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139 Cards in this Set

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According to the JNC 7 HTN Guidelines, what is normal BP?
<120/80
According to the JNC 7 HTN Guidelines, what is Pre-hypertensive BP?
120-139 systolic
80-89 diastolic
According to the JNC 7 HTN Guidelines, what is Stage I HTN BP?
140-159 systolic
90-99 diastolic
According to the JNC 7 HTN Guidelines, what is Stage II HTN BP?
>160 systolic
>100 diastolic
What is the first thing to encourage with beginning HTN?
lifestyle change. with lower sodium in diet and increase exercise.
What is Step I Antihypertensive Drug Therapy?
one of the following:
-diuretic
-beta-blocker
-CCB
-ACE inhibitor
What is Step II Antihypertensive Drug Therapy?
-increase dose of initial drug or add another drug
What is Step III Antihypertensive Drug Therapy?
-select drug from a different class
What is Step IV Antihypertensive Drug Therapy?
-add a third or fourth drug
What step therapy are diuretics for HTN?
step 1
What is the major site of action for diuretics?
kidney nephron
How do diuretics work?
interfere w/reabsorption in the tubules
What are the four major classifications of diuretics?
-osmotic (mannitol)
-loop (furosemide)
-thiazide (hydrochlorothiazide)
-potassium sparing (spironolactone)
What electrolytes fluctuate with use of diuretics?
decrease
-sodium (Na+)
-potassium (K+)
-chloride (Cl-)
-calcium (Ca+)
-magnesium (Mg)
What is the electrolyte of greatest fluctuation that we must monitor with use of diuretics?
potassium (K+)
What follows sodium (Na+)?
water
Generally what are the big SE of diuretics?
-hypovolemia
-hypokalemia/hyperkalemia
-hypocalcemia/hypercalcemia
-hyperlipidemia
-hyperglycemia in DM
What drugs are more powerful in reducing fluid?
proximal & loop diuretics
What symptoms might you see with OD on diuretic?
-hypovolemia leads to hypotension
-electrolyte imbalances (potassium)
Why don't people stay on their diuretic?
-they do not notice a change
-they do not like the polyuria
Why do we use diuretics?
-HTN
-edema w/ HF (let heart work less)
-cirrhosis of liver
-cerebral edema
Where do the proximal tubule diuretics work?
proximal convoluted tubule (PCT)
How does proximal tubule diuretics work?
excretes bicarbonate
How much sodium and chloride are reabsorbed in the PCT?
65%
Are proximal tubule diuretics used for HTN?
No
What is the Proximal Tubule Diuretic prototype?
acetazolamide (Diamox)

as-et-e-zol-e-mid
What are the indications for Proximal Tubule Diuretics?
-glaucoma
-altitude sickness
What are the contraindications for Proximal Tubule Diuretics?
allergy to sulfonamides
Special considerations with proximal tubule diuretics:
-rapid water loss can cause hypotension
-diabetics rise blood sugar levels
-cause kidney stones
How do osmotic diuretics work?
create intensified osmotic force within the tubules
What is Osmotic Diuretics prototype?
Mannitol
How does (osmotic diuretic) Mannitol work?
it is a large sugar molecule that pulls in water to be excreted in the urine
What are the indications for (osmotic diuretic) Mannitol?
cerebral edema
What are the contraindications for (osmotic diuretic) Mannitol?
-intracranial bleeding
-renal/cardiac dysfunction
What are the SE for (osmotic diuretic) Mannitol?
-GI sx
-dry mouth
-HA
-polyuria
-weakness/dizziness
How do loop diuretics work?
block reabsorption of sodium and chloride in the ascending limb of Henle's loop.
What is the loop diuretics prototype?
furosemide (Lasix)

fyu-ro-se-mid
What are the indications for (loop diuretic) furosemide (Lasix)?
-significant edema (HF, cirrhosis, renal disease)
-HTN
What are the SE for (loop diuretic) furosemide (Lasix)?
-hypotension
-ototoxicity (hearing loss)
Typically why do we see the SE ototoxicity with loop diuretics (furosemide: Lasix)?
the medication was pushed too fast through IV
What are the drug to drug interactions to be aware of with loop diuretics (furosemide:Lasix)?
-digoxin (ototoxcity)
-lithium (ototoxcity)
-NSAIDs
Can loop diuretic (furosemide:Lasix) be used with GFR?
yes it is the one diuretic that is used with failing kidneys.
How do thiazides diuretics work?
-blocks sodium & chloride reabsorption in early distal convoluted tubule.
-very similar to high-ceiling (loop) diuretics just not as strong.
-first line drug.
List an important difference between high-ceiling (loop) diuretic and thiazide diuretic.
-Thiazides elevate plasma levels or uric acid and glucose. -They also increase LDL and triglycerides.
-Therefore, not great for pt. w/ hyperlipidemia.
What is the thiazides prototype?
hydrochlorothiazide (HCTZ)
What are the indications for thiazide (hydrochlorothiazide:HCTZ)?
-HTN
-chronic edema (HF, cirrhosis, renal failure)
-treatment of hypocalcemia
What are the contraindications for thiazide (hydrochlorothiazide:HCTZ)?
-pregnant women
-gout
-hyperlipidemia
-renal disease
What are the SE for thiazide (hydrochlorothiazide:HCTZ)?
-hypovolemia
-hyponatremia (low sodium outside of cells)
-polyuria
-hypokalemia
What SE will you see with OD on thiazide (hydrochlorothiazide:HCTZ)?
excessive hypokalemia
Special considerations with Thiazides
drink more water to help with dry mouth and minimize fatigue
What time of day is best to take Thiazides?
morning so they are not urinating while sleeping
What are the two ways that potassium-sparing diuretics work?
-increase in urine output
-produce substantial decrease in potassium excreted.
What is the potassium-sparing diuretic prototype?
spironolactone (Aldactone)

spi-re-no-lak-ton
What is the action of potassium-sparking diuretic spironolactone?
blocks aldosterone in distal tubule & promotes sodium & water excretion. allows K+ to stay in the system.
What are the indications for potassium-sparing diuretic (spironolactone)?
-prevention/treatment of hypokalemia
-HTN & edema
-use in combo w/HCTZ to balance K+
What are the SE of potassium-sparing diuretic (spironolactone)?
same as normal diuretics
What are the drug to drug interactions of potassium-sparing diuretic (spironolactone)?
-ACE inhibitors
-salt substitutes
-K+ supplements
-some antibiotics
-decreases effects of anticoagulants
What are the SE of OD on potassium-sparing diuretic (spironolactone)?
-hypovolemia
-hypotension
Do we encourage K+ foods for potassium-sparing diuretics?
No
How do we remove crystallization in diuretics before administering IV?
warm in hot water bath
Do we need a filter when administering diuretics IV?
yes
How can we properly measure if diuretic is working?
Foley catheter. empty prior to administration.
What diuretic do we want to educate pt. to inform us of hearing loss right away?
furosemide (Lasix)
furosemide (Lasix) should not be given to pt with what allergy?
sulfa
What are some foods that are high in potassium?
-bananas
-dried fruit
-milk
-nuts
-spinach
-oranges
-honeydew
-peaches
-avocados
Important diet notes for diuretic therapy:
-low salt intake
-adequate water intake
What are some signs of hypovolemia?
-dizziness
-confusion
-salt craving
-insatiable thirst
What are some signs of hypokalemia?
-thirst
-mm weakness
-lethargy
-vomiting
What are the most important points for diuretic therapy?
-FALLS!
-BP changes
-K+ levels
-signs of hypovolemia
What do Alpha receptors work on?
BV
What happens when alpha 1 receptors are simulated?
vasoconstriction of BV
What happens when alpha 1 receptors are blocked?
vasodilation of BV
What do beta 1 receptors effect?
heart
What happens when beta 1 receptors are simulated?
increase HR
What happens when beta 1 receptors are blocked?
decrease HR
What do beta 2 receptors effect?
lungs
What happens when beta 2 receptors are stimulated?
bronchodilation
What happens when beta 2 receptors are blocked?
bronchial constriction
What stage is BB for HTN treatment?
stage 1
What does a nonselective beta blocker work on?
beta 1 & beta 2 receptors
What does a selective beta blocker work on?
beta 1 only
What happens when you use a BB 1?
-decreases HR, conduction, contractility & CO
-inhibits renin release by the kidney
-reduces myocardial oxygen demand
-decreases peripheral vascular resistance which lowers BP
What happens when you use a BB 2?
-bronchoconstriction
How do BB work?
-decrease cardiac contractility which drops arterial pressure
-inhibits renin release
What are the indications for a BB?
-chronic angina, HTN
-cardiac dysrhythmias
-prevent second MI
-vascular HA
-tremors
-anxiety (stage freight lower HR
What are the SE for a BB?
-negative chronotrope (HR)
-negative inotrope (contractility of heart)
-negative dromotrope (electrical current of heart)
-lower CO/BP
-bradycardia
-fatigue/drowsiness** most common**
-impotence**most common**
-difficulty breathing
What is the BB prototype?
propranolol (Inderal) nonselective
All BB end in what?
-olol
What should we check before giving BB?
HR
What happens if you abruptly stop taking BB?
-rebound HTN
-tachycardia
What are some important education points for pt. on BB?
-administer consistently
-no OTC decongestants/cold meds
-how to prevent orthostatic hypotension
-check weight
-check pulse <45 (DO NOT TAKE)
-signs of depression
What stage is CCB for HTN treatment?
stage 1
How do CCB work?
-decrease force of myocardial contraction (blocks inward flow of Ca into cells)
-decreases automaticity of SA node/conduction through AV node
-coronary artery dilation to improve coronary blood flow
-peripheral dilation to improve peripheral resistance
CCB target what?
-heart AND arteries
OR
-arteries ONLY
What are the indications for a CCB?
-HTN
-angina
-prophylaxis for vascular HA
What are the common SE with CCB?
-edema (lower extremities)
-constipation
When should we use a CCB with extreme caution?
-pt w/renal or hepatic dysfunction (reduced clearance)
-older adults
What are some important education points for pt. on CCB?
-do not crush or chew
-HR must be at least 45
-CCB can make HF worse
-support hose/elevate legs
CCB end in what?
-pine
CCB are similiar to what drugs (many of the same SE)?
BB
What step is RAAS inhibition used in HTN?
step 1
How do Direct Renin Inhibitors (DRI) work?
binds with renin to stop the whole RAAS cascade from the top.
Indications Direct Renin Inhibitors (DRI)
HTN
SE of Direct Renin Inhibitors (DRI)
-cough
-hyperkalemia
-angioedema
How do ACE-I's work?
-completely blocks angiotensin I converting enzyme
-prevents production of angiotensin II (powerful vasoconstrictor)
What are the indications for ACE-I?
-HTN w/ normal renal function
-used with Thiazide or Loop
-HF (used with digoxin and diuretics)
What are the contraindications for ACE-I?
-pregnancy
What are the SE of ACE-I?
-angioedema
-hypotension (first dose)
-hyperkalemia
-cough (not indicative of lung disease)
What is the ACE-I prototype?
lisinopril
What electrolyte can elevate with ACE-I use?
potassium (K+)
How do Angiotensin II Receptor Blockers (ARB) work?
block at the RECEPTOR sites of angiostensin I and Angiostensin II
What is the prototype for Angiotensin II Receptor Blockers (ARB)?
Iosartan (Cozaar)
Are ARBs and ACE-I the same?
Mostly they are the same.
-ARBs do not have the angioedema and cough as SE. -ARBs are more expensive
Should every diabetic be on an ACE-I or ARB?
Yes
What may the physician do if we must go to Step II Drug Therapy for HTN?
-Increase dose of step I therapy drug
-Add diuretic if not done yet
-Add additional class of drug
What stage are Sympatholytic Drugs for treating HTN?
step II therapy
Sympatholytic drugs inhibit what system?
SNS
Where does sympatholytic drug act?
brain
Why are these step II therapy?
-orthostatic hypotension
-possible rebound HTN
-psychiatric disturbances
What is the prototype for sympatholytic drugs?
clonidine (Catapres) alpha 2 agonist
How does clonidine work?
-decreases SNS outflow from the brain to periphery.
-binds to alpha 2 receptors to turn them on.
-now blocks SNS output to the body.
-decrease in sympathetic tone. -lowers CO, HR, peripheral resistance.
What are some indications for clonidine?
moderate HTN
What are some SE for clonidine?
rebound HTN (if abrubtly withdrawn)
What are the risks with using a BB with a sympatholytic drug (clonidine)?
it can cause severe HTN
What is the prototype for Peripheral-acting Alpha Adrenergic Blocker (Alpha blockers)?
doxazosin (Cardura)
How does alpha 1 blockers work?
blocks (alpha 1 receptors) bv squeeze. result is vasodilation and lowered PVR
What are the indications of doxazosin?
BPH
What are the SE of doxazosin?
-HUGE first-week effect (hypotension)
-educate pt. to take at night
All alpha blockers end with?
-osin
How do the direct-acting vasodilators (HTN Crisis) work?
dilate veins and arteries to decrease BP
Which (HTN Crisis) drugs dilate arteries?
-hydralazine (Apresoline)
**hi-dral-e-zen
-diazoxide (Hyperstat IV)
**di-az-ak-sid
-minoxidil (Loniten)
**min-ak-se-dil
What drugs dilates veins and arteries?
sodium nitroprusside (Nipride)
What are the SE of direct acting vasodilators (HTN Crisis)?
-reflex tachycardia (decrease afterload then baroreceptors drop BP and the HR has to increase)
-postural hypotension
Name the three hypertensive emergencies
-diazoxide (Hyperstat IV)
-minoxidil (Loniten)
-sodium nitroprusside (Nipride)
What type of poisioning/toxicity do pt. get with nitroprusside (Nipride)?
cyanide poisoning
What is the antidote to nipride toxicity?
sodium thiosulfate most commonly used
Why might you have to wrap the tubing with foil if administering nitroprusside (Nipride)?
it is light sensitive
What are some SE you will see with cyanide poisoning?
-cherry red skin
-almond breath
What should be monitored closely when administering and throughout treatment with nitroprusside?
blood pressure