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139 Cards in this Set
- Front
- Back
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According to the JNC 7 HTN Guidelines, what is normal BP?
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<120/80
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According to the JNC 7 HTN Guidelines, what is Pre-hypertensive BP?
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120-139 systolic
80-89 diastolic |
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According to the JNC 7 HTN Guidelines, what is Stage I HTN BP?
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140-159 systolic
90-99 diastolic |
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According to the JNC 7 HTN Guidelines, what is Stage II HTN BP?
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>160 systolic
>100 diastolic |
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What is the first thing to encourage with beginning HTN?
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lifestyle change. with lower sodium in diet and increase exercise.
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What is Step I Antihypertensive Drug Therapy?
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one of the following:
-diuretic -beta-blocker -CCB -ACE inhibitor |
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What is Step II Antihypertensive Drug Therapy?
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-increase dose of initial drug or add another drug
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What is Step III Antihypertensive Drug Therapy?
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-select drug from a different class
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What is Step IV Antihypertensive Drug Therapy?
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-add a third or fourth drug
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What step therapy are diuretics for HTN?
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step 1
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What is the major site of action for diuretics?
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kidney nephron
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How do diuretics work?
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interfere w/reabsorption in the tubules
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What are the four major classifications of diuretics?
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-osmotic (mannitol)
-loop (furosemide) -thiazide (hydrochlorothiazide) -potassium sparing (spironolactone) |
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What electrolytes fluctuate with use of diuretics?
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decrease
-sodium (Na+) -potassium (K+) -chloride (Cl-) -calcium (Ca+) -magnesium (Mg) |
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What is the electrolyte of greatest fluctuation that we must monitor with use of diuretics?
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potassium (K+)
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What follows sodium (Na+)?
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water
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Generally what are the big SE of diuretics?
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-hypovolemia
-hypokalemia/hyperkalemia -hypocalcemia/hypercalcemia -hyperlipidemia -hyperglycemia in DM |
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What drugs are more powerful in reducing fluid?
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proximal & loop diuretics
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What symptoms might you see with OD on diuretic?
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-hypovolemia leads to hypotension
-electrolyte imbalances (potassium) |
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Why don't people stay on their diuretic?
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-they do not notice a change
-they do not like the polyuria |
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Why do we use diuretics?
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-HTN
-edema w/ HF (let heart work less) -cirrhosis of liver -cerebral edema |
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Where do the proximal tubule diuretics work?
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proximal convoluted tubule (PCT)
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How does proximal tubule diuretics work?
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excretes bicarbonate
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How much sodium and chloride are reabsorbed in the PCT?
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65%
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Are proximal tubule diuretics used for HTN?
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No
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What is the Proximal Tubule Diuretic prototype?
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acetazolamide (Diamox)
as-et-e-zol-e-mid |
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What are the indications for Proximal Tubule Diuretics?
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-glaucoma
-altitude sickness |
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What are the contraindications for Proximal Tubule Diuretics?
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allergy to sulfonamides
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Special considerations with proximal tubule diuretics:
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-rapid water loss can cause hypotension
-diabetics rise blood sugar levels -cause kidney stones |
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How do osmotic diuretics work?
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create intensified osmotic force within the tubules
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What is Osmotic Diuretics prototype?
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Mannitol
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How does (osmotic diuretic) Mannitol work?
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it is a large sugar molecule that pulls in water to be excreted in the urine
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What are the indications for (osmotic diuretic) Mannitol?
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cerebral edema
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What are the contraindications for (osmotic diuretic) Mannitol?
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-intracranial bleeding
-renal/cardiac dysfunction |
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What are the SE for (osmotic diuretic) Mannitol?
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-GI sx
-dry mouth -HA -polyuria -weakness/dizziness |
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How do loop diuretics work?
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block reabsorption of sodium and chloride in the ascending limb of Henle's loop.
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What is the loop diuretics prototype?
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furosemide (Lasix)
fyu-ro-se-mid |
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What are the indications for (loop diuretic) furosemide (Lasix)?
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-significant edema (HF, cirrhosis, renal disease)
-HTN |
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What are the SE for (loop diuretic) furosemide (Lasix)?
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-hypotension
-ototoxicity (hearing loss) |
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Typically why do we see the SE ototoxicity with loop diuretics (furosemide: Lasix)?
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the medication was pushed too fast through IV
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What are the drug to drug interactions to be aware of with loop diuretics (furosemide:Lasix)?
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-digoxin (ototoxcity)
-lithium (ototoxcity) -NSAIDs |
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Can loop diuretic (furosemide:Lasix) be used with GFR?
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yes it is the one diuretic that is used with failing kidneys.
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How do thiazides diuretics work?
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-blocks sodium & chloride reabsorption in early distal convoluted tubule.
-very similar to high-ceiling (loop) diuretics just not as strong. -first line drug. |
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List an important difference between high-ceiling (loop) diuretic and thiazide diuretic.
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-Thiazides elevate plasma levels or uric acid and glucose. -They also increase LDL and triglycerides.
-Therefore, not great for pt. w/ hyperlipidemia. |
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What is the thiazides prototype?
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hydrochlorothiazide (HCTZ)
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What are the indications for thiazide (hydrochlorothiazide:HCTZ)?
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-HTN
-chronic edema (HF, cirrhosis, renal failure) -treatment of hypocalcemia |
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What are the contraindications for thiazide (hydrochlorothiazide:HCTZ)?
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-pregnant women
-gout -hyperlipidemia -renal disease |
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What are the SE for thiazide (hydrochlorothiazide:HCTZ)?
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-hypovolemia
-hyponatremia (low sodium outside of cells) -polyuria -hypokalemia |
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What SE will you see with OD on thiazide (hydrochlorothiazide:HCTZ)?
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excessive hypokalemia
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Special considerations with Thiazides
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drink more water to help with dry mouth and minimize fatigue
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What time of day is best to take Thiazides?
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morning so they are not urinating while sleeping
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What are the two ways that potassium-sparing diuretics work?
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-increase in urine output
-produce substantial decrease in potassium excreted. |
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What is the potassium-sparing diuretic prototype?
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spironolactone (Aldactone)
spi-re-no-lak-ton |
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What is the action of potassium-sparking diuretic spironolactone?
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blocks aldosterone in distal tubule & promotes sodium & water excretion. allows K+ to stay in the system.
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What are the indications for potassium-sparing diuretic (spironolactone)?
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-prevention/treatment of hypokalemia
-HTN & edema -use in combo w/HCTZ to balance K+ |
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What are the SE of potassium-sparing diuretic (spironolactone)?
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same as normal diuretics
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What are the drug to drug interactions of potassium-sparing diuretic (spironolactone)?
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-ACE inhibitors
-salt substitutes -K+ supplements -some antibiotics -decreases effects of anticoagulants |
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What are the SE of OD on potassium-sparing diuretic (spironolactone)?
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-hypovolemia
-hypotension |
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Do we encourage K+ foods for potassium-sparing diuretics?
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No
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How do we remove crystallization in diuretics before administering IV?
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warm in hot water bath
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Do we need a filter when administering diuretics IV?
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yes
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How can we properly measure if diuretic is working?
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Foley catheter. empty prior to administration.
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What diuretic do we want to educate pt. to inform us of hearing loss right away?
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furosemide (Lasix)
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furosemide (Lasix) should not be given to pt with what allergy?
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sulfa
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What are some foods that are high in potassium?
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-bananas
-dried fruit -milk -nuts -spinach -oranges -honeydew -peaches -avocados |
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Important diet notes for diuretic therapy:
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-low salt intake
-adequate water intake |
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What are some signs of hypovolemia?
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-dizziness
-confusion -salt craving -insatiable thirst |
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What are some signs of hypokalemia?
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-thirst
-mm weakness -lethargy -vomiting |
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What are the most important points for diuretic therapy?
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-FALLS!
-BP changes -K+ levels -signs of hypovolemia |
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What do Alpha receptors work on?
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BV
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What happens when alpha 1 receptors are simulated?
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vasoconstriction of BV
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What happens when alpha 1 receptors are blocked?
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vasodilation of BV
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What do beta 1 receptors effect?
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heart
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What happens when beta 1 receptors are simulated?
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increase HR
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What happens when beta 1 receptors are blocked?
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decrease HR
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What do beta 2 receptors effect?
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lungs
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What happens when beta 2 receptors are stimulated?
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bronchodilation
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What happens when beta 2 receptors are blocked?
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bronchial constriction
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What stage is BB for HTN treatment?
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stage 1
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What does a nonselective beta blocker work on?
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beta 1 & beta 2 receptors
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What does a selective beta blocker work on?
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beta 1 only
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What happens when you use a BB 1?
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-decreases HR, conduction, contractility & CO
-inhibits renin release by the kidney -reduces myocardial oxygen demand -decreases peripheral vascular resistance which lowers BP |
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What happens when you use a BB 2?
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-bronchoconstriction
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How do BB work?
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-decrease cardiac contractility which drops arterial pressure
-inhibits renin release |
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What are the indications for a BB?
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-chronic angina, HTN
-cardiac dysrhythmias -prevent second MI -vascular HA -tremors -anxiety (stage freight lower HR |
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What are the SE for a BB?
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-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 |
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What is the BB prototype?
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propranolol (Inderal) nonselective
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All BB end in what?
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-olol
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What should we check before giving BB?
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HR
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What happens if you abruptly stop taking BB?
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-rebound HTN
-tachycardia |
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What are some important education points for pt. on BB?
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-administer consistently
-no OTC decongestants/cold meds -how to prevent orthostatic hypotension -check weight -check pulse <45 (DO NOT TAKE) -signs of depression |
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What stage is CCB for HTN treatment?
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stage 1
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How do CCB work?
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-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 |
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CCB target what?
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-heart AND arteries
OR -arteries ONLY |
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What are the indications for a CCB?
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-HTN
-angina -prophylaxis for vascular HA |
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What are the common SE with CCB?
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-edema (lower extremities)
-constipation |
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When should we use a CCB with extreme caution?
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-pt w/renal or hepatic dysfunction (reduced clearance)
-older adults |
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What are some important education points for pt. on CCB?
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-do not crush or chew
-HR must be at least 45 -CCB can make HF worse -support hose/elevate legs |
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CCB end in what?
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-pine
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CCB are similiar to what drugs (many of the same SE)?
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BB
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What step is RAAS inhibition used in HTN?
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step 1
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How do Direct Renin Inhibitors (DRI) work?
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binds with renin to stop the whole RAAS cascade from the top.
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Indications Direct Renin Inhibitors (DRI)
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HTN
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SE of Direct Renin Inhibitors (DRI)
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-cough
-hyperkalemia -angioedema |
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How do ACE-I's work?
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-completely blocks angiotensin I converting enzyme
-prevents production of angiotensin II (powerful vasoconstrictor) |
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What are the indications for ACE-I?
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-HTN w/ normal renal function
-used with Thiazide or Loop -HF (used with digoxin and diuretics) |
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What are the contraindications for ACE-I?
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-pregnancy
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What are the SE of ACE-I?
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-angioedema
-hypotension (first dose) -hyperkalemia -cough (not indicative of lung disease) |
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What is the ACE-I prototype?
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lisinopril
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What electrolyte can elevate with ACE-I use?
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potassium (K+)
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How do Angiotensin II Receptor Blockers (ARB) work?
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block at the RECEPTOR sites of angiostensin I and Angiostensin II
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What is the prototype for Angiotensin II Receptor Blockers (ARB)?
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Iosartan (Cozaar)
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Are ARBs and ACE-I the same?
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Mostly they are the same.
-ARBs do not have the angioedema and cough as SE. -ARBs are more expensive |
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Should every diabetic be on an ACE-I or ARB?
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Yes
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What may the physician do if we must go to Step II Drug Therapy for HTN?
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-Increase dose of step I therapy drug
-Add diuretic if not done yet -Add additional class of drug |
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What stage are Sympatholytic Drugs for treating HTN?
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step II therapy
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Sympatholytic drugs inhibit what system?
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SNS
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Where does sympatholytic drug act?
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brain
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Why are these step II therapy?
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-orthostatic hypotension
-possible rebound HTN -psychiatric disturbances |
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What is the prototype for sympatholytic drugs?
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clonidine (Catapres) alpha 2 agonist
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How does clonidine work?
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-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. |
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What are some indications for clonidine?
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moderate HTN
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What are some SE for clonidine?
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rebound HTN (if abrubtly withdrawn)
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What are the risks with using a BB with a sympatholytic drug (clonidine)?
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it can cause severe HTN
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What is the prototype for Peripheral-acting Alpha Adrenergic Blocker (Alpha blockers)?
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doxazosin (Cardura)
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How does alpha 1 blockers work?
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blocks (alpha 1 receptors) bv squeeze. result is vasodilation and lowered PVR
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What are the indications of doxazosin?
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BPH
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What are the SE of doxazosin?
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-HUGE first-week effect (hypotension)
-educate pt. to take at night |
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All alpha blockers end with?
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-osin
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How do the direct-acting vasodilators (HTN Crisis) work?
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dilate veins and arteries to decrease BP
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Which (HTN Crisis) drugs dilate arteries?
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-hydralazine (Apresoline)
**hi-dral-e-zen -diazoxide (Hyperstat IV) **di-az-ak-sid -minoxidil (Loniten) **min-ak-se-dil |
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What drugs dilates veins and arteries?
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sodium nitroprusside (Nipride)
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What are the SE of direct acting vasodilators (HTN Crisis)?
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-reflex tachycardia (decrease afterload then baroreceptors drop BP and the HR has to increase)
-postural hypotension |
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Name the three hypertensive emergencies
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-diazoxide (Hyperstat IV)
-minoxidil (Loniten) -sodium nitroprusside (Nipride) |
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What type of poisioning/toxicity do pt. get with nitroprusside (Nipride)?
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cyanide poisoning
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What is the antidote to nipride toxicity?
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sodium thiosulfate most commonly used
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Why might you have to wrap the tubing with foil if administering nitroprusside (Nipride)?
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it is light sensitive
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What are some SE you will see with cyanide poisoning?
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-cherry red skin
-almond breath |
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What should be monitored closely when administering and throughout treatment with nitroprusside?
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blood pressure
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