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63 Cards in this Set
- Front
- Back
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What is hypertensive? |
Hypertensive is persistent systolic pressure greater than 140mmHg and diastolic pressure greater than 90mmg. |
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What is hypertensive a risk for? |
Cardiovascular disease, coronary artery disease, renal failure, peripheral vascular disease. |
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Name four different types of hypertension |
1. Primary hypertension (aka essential) 2. Secondary hypertension 3. Isolated systolic 4. Malignant hypertension |
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Primary hypertension |
Aka essential hypertension. Most common form of hypertension (90%), the cause is unknown and generates from lifestyle choices |
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Secondary hypertension |
Generates from another disease such as renal artery disease, dyspnea, thyroid disease, etc. |
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Isolated systolic hypertension |
Occurs mostly in elderly. Characterized by high systolic blood pressure and normal diastolic pressure Can be stopped with screenings! |
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Malignant hypertension |
Rare type of hypertension! Mainly happens during surgery with a high diastolic pressure. Complications can lead to myocardial infarction, strokes |
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What are different (2) types of risk factors for hypertensions? |
1. Modifiable 2. Unmodifiable |
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What are modifiable risks for hypertension? |
Lifestyle choices! such as smoking, practicing daily exercise. Primarily things that we can CHANGE |
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What are unmodifiable risks for hypertension? |
Gender, age, ethnicity, genetics. These are things we CANNOT change/do not have control over |
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What are the theories for pathogenesis? |
1. Sensitive Sympathetic Nervous System 2. Renin Angiotensin Aldosterone System 3. Defect in renal sodium excretion 4. Interactions involving insulin resistance |
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What occurs with endothelial injury and tissue ischemia? |
Leads to inflammation! Increasing blood pressure |
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Renin Angiotensin Aldosterone System |
1. Liver produces angiotensinogen and kidneys produce renin 2. Together, they form angiotensin I 3. Angiotensin I reacts with angiotensin converting enzyme (ACE) produced in the lungs 4. Together, they form angiotensin II (potent vasoconstrictor) which stimulates the production of aldosterone 5. Aldosterone stimulates retention of Na and intake of H2O 5. Leading to high blood pressure! |
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Why is it dangerous to not get screened for hypertension? |
It is a silent killer. Often, there aren't visual symptoms other than knowing you have high blood pressure. |
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What are the categories of antihypertensive drugs? (6) |
1. Andrenergic Drugs 2. ACE Inhibitors 3. Angiotensin II Receptor Blockers 4. Calcium Channel Blocker 5. Diuretics 6. Vasodilators |
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Which drugs target cardiac factors (like heart rate and contractibility)? |
Beta blockers, calcium channel blockers, centrally acting andrenergics |
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Which drugs target circulating volume? |
ACE Inhibitors, Diuretics |
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Which drugs target hormones? |
Vasodilators, ACE inhibitors, Calcium Channel Blockers, Angiotensin II Receptor Blockers |
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Which drugs target peripheral sympathetic receptors? |
Diuretics, Vasoconstrictors |
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Which drug targets CNS? |
Centrally acting adrenergics |
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Which drug targets PNS? |
Peripherally acting adrenergics |
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Andrenergic Drugs |
antihypertensive medications that involve alpha/beta receptor blockers |
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Centrally acting alpha2 receptor agonists |
Affect primarily in the brain - stimulates receptors in CNS, reducing sympathetic outflow --> lack of norepinephrine production which reduces blood pressure - reduces renin activity in kidney |
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Peripherally acting alpha1 receptor agonist |
Affect primarily heart and blood vessels Has the ability to dilate arteries and veins, reducing peripheral vascular resistance |
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Peripherally acting beta receptors blockers (aka beta blockers) |
Affect heart rate by reducing heart rate and reduces secretion of renin; used mostly for angina/conduction problems and for when the heart rate is too fast for heart to refill efficiently |
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Peripherally acting dual alpha1/beta receptor blockers |
Uses both functions: reduces heart rate and vasodilates |
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Drug for centrally acting alpha2 receptor agonists |
Clonidine -- very useful for withdrawals in opioid dependent people Methyldopa -- used for pregnancies |
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Drugs for peripherally alpha1 receptor blockers |
-azosin 1. Doxazosin 2. Terazosin 3. Prazosin Used for congestive heart failure all ORAL medication |
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Drugs for beta blockers |
-olol 1. Atenolol 2. Propranolol 3. Metoprolol 4. Nebivolol 5. Nadolol 6. Sotalol |
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Drugs for peripherally acting dual alpha1 and beta blockers |
Carvedilol Labetalol |
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Adverse affects from andrenergics |
Orthostatic hypotension Bradycardia (slow HR) with reflex tachycardia Dry mouth Constipation Depression Edema Sexual dysfunction Headaches Nausea |
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Angiotensin Converting Enzyme (ACE) Inhibitor |
Inhibits ACE in RAAS Prevents kininase which breaks down bradykinin and substance P (both vasodilators) |
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What effect do ACE Inhibitors have on hypertension? |
Affects the circulating volume in the body Decreases afterload and stimulates vasodilation |
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When are ACE Inhibitors favored over other drugs? |
Good for diabetic patients because they protect kidneys, the first-line choice for patients with cardiac heart failure (CHF) because very safe and effective, and some are good for patients with liver failure |
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How do ACE inhibitors protect kidneys? |
They inhibit aldosterone and prevent sodium and water reabsorption |
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Why are some ACE inhibitors good for patients with liver failure? |
Two drugs (Captopril and lisinopril) are not prodrugs and do not have to be metabolized in the liver |
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Prodrugs |
Drugs that are inactive in the body and must be metabolized to an active form in the liver; bad for patients with liver failure |
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What are the differences between Captopril and Lisinopril? |
Captopril has a short half life and is bad for patients with a history of non-adherence but good for chronically ill patients in case problems arise Lisinopril has a longer half life and is good for patients with non-adherence history |
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ACE Inhibitor drugs |
-opril 1. Captopril 2. Benazepril 3. Enelapril 4. Fosinopril 5. Lisinopril 6. Quinapril |
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Adverse effects for ACE Inhibitors |
- most commonly with COUGH (from substance P and bradykinin) - fatigue - dizziness - first dose hypertension - headaches - mood changes - Hyperkalemia (increased potassium) - Angiodema rare but potentially fatal |
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What is angiodema? |
laryngeal inflammation, swollen lips, face, hands |
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What do ACE Inhibitors do to potassium? |
Increases potassium by stopping aldosterone, at risk for hyperkalemia --> nurses need to take labs and possibly limit potassium intake |
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Angiotensin II Receptor Blockers |
Stops angiotensin II receptors to block vasoconstriction and to block the release of aldosterone |
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Drugs for ARBs |
-sartan 1. losartan 2. valsartan 3. irbesartan 4. candesartan 5. olmesartan 6. telmisartan |
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Adverse effects for ARBs |
No COUGH - Upper respiratory infections - Headache/dizzieness - Hyperkalemia is less likely to occur than ACE inhibitors, but still occurs |
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Calcium Channel Blockers |
smooth muscle relaxation by inhibiting calcium binding - decreases contraction - decreases afterload these are very safe and on the list of first-line drugs |
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What do calcium channel blockers result in? |
affect heart rate and contractibility Decreased peripheral smooth muscle tone Decreased vascular resistance Decreased blood pressure |
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Calcium channel drugs |
used for angina, HTN, dysrhythmias - odipine 1. Amlodipine 2. Nifedipine 3. Felodipine 4. Diltiazem (oral or IV) 5. Verapamil (IV) |
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Adverse affects for Calcium Channel Drugs |
- Constipation - Dizziness - Facial flushing - Dry mouth - Headache - Edema of hands and feet |
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Vasodilators |
dilates blood vessels by directly relaxing smooth muscle - use with caution because it directs acts onto veins fast |
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Drugs for vasodilators |
use for hypertension 1. diazoxide 2. hydralazine HCl - most commonly used 3. minoxidil - available over-the-counter, for hair loss 4. sodium nitroprusside |
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Diuretics |
accelerate the rate of urine formation, removing sodium and water from the body - affects circulating volume - decreases PRELOAD - cause direct arterial dilation and decreases peripheral vascular resistance |
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Advantages of diuretics |
- relatively low cost - favorably safe profile |
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Types of diuretics |
1. Loop diuretics 2. Potassium-sparing diuretics 3. Thiazide and thiazide-like diuretics |
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Loop diuretics |
block sodium reabsorption in the thick ascending loop - affects preload - used for: edema, HTN, hypercalcemia (too much calcium excreted by heart), and CHF |
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Loop diuretics drug effects |
- frequent peeing - decreased fluid volume - potassium and sodium depletion (check the labs for these! dangerous) |
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Loop diuretic drugs |
-mide 1. Furosemide 2. Bumetanide 3. Torsemide |
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Loop Diuretic Adverse Effects |
CNS - dizziness, headaches Gastro - nausea, vomiting, diarrhea Hematologic - agranulocytosis, neutropenia (look at white blood cells!) |
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Potassium Sparing Diuretic |
blocks aldosterone receptors, blocking the resorption of sodium/water keeping potassium |
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Adverse effects Potassium Sparing Diuretic |
CNS: dizziness, headaches GI: cramps, nausea, vomiting Other: urinary frequency, weakness, hyperkalemia |
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Thiazide and Thiazide-like Diuretics |
inhibits tubular reabsorption of sodium, chloride, and potassium ions - works in the distal convoluted tubule - excretion of water, sodium, chloride - lowered peripheral vascular resistance |
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What is thiazide and thiazide-like diuretics used for? |
used for - hypertension - edema - hypercalciuria - congestive heart failure |
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Adverse effects of thiazide drugs |
main thing is metabolic effects - hyperglycemia, hyperuricemia, hyponatremia Not good for diabetic patients |
