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71 Cards in this Set
- Front
- Back
What blood pressure is considered to be hypertension?
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Greater than or equal to:
140 / 90 |
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HTN leads to an increased risk of what cardiovascular diseases?
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MI
Heart Failure Stroke Renal Disease |
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What is the criteria for prehypertension?
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SBP of 120 -139
or DBP of 80-89 |
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IS an increase in systole BP or diastole BP more important in developing HTN in people over 50?
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SBP
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What is the number one cause of death in US women and most developed areas of the world?
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Cardiovascular disease (CVD)
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30% of people with hypertension?
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Do not know they have it since it is generally an asymptomatic condition
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What is Cardiac Output (CO)?
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Total blood flow through the systemic or pulmonary circulation per minute
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Systemic Vascular Resistance (SVR)?
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The force opposing the movement of blood within the blood vessels
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The mechanisms that can regulate BP effect either?
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CO or SVR
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Primary hypertension?
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Elevated BP without an identified cause (90 - 95% of all cases)
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Secondary hypertension?
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Elevated BP with a specific cause that can often be identified and corrected
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When should a secondary cause of HTN be suspected?
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If a person below 20 or over 50 suddenly develops HTN (especially if it is severe)
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What is the hallmark of HTN (patho)?
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Persistently increased SVR
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What are the risk factors for primary HTN?
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Age
Alcohol Cigarette Smoking DM Elevated serum lipids Excess Sodium Age (men until age 55 then women) Family history Obesity Ethnicity (2x if Black) Sedentary lifestyle Socioeconomic status Stress |
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Secondary symptoms of HTN (usually after damage to blood vessels in various organs and increased workload of heart)?
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Fatigue
Reduced activity intolerance Dizziness Palpitations Angina Dyspnea |
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The most common complications of hypertension are?
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Target organ diseases:
Hypertensive heart disease Cerebrovascular disease PVD Nephrosclerosis Retinal Damage |
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"White coat" HTN?
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Elevated BP in clinical settings and normal BP when measured elsewhere
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Lifestyle modifications for persons with HTN?
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Weight reduction
DASH eating plan Sodium restriction Moderation of alcohol Regular exercise Avoidance of tobacco |
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What does the DASH eating plan involve?
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Fish several times / week
Plenty of fruits and veggies Increasing fiber Lots of water |
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What is the most frequent cause of secondary HTN in the U.S.?
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Excessive alcohol consumption that results in cirrhosis
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Drugs currently available for treating HTN have what two main actions?
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Decrease the volume of circulating blood
Reduce SVR |
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What are the classes of drugs used to treat HTN?
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Diuretics
Adrenergic (SNS) inhibitors Direct vasodilators Angiotensin inhibitors Calcium channel blockers |
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What are the two classes of angiotensin inhibitors
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Angiotensin-converting enzyme inhibitors (ACE)
A-II receptor blockers |
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What do angiotensin inhibitors do?
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Prevent vasoconstriction and sodium and water retention
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ACE inhibitors often have which side effect that causes people to swith to an ARB?
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Coughing
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Main side effects with HTN meds?
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Orthostatic hypertension
Sexual dysfunction Tachycardia (vasodilators and angiotensin inhibitors) |
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What time of day is BP the highest?
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Shortly after waking
(Take 24hr meds early in the morning) |
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The failure to reach goal BP in patients who are adhering to full doses of a an appropriate 3 drug therapy regimen that includes a diuretic?
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Resistant hypertension
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How is orthostatic HTN defined?
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Decrease of 20 or more in SBP,
Decrease of 10 or more in DBP AND/OR Increase of 20 beats or more in pulse (when going from supine to standing) |
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A severe and abrupt elevation in BP, arbitrarily defined as a DBP greater than 140 is?
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Hypertensive crisis
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Who is most likely to experience hypertensive crisis?
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HTN patients who are not complying with meds or who are undermedicated
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A hypertensive emergency is often manifested as?
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Hypertensive encepholapathy syndrome including:
HA Nausea Vomiting Seizures Confusion Stupor Coma |
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What is a good indicator of the seriousness of hypertensive crisis?
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Association of BP and target organ damage (not just BP alone)
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How quickly do you want to lower BP in a patient with hypertensive crisis?
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Over 24 to 48 hours in a stable patient
(some seriously bad shit can happen if BP is lowered too fast) |
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What is the most effective IV drug for the treatment of hypertensive crisis?
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Sodium nitroprusside
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Abnormal clinical condition that results in physiologic changes of vasoconstriction and fluid retention
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Heart Failure
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HF is associated with what cardiovascular diseases?
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HTN
CAD MI |
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HF is the most common reason for hospital admission in?
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Adults over 65
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Primary risk factors for HF?
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CD and advancing age (primary)
(HTN, DM, obesity, smoking and serum lipids also risk factors) |
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What is the most common cause of HF?
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Systolic failure, which results in the inability of the heart to pump blood
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What is the hallmark of systolic dysfunction?
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Decrease in the left ventricular ejection fraction
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The impaired ability of the the ventricles to relax and fill?
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Diastolic failure
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The diagnosis of diastolic failure is made on the basis of the presence of?
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Pulmonary congestion
Pulmonary HTN Ventricular hypertrophy (and a normal ejection fraction) |
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Dilated cardiomyopathy can lead to?
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Mixed systolic and diastolic failure
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Compensatory mechanisms to try and maintain adequate CO associated with HF?
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Sympathetic nervous system activation
Neurohormonal responses Ventricular dilation Ventricular hypertrophy |
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What is the most common form of HF?
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Left-sided failure
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Left-side failure results from ventricular dysfunction which is manifested as?
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Pulmonary congestion and edema
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What is the primary cause of right sided failure?
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Left-sided failure
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Right sided heart failure causes a backup of blood into the?
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Right atrium and venous circulation
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Venous congestion from right-sided heart failure results in?
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Jugular venous distention
Hepatomegaly Splenomegaly Vascular congestion of GI tract Peripheral edema |
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Acute decompensated heart failure (ADHF) typically manifests as?
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Pulmonary edema
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Clinical manifestations of pulmonary edema?
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Anxious
Pale Possibly cyanotic Cold and clammy skin Severe dyspnea Respiratory rate greater than 30 Rapid HR Crackles Wheezing and coughing with frothy, blood-tinged sputum |
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Clinical manifestations of Chronic heart failure?
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Fatigue
Dyspnea Tachycardia Edema Nocturia Skin changes Behavioral changes Chest pain Weight changes (gain at first and eventually anorexia and nausea) |
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What are some complications of heart failure?
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Pleural effusion
Dysrhythmias Left ventricular thrombus Hepatomegaly Renal Failure |
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What are the JHACO core measures for heart failure? (4)
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1) Written discharge instructions covering all aspects of care
2) Documentation of left ventricular function 3)ACE inhibitors (angiotensin receptor blockers if ACE not tolerated) should be prescribed for patients with moderate to severe systolic dysfunction 4) Don't smoke |
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How do you decrease intravascular volume?
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Diuretics
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Is the use of IV loop diuretics alone effective?
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No, associated with an increased risk of fatal dysrhythmias, aggravated renal dysfunction, and enhanced activation of RAAS and SNS.
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What medication dilates coronary arteries?
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IV nitroglycerin
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How can you reduce venous return (preload)
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Place the patient in high fowler's position
IV nitroglycerin |
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What is afterload?
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Amount of work that the left ventricle has to produce to eject blood into the systemic circulation
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How do you decrease afterload?
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IV sodium nitroprusside (drug of choice for ADHF)
Morphine sulfate Nesitride |
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What pulmonary artery wedge pressure (PAWP) will generally increase CO?
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14-18 mm Hg
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Other important goals in treating patient with HF?
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Improving gas exchange and oxygenation
Reducing anxiety Nutritional therapy Education |
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Classes of drugs used to treat HF?
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Diuretics
Vasodilators ACE inhibitors Angiotensin II receptor blockers B-adrenergic blockers Positive inotropes BiDil |
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What inotrope is a mainstay in the treatment of HF?
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Digitalis
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If someone is experiencing yellow vision, what would you expect?
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Digitalis toxicity
(other symptoms: nausea, anorexia, and vomiting) |
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What effects do potassium levels have on digitalis?
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Hypokalemia enhances the action of digitalis (toxicity)
Hyperkalemia inhibits the action of digitalis |
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What is the antidote to digitalis toxicity?
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Digibind
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What drug is only used in the treatment of HF in African Americans?
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BiDil
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Patients with HF should obtain vaccinations against?
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Flu and pneumonia
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What should be assessed prior to giving a B blocker or digitalis
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HR for 1 minute, may not give if lower than 50 (MD orders)
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