if this is a TRUE or FALSE statement regarding iron the body
- we do not recycle the vast majority of the iron in our body
- red blood cells live for 220 days and when they are they open up
false, we do recycle the vast majority of the iron in our body
false, red blood cells live for 120 days and when they are broken down ( not open up)
41
What do we keep and reuse in the body
iron
42
true or false. We excrete only 1 mg iron/day ?
true
43
name characteristics about iron- deficiency anemia
most common worldwide
decrease iron impedes synthesis of Hgb --> less o2 transported
44
etiology of iron deficiency anemia
inadequate dietary intake of iron, especially during growth spurts or pregnancy
chronic blood loss from GI ulcer, hemorrhoids, cancer , or excessive menstrual flow = loss of iron from body as blood is lost ( not re-cycled ) - results in low iron stores
45
true or false. Etiology of iron deficiency anemia : impaired absorption of iron resulting from gastritis, chronic inflammatory bowel disease, or diarrhea can be a caused?
true
46
Signs & Symptoms of iron - deficiency anemia:
weakness
pallor
low exercise tolerance
Fatigue
fissures at corners of mouth
serum Hgb and HCt decreased
serum ferritin decreased
serum iron decreased
47
How is Iron deficiency anemia treated ?
change in diet- include iron-rich foods meat. fish, poultry, beans, peas, lentils, some fruits, and vegetables, iron fortified, flour, pasta, cereals
treat/heal GI tract if bleeding is cause
iron supplement (ferrous, coated, duodenum)
48
what is an example of iron supplement ?
ferrous sulfate
49
Iron is best absorbed as ferrous sulphate in what environment ?
acidic environment
50
Iron supplement : Ferrous suplhate can only be taken as an oral tablet
false, it can be taken as a liquid administration as well along with oral tablet
51
true or false. Ferrous sulfate is taken 3 hours prior to meals
false, it's taken 1 hour before
52
What type of vitamin helps increase absorption of iron?
vitamin c
53
true or false .
Iron supplement : Ferrous Sulfate
undiluted liquid iron may stain teeth - give diluted through a straw
true
54
iron supplement : Ferrous Sulfate. Gastrointestinal side effects
heartburn, constipation, and diarrhea
55
select all that is true about VTE: Pulmonary Embolism:
Blockage of pulmonary artery by air, fat, tumor tissue or a thrombus
Lodges in blood vessel obstructs perfusion of alveoli
30% mortality in untreated clients
Diagnosis plus anticoagulant therapy mortality rate is 6-8%
all true
56
Makes red blood cells, but also had a place in neuro- numbness and tingiling with iron deficiency anemia ( this can lead into confusion and memory loss)
vitamin b12
57
what kind of embolism is this? rare cases surgery will be performed to remove the clot
saddle embolism
58
what are some pharmacological treatment of clotting disorders?
Anticoagulants: Heparin, enoxaparin, warfarin
Antiplatelet drugs: Aspirin, clopidogrel
Thrombolytics: Alteplase (tPA)
59
true or false: We can use three drug classes (anticoagulants, antiplatelet and thrombolytic) to treat clients who are at risk for blood clots, or clients who have formed blood clots.
true
60
DRUG CARD: Anticoagulants: Heparin
injection/ IV only
inactivates two major clotting factors in blood (Xa and Thrombin) - causes clot action to supress
rapid acting (works in minutes)
used to prevent formation of clots, OR extension of DVT or Pulmonary Embolus (PE) so that those clots do not enlarge or break off into emboli.
ADVERSE EFFECTS: risk of bleeding. possible hypersensitivity reactions
61
Deficiency causes impaired DNA formation- results in a larger than normal cell. These abnormalities target the cell for early destruction. What is this describing ?
Vitamin B 12 deficiency anemia ( cobalamin)
62
true or false: Anticoagulants: Heparin is rapid acting works within minutes?
true
63
does anticoagulants (Heparin) Needs close monitoring?
yes, We use aPTT to measure effectiveness of heparin (if IV every 6-8 hours)
64
Name characteristics about vitamin b 12 deficiency anemia ( coablamin )
can be rarely caused by dietary deficiency ( vegan diets, low protein diets ). Usually caused by conditions that affect the bowel such as chronic diarrhea, celiac disease or intestinal surgery
failure to absorb B12 from lack of intrinsic factor in gut needed to uptake the vitamin ( automimmune )
65
what is the antidote drug in case of overdose for anticoagulant heparin?
protamine Sulfate
66
DRUG CARD: Anticoagulants Enoxaparin
- form of heparin chemically altered to have shorter molecule chain, makes a "low molecular weight" heparin
Inactivates one important clotting factor (Xa)
works well as heparin SAFER AND EASIER TO USE, highly predictable effects. Used to prevent and treat DVT and PE.
given injection, no monitoring of aPTT
can be administered at home
longer half life than heparin: lasts longer
Adverse effect: risk fo bleeding
67
Neuropathy occurs only with_______, as lack of B12 affects nerve function.
B12 deficiency
68
what is the overdose treatment for anticoagulant enoxaparin?
protamine sulfate (same as heparin bc they are similar)
69
What are the signs and symptoms of Vitamin B12 deficiency anemia ?
Jaundice
Pallor
Glossitis ( red smooth beefy tongue )
Fatigue
Weight loss
Paresthesias of feet and hands
- Serum Hgb & Hct decreased
-Serum B12 decreased
70
DRUG CARD: Anticoagulants: Wafarin
suppresses four clotting factors made using vitamin K. Warfin INHIBITS Vitamin K being activated in body, so clotting factor cant be made normal - decreased 30-50%
highly protein bound : takes a long time
long term prevention (DVT and PE) oral med
frequently monitored to ensure therapeutic levels: monitor INR (min is monthly)
adverse: drug interactions with many other drugs, risk of bleeding
Antidote for overdose: Vitamin K
71
what drug inactivates only one clotting factor (Xa)?
Enoxaparin anticoagulants
72
DRUG CARD: Antiplatelet: Aspirin (ASA)
surpasses platelets clumping together by inhibiting COX. platelets need COX to synthesize TXA - one factor that makes platelets aggregate together
oral
assess ASA use before procedures that cause bleeding (surgery)
used to reduce risk of clotting that cause stroke or myocardial infraction
side affect: increased risk of bleeding, GI bleeding, stomach ulcers
73
Vitamin B12 ( Cyanocobalamin) ( name the characteristics )
purified form of b12
can be given orally, intranasally , or by injection
if diet is the cause nutritional education is required. May also treat underlying cause if malabsorption is the issue
74
Vitamin B12
( cyanocobalamin )
if lack of intrinsic factor is the cause, will be treated with parenteral B12 given by injection ?
yes, this is indeed true
75
Vitamin B12
( Cyanocobalamin ): when injected is usally start with maintenance dose an taper down to monthly for life
nope, nope, nope. LOADING dose
76
what are the side or adverse effects of vitamin b12 (cyanocobalamin)?
rare
best if treated significant neuro symptoms - may not reverse
77
DRUG CARD: Antiplatelet: Clopidogrel
stops platelets from aggregating by blocking receptors on surface or platelets
Irreversible binding like ASA, effects last the life of the platelet (7-10 days)
platelet aggregation reduced by 40-60%
oral, liver converts into active form
used to prevent clots - specific clots in heart's arteries
adverse: abdominal cramping, heartburn, diarrhea. Risk for bleeding.
78
what is a higher risk for cancer if long term used ?
folic acid
79
which two drugs are irreversible when given to bound platelets (last the life of platelet 7-10 days)
antiplatelet Clopidogrel and Aspirin ASA
80
Folic Acid deficiency anemia what are the signs and symptoms?
jaundice
pallor
fatigue
weight loss
serum Hgb & Hct decreased
Serum folate decreased
81
Thrombolytic: Alteplase (tPA)
IV - short acting
used to treat life-threatening clots in brain (stroke) heart (myocardial infraction) or lungs (pulmonary embolus)
Tissue plasminogen activator: tPA. This is a substance normally in our body that is used to break down old clots that have done their job after healing has occurred. We give it here as a medication.
breaks down clotting factors, and the fibrin that holds thrombi together. Lyses clots that are already formed. Also called fibrinolytics and “Clot busters”
Side/adverse effects: Can cause severe bleeding. Cannot form new clots.
82
Folic acid deficient anemia :folic acid is the natural vitamin while folate is the synthethic.
false, it's the other way around.
83
what are some signs of bleeding?
bruising, ecchymosis, petechiae
Hematuria
Vomiting blood
Retroperitoneal tenderness
Bleeding gums
Melena
Stiff/boardlike or painful abdomen
Low BP, high or low HR Sao2
fatigue
Epitaxis
Positive occult blood (fecal test)
Cullens sign (brusie around peri-umbilical region)
Decreased LOC, confusion
84
Folic Acid deficiency anemia : like B12 deficiency , Folic Acid causes what ? which an result in what ?
impaired DNA formation, result in a larger than normal cell, these abnormalities target the cell for early destruction
85
Folic acid deficiency anemia can be caused poor nutrition, especially diet, now name those ditet?
diet low in leafy vegetables, citrus , dried beans and nuts. Uncommon in US and Canada due to fortified foods.
86
DRUG CARD: Anti-fibrinolytic: Aminocaproic acid
stops normal process of fibrin breakdown that usually occurs when clot has served its use
preserves a clot or stabilizes one
most useful for preventing reoccurring bleeding, not used to manage severe ongoing bleeding (denture surgeries for at risk clients)
IV or oral
Can be given to treat severe bleeding caused by alteplase (tPA).
87
True or false. Folic acid deficiency can also be intestinal malabsorption caused by conditions that affect the gut such as Crohn's disease.
true
88
True or false. Medications CANNOT lead to folic acid deficiency ( especially oral contraceptives)
false, they can lead to folic acid deficiency
89
What if the problem is bleeding itself?
patient have conditions that increase risk of bleeding and low platelet count known as thrombocytopenia.
90
Folic acid should be used long term, and diet changes should be altered.
false, folic acid should be used short term, however diet changes should be altered that is correct.
91
not enough platelets = ?
abnormal bleeding can occur
92
Changes to diet are required or treatment of underlying condition to improve absorption of folate. When using Folic acid.
true.
93
what are some assessment findings for thrombocytopenia (objective data)
general -
fever lethargy
integumentary-
petechiae, ecchymoses, purpura
gastro intestinal
splenomegaly, abdominal distension, guaiacpositive stools(blood in stool)
possible findings: decrease in hemoglobin and hematocrit
94
folic acid is active when administered, activated in the body
false, inactive.
95
Folic acid is taken orally as a supplement
yes this is true
96
what are some signs of bleeding in skin?
petechiae, Purpura, Ecchymosis
97
what are the side or adverse effects of folic acid.
long term use can increase risk of certain cancers
98
Question: A client with a venous thrombo-embolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are necessary. Which of the following responses by the nurse is accurate?
1. “Administration of two anticoagulants reduces the risk for recurrent venous thrombosis.”
2. “Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from occurring.”
3.“The enoxaparin will work immediately, but the warfarin takes several days to have an effect on coagulation.”
4. “Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant.”
3.
99
Anemia from blood loss
blood loss may be
acute ( develops quickly from an an active bleed )
chronic ( develops slowly as small amounts of blood are lost over a long period of time )
100
Blood loss acute and chronic, what is under it ?
Acute
- trauma
- blood vessel rupture
chronic
- gastritis
-menstrual flow
-hemorrhoids
101
not enough O2 attached to RBC, not able to distribute enough to body - very detrimental?
true
102
this is when internal bleed may go unnoticed - causing you to have abdominal pain, back pain, hidden in bowel
acute blood loss
103
In acute blood loss: what can happen?
may first be noticed with low blood pressure and increase in heart rate ( can become tatcharydia)
rapid, acute blood loss, body cannot adjust if too much blood leaves vascular system
104
this is when the body can adjust but may use up iron stores - appears as an iron deficiency anemia
chronic blood loss
105
in chronic blood loss: what can happen?
heavy exercise menstrual periods can become a concern if too much blood is lost
bleeding from bowel, gastritis, ulcer may be slow and unnoticed ( FOBT ) fecal occult blood test
106
Treatment of anemia from blood loss
if acute need to determine cause and treat it ( stop acute bleeding )
may replace blood or components of blood ( transfusion)
if chronic need to determine cause and treat it ( stop chronic bleeding )
107
which one is the most in leukocytes?
basophils
monocytes
eosinophils
lymphocytes
neutrophils
neutrophils
108
what does blood contain the most?
fibrinogen
globulin
prothrombin
albumin
albumin
109
Treatment of anemia from blood loss
iron supplements are common treatment to replace lost iron and rebuild the body's stores so that normal RBC production can resume in the bone marrow?
true or false
true
110
what is one route of stem cell formation?
erythroblasts - normowblast - reticulocyte - erythrocytes (RBC's)
111
Treatment of anemia from blood loss
some other treatments might include hematopoetic agents ( what type of agent are we talking about )
erythropoetin
112
whats an immature RBC?
Reticulocyte
113
what is the lifespan of RBC
120 days
114
what does CBC mean
complete blood count
115
hematopoetic growth factors : Epoetin Alfa ( Erythropoetin )
what type of hormone is this ?
hormone that is normally made in the kidneys which stimulates RBC production in the bone marrow
116
true or false: Hemoglobin and hematocrit amounts vary between genders
* A low hemoglobin/ hematocrit could signal anemia
true
117
lab values for anemia:
hemoglobin (hg)
Hematocrit (Hit)
Reticulocytes
Serum iron
Ferritin
Transferin
Serum B12 - lab values show if there's deficiency for RBC production
Folate - rbc production
118
this is used to increase erythrocyte counts in clients which chronic anemia due to certain diseases ( cancer, kideny disease), or before a surgery or procedure where bleeding might occur
hematopoetic growth factors: epoetin alfa ( erythropoetin)
119
hematopoetic growth factors: epoetin alfa ( erythropoetin) is administered orally ?
no intravenously
120
what is transferrin ?
Iron is bound to a globulin protein called transferrin and carried to the bone marrow for incorporation into hemoglobin. Transferrin exists in relationship to the need for iron. When iron stores are low, transferrin levels increase, whereas transferrin is low when there is too much iron.
121
Is this true or false. Small doses should be given to gradually raise erythrocyte levels. Levels that rise too quickly can lead to adverse effects that can be severe .
true
122
What happens when we don’t have enough red blood cells (anemia)?
Blood cannot carry enough oxygen to cells.
* Without enough oxygen to part of the body these symptoms can occur
122
what are the side/adverse effects of erythropoetin
can cause hypertension, can cause MI ( Myocardial infraction), clots and cardiac arrest if hemoglobin increases too much. Cannot given if hemoglobin is 110 g/ L or higher.
123
signs and symptoms of anemia
skin: general pallor
cool to touch
patient cant tolerate cooler temperatures
chronic: nails are brittle and concaved
Cardio:
continuous rapid heartbeat and increases with meals and activity
severe-abnormal heart sounds
orthostatic hypertension
respiratory: breathless on extortion
decreased O2 sat levels
neurologic:
fatigue
increase need for sleep
reduced energy levels
124
The nurse is caring for a client who is showing signs of anemia. Which question by the nurse is most appropriate ?
how many miles can you run before you are fatigued?
do you feel difficulty falling asleep at night?
do you ever feel short of breath ?
is your heart rate abnormally slow ?
do you ever fell short of breath ?
125
How does the body respond to a blood pressure that is too low : Hypotension?
Sympathetic nervous sytsem reacts to low BP with increased HR and arterial vasoconstriction
126
This happens when the blood pressure is too low ( hypotension)
the arteries get smallers ( trying to increase the blood pressure, in other words narrowing the sides to constrict ?)
true or false.
true
127
which lab value assesses intrinsic coagulation? extrinsic coagulation?
intrinsic - aPTT
extrinsic - prothrombin time (PT)
128
risk factors for impaired perfusion: Perfusion
Population risk factors :
black Canadians and people of South Asian descent hae increased rates of HTN and develop it at younger ages
indigenous adults have a higher prevalence of HTN than the overall Canadian population
HTN is more common in older women than older men
129
Risk Factors for impaired perfusion: Modifiable risk factors
smoking : nicotine vasocontricts
elevated serum lipids
sedentary lifestyle
obesity
diabetes millitus
hypertension
130
what are the unmodifiable risk factors
age : increases with age
gender: men > women
genetics : family history
131
how is htn diagnosed ?
true or false. Nurses do not diagnose, but it is important to know that one high measurement alone does not mean hypertension
true
132
the diagnosis of hypertension is complex ?
true it is complex
133
When diagnosing hypertension, it is required more than one measure on more than one visit within a month.
This makes sure that outside factors like stress or exercise are not cause of the high blood pressure.
True or false?
true
134
what is the high blood pressure considered ?
140/90 mmHg
135
what are the two type of hypertension?
primary/ essential hypertension
secondary hypertension
136
Name the characteristics under Primary/ Essential Hypertension
Most common type
cause is unknown
90 - 95% clients
137
name the characteristics of secondary hypertension
less common
cause is usually an underlying disease or medication
5- 10 % adults with HTN
80 % children with HTN
138
Clinical Manifestations of Hypertension
known as a silent disease. almost all clients are asymptomatic = this is why screening is so important
clients who are untreated may have end organ damage to kidney
139
there are some symptoms that may occur with very SEVERE HTN : what are they ?
Fatigue
Dizziness
Palpitations
Angina
Dyspnea
Low exercise tolerance
140
why do you feel dizziness when hypertension ( severe ) might be occurring ?
get too much pressure in the brain
141
How do we treat hypertension?
First line : lifestyle changes including :
- weight loss if indicated
-dietary changes ( DASH diet : healthy foods, low sodium, low saturated fat, reduce alcohol)
-regular physical activity
- smoking cessation
142
true or false. If after approx. 3 months lifestyle factors have not reduced BP, then pharmacotherapy will be initiated.
true
143
Pharmacological treatment of hypertension ( many medications for hypertension). true or false.
true
144
what are the 3 types of treatment for hypertension
diuretics :
thiazide diuretics (hydrochlorothiazide)
loop diuretics ( furosemide)
potassium sparing diuretics (spironolactone)
ACE inhibitors : captopril
Beta- Adrenergic Blockers : Metaprolol
145
Diuretics
- decrease in the stroke volume - decrease in the blood pressure
what are the two things you want to know when taking a diuretics?
how strong it is ? and what is it doing to the potassium
146
the closer to the nephron, the more effective the drug is at removing water and solutes from the system.
diuretics
147
Diuretics : Thiazides : hydrochlorothiazide
first line drug for hypertension in Canada
148
true or false. Thiazide : hydrochlorothiazide is taken within during the bedtime and not taken during morning and lunch.
false, it is the opposite
149
Diuretics : Thiazides : hyrochlorothiazidde work through two mechanism : what are those mechanisms ?
reduce blood volume and reduce arterial resistance
150
This causes increased urination, take orally in the morning or lunch.
Thiaizdes : hydrochlorothiazide
151
what are the side/adverse effects of Diuretics : Thiazides : hyrochlorothiazidde
causes hypokalemia
cause hypotension, hypovolemia
clients should be encouraged to eat potassium-rich foods like bananas, and citrus. May take potassium supplements or add a potassium- sparing diuretic like spironolactone
152
Diuretics : Loop: furosemide
stronger diuretic because it works on the loop of henle where most of the sodium and chloride is reabsorbed
capable of producing profound diuresis : removes excess water quickly
153
this is not commonly used to treat general hypertension because they are too strong but may be used in certain cases.
furosemide
154
Can Furosemide be given orally, and intravenously? and given during the night ?
false, it can be given oraly and iv, however it is taken during the morning/da as it will cause frequent urination
155
Furosemide= lower blood volume and promote vasoconstriction?
false, not constriction but dialation
156
what are the side/ adverse effects of furosemide ?
causes hypokalemia ( may need supplements), hyponateremia ( low sodium ), dehydration, hypotension, hyperglycaemia, may lead to ototxocity and hearing loss.
157
Potassium - Sparing: Spironolactone
causes a small degree diuresis to help manage hypertension. not effective enough at diuresis to be used alone to manage HTN.
used to help when other HTN therapy decreases potassium in the body ( furosemide, thiazides ).
conserves potassium causing potassium to be reabsorbed in the kidney
158
what are the side effects or adverse effects of spironolactone
hyperkalemia, this can be very dangerous as it affects functioning of the heart. HAs endocrine effects. Can cause gynecomastia ( an overdevelopment or enlargement of the breast tissue in men or boys) , menstrual irregularities
159
the characteristics of ACE INHIBITORS : captoril
inhibit the renin - angiotension - aldosterone system ( RAAS)
work by stopping conversion of angiotensin I to angiotensin II
dialte blood vessles decrease blood volume
less effective in african americans
160
what are the side/ adverse effects of ace inhibitors ( captoril )
risk of first dose hypotension
with captopril
risk of hyperkalemia
may cause renal injury in patients with renal conditions
also prevent breakdown of bradykinin. by Ace. this can lead to side effects such as angioedma and dry cough
hypotension
161
True or false. Ace inhibitors and ace kinase are physically the same thing?
yes
162
beta Adrenergic Blockers : Metoprolol
Also called Beta- blockers , BB ( Beta antagonists ) Target SNS
163
Beta Adrenergic Blockers : Metoprolol
Block beta 1 cardiac receptors :
this decreased heart-rate and contractility so cardiac output falls
suppresses reflect tachycardia caused by vasodilators
164
Beta Adrenergic Blockers : Metoprolol : block beta 1 renal receptors : renin release is increased whic will decrease Bp via inhibition of the RAAS
false, it decreased , which will decrease the BP
165
true or false. Beta Adrenergic Blockers : Metoprolol decreases systemic vascular resistance if taken long term ( MOA unknown)
true
166
side/ adverse effects of Beta Adrenergic Blockers : Metoprolol
bradycardia, low cardiac output, hypotension, masks signs of hypoglycemia. May result in dizziness, lightheadness
167
Was there a common side/adverse effect you noticed for the antihypertensive medications?
- many drugs hypokalemia, especially if they work on the kidney.
-all antihypertensive therapy has the potential to cause hypotension, or a blood pressure that is too low.
