Ch 31 Hypertension

Front 1

dyslipidemia

Back 1

abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels

Front 2

glomerular filtration rate (GFR)

Back 2

flow rate of filtered fluid through the kidney, an indicator of renal function

Front 3

hypertensive emergency

Back 3

a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage

Front 4

hypertensive urgency

Back 4

a situation in which blood pressure is severely elevated but there is no evidence of target organ damage

Front 5

isolated systolic hypertension

Back 5

a condition most commonly seen in the older adult in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is within normal limits (less than 90 mm Hg)

Front 6

monotherapy

Back 6

medication therapy with a single medication

Front 7

primary hypertension

Back 7

denotes high blood pressure from an unidentified cause; also called essential hypertension

Front 8

rebound hypertension

Back 8

blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication

Front 9

secondary hypertension

Back 9

high blood pressure from an identified cause, such as renal disease

Front 10

Hypertension

Back 10

is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a health care provider

Front 11

120/80 mm Hg

Back 11

JNC 7 defines a blood pressure of less than ________ mm Hg diastolic as normal

Front 12

Prehypertension

Back 12

120 mm Hg - 139 mm Hg systolic BP

Front 13

Stage 1 hypertension

Back 13

140 mm Hg - 159 mm Hg systolic BP

Front 14

Stage 2 hypertension

Back 14

≥160 mm Hg systolic BP

Front 15

30 %

Back 15

About _____ % of the adults in the United States have hypertension, and the prevalence increases significantly as people get older or have other cardiovascular risk factors.

Front 16

54%

Back 16

Approximately_______% of persons with hypertension do not have their blood pressure under control as defined by JNC 7.

Front 17

Hispanics and African Americans

Back 17

The prevalence of uncontrolled hypertension varies by ethnicity, with ________ and ________ having the highest prevalence at approximately 63% and 57%, respectively

Front 18

Causes of secondary hypertension

Back 18

Causes for this kind of hypertension include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoetin alfa [Epogen]), and coarctation of the aorta

Front 19

High blood pressure

Back 19

___________________ can also occur with pregnancy; women who experience ___________________ during pregnancy are at increased risk of ischemic heart disease, heart attacks, strokes, kidney disease, diabetes, and death from heart attack.

Front 20

silent killer

Back 20

Hypertension is sometimes called the _________ because people who have it are often symptom free.

Front 21

lifelong condition

Back 21

Once identified, elevated blood pressure requires monitoring at regular intervals because hypertension is a__________.

Front 22

atherosclerotic heart disease

Back 22

Hypertension often accompanies other risk factors for __________________, such as dyslipidemia (abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low highdensity lipoprotein [HDL] levels), obesity, diabetes, metabolic syndrome, a sedentary lifestyle, and obstructive sleep apnea

Front 23

Elevated

Back 23

__________ pressure may indicate an excessive dose of vasoconstrictive medication, stress, or other problems.

Front 24

heart, kidneys, brain, and eyes.

Back 24

Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the _________, ________, _________, and ________.

Front 25

typical outcomes of prolonged, uncontrolled hypertension

Back 25

myocardial infarction

heart failure

renal failure

strokes

impaired vision

hypertrophy (enlargement) of the left ventricle of the heart

Front 26

Blood pressure

Back 26

___________ is the product of cardiac output (systolic) multiplied by peripheral resistance( diastolic).

Front 27

Cardiac output

Back 27

______________is the product of the heart rate multiplied by the stroke volume.

Front 28

Causes of Hypertension

Back 28

Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system

• Increased renal reabsorption of sodium, chloride, and water related to a genetic variation in the pathways by which the kidneys handle sodium

• Increased activity of the renin–angiotensin–aldosterone system, resulting in expansion of extracellular fluid volume and increased systemic vascular resistance

• Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium

• Resistance to insulin action, which may be a common factor linking hypertension, type 2 diabetes, hypertriglyceridemia, obesity, and glucose intolerance

• Activation of the innate and adaptive components of the immune response that may contribute to renal inflammation and dysfunction

Front 29

Isolated systolic hypertension

Back 29

The aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume) because of decreased elasticity, and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure, which is known as ____________, more common in older adults.

Front 30

papilledema

Back 30

In severe hypertension, ____________(swelling of the optic disc) may be seen.

Front 31

Coronary artery disease

Back 31

_________________ with angina and myocardial infarction are common consequences of hypertension.

Front 32

Left ventricular hypertrophy

Back 32

__________ ___________ __________ occurs in response to the increased workload placed on the ventricle as it contracts against higher systemic pressure.

Front 33

nocturia

Back 33

Pathologic changes in the kidneys (indicated by increased blood urea nitrogen [BUN] and serum creatinine levels) may manifest as ___________.

Front 34

transient ischemic attack (TIA) or stroke

Back 34

Cerebrovascular involvement may lead to a ___________ or _____________, manifested by alterations in vision or speech, dizziness, weakness, a sudden fall, or transient or permanent paralysis on one side (hemiplegia)

Front 35

Cerebral infarctions

Back 35

___________ account for most of the strokes in patients with hypertension.

Front 36

urinalysis, blood chemistry, 12-lead electrocardiogram

Back 36

Routine laboratory tests include _________, ___________ (i.e., analysis of sodium, potassium, creatinine, fasting glucose, and total and HDL cholesterol levels), and a _____________.

Front 37

echocardiography

Back 37

Left ventricular hypertrophy can be assessed by ____________.

Front 38

Renal damage

Back 38

______________ may be suggested by elevations in BUN and creatinine levels or by microalbuminuria or macroalbuminuria.

Front 39

complications and death

Back 39

The goal of hypertension treatment is to prevent ___________ and __________ by achieving and maintaining the arterial blood pressure at 140/90 mm Hg or lower.

Front 40

130/80 mm Hg

Back 40

JNC 7 specifies a lower goal pressure of ___________ mm Hg for people with diabetes or chronic kidney disease, which is defined as either a reducedglomerular filtration rate (GFR)

Front 41

Major Risk Factors (in Addition to Hypertension)

Cardiovascular Problems

Back 41

• Smoking

• Dyslipidemia (elevated LDL [or total] cholesterol and/or low HDL cholesterol)*

• Diabetes*

• Impaired renal function (GFR <60 mL/min and/or microalbuminuria)

• Obesity (BMI ≥30 kg/m2)*

• Physical inactivity

• Age (>55 years for men, >65 years for women)

• Family history of cardiovascular disease (in female relative <65 years or male relative <55 years)

Front 42

Target Organ Damage or Clinical Cardiovascular Disease in patients with Hypertension

Back 42

• Heart disease (left ventricular hypertrophy, angina or previous myocardial infarction, previous coronary revascularization, heart failure)

• Stroke (cerebrovascular accident, brain attack) or TIA

• Chronic kidney disease

• Peripheral arterial disease

• Retinopathy

Front 43

metabolic syndrome

Back 43

Dyslipidemia and diabetes plus hypertension, elevated triglyceride levels, and abdominal obesity are components of the ___________.

Front 44

diuretics, beta-blockers, or both.

Back 44

For patients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medications include ________, __________, or __________.

Front 45

systolic

Back 45

Hypertension, particularly elevated blood ___________pressure, increases the risk of death, stroke, and heart failure in people older than 50 years, and treatment reduces this risk

Front 46

hyperkalemia and orthostatic hypotension

Back 46

Older adults are at increased risk for the side effects of____________ and ________________ , putting them at increased risk for falls and fractures

Front 47

ifestyle Modifications to Prevent and Manage Hypertension*

Back 47

Weight reduction

Adopt DASH eating plan

Dietary sodium reduction

Physical activity

Moderation of alcohol consumption

Front 48

The DASH (Dietary Approaches to Stop HYPERTENSION

Back 48

Grains and grain products 7 or 8 servings/day

Vegetables 4 or 5

Fruits 4 or 5

Low-fat or fat-free dairy foods 2 or 3

Meat, fish, and poultry ≤ 2

Nuts, seeds, and dry beans 4 or 5 weekly

Front 49

insufficient

Back 49

A consensus document on the treatment of hypertension in the older adult concluded that there were ___________ data to establish blood pressure goals for persons older than 80 years

Front 50

auscultatory gap

Back 50

An ________________ is when the Korotkoff sounds disappear for a brief period as the cuff is being deflated.

Front 51

higher; lower

Back 51

Using a cuff that is too small will give a ______________ BP measurement, and using a cuff that is too large results in a ____________ BP measurement compared to one taken with a properly sized cuff.

Front 52

Thiazide Diuretics

Back 52

Chlorthalidone

chlorothiazide (Diuril)

hydrochlorothiazide

indapamide

methyclothiazide

metolazone (Zaroxolyn)

Front 53

Thiazide Diuretics mechanism of action

Back 53

Decrease of blood volume, renal blood flow, and cardiac output

Depletion of extracellular fluid

Negative sodium balance (from natriuresis), mild hypokalemia

Directly affect vascular smooth muscle

Front 54

Thiazide Diuretics advantages

Back 54

Relatively inexpensive

Effective orally

Effective during long-term administration

Mild side effects

Enhance other antihypertensive medications

Counter sodium retention effects of other antihypertensive medications

Front 55

Thiazide diuretics and loop diuretics contraindications

Back 55

Contraindications: Gout, known sensitivity to sulfonamide-derived medications, severely impaired kidney function, and history of hyponatremia

Front 56

Thiazide side effects

Back 56

Side effects include dry mouth, thirst, weakness, drowsiness, lethargy, muscle aches, muscular fatigue, tachycardia, GI disturbance.

Front 57

Thiazide nursing considerations

Back 57

Postural hypotension may be potentiated by alcohol, barbiturates, opioids, or hot weather.

Because thiazides cause loss of sodium, potassium, and magnesium, monitor for signs of electrolyte imbalance.

Encourage intake of potassium-rich foods (i.e., fruits).

Front 58

Thiazide and loop duretic gerontoligic considerations

Back 58

Risk of postural hypotension is significant because of volume depletion; measure blood pressure in 3 positions; caution patient to rise slowly.

Front 59

Loop Diuretics

Back 59

furosemide (Lasix)

bumetanide (Bumex)

torsemide (Demadex)

Front 60

Loop diuretics mechanism of action

Back 60

Volume depletion

Blocks reabsorption of sodium, chloride, and water in kidney

Front 61

Loop diuretics advantages

Back 61

Action rapid

Potent

Used when thiazides fail or patient needs rapid diuresis

Front 62

Loop diuretics effects and nursing consideration

Back 62

There is risk of volume and electrolyte depletion from the profound diuresis that can occur.

Fluid and electrolyte replacement may be required.

Front 63

Potassium-Sparing Diuretics

Back 63

amiloride (Midamor)

triamterene (Dyrenium)

Front 64

Potassium-Sparing Diuretics mechanism of action

Back 64

Blocks sodium reabsorption

Acts on distal tubule independently of aldosterone

Front 65

Potassium-Sparing Diuretics advantage

Back 65

Causes potassium retention

Front 66

Potassium-Sparing Diuretics contraindication

Back 66

Contraindications: Renal disease, azotemia, severe hepatic disease, hyperkalemia

Front 67

Potassium-Sparing Diuretics side effects

Back 67

Drowsiness, lethargy, headache, hyperkalemia, diarrhea and other GI symptoms

Front 68

Potassium-Sparing Diuretics nursing consideration

Back 68

Monitor for hyperkalemia if given with ACE inhibitor or angiotensin receptor blocker.

Diarrhea and other GI symptoms—administer medication after meals.

Front 69

Aldosterone Receptor Blockers

Back 69

eplerenone (Inspra)

spironolactone (Aldactone)

Front 70

Aldosterone Receptor Blockers mechanism of action

Back 70

Competitive inhibitors of aldosterone binding

Front 71

Aldosterone Receptor Blockers advantage

Back 71

Indicated for patients with a history of myocardial infarction or symptomatic ventricular dysfunction

Front 72

Aldosterone Receptor Blockers contraindication

Back 72

Contraindications:Hyperkalemia and impaired renal functionEplerenone is contraindicated in diabetes with microalbuminuria.

Front 73

Aldosterone Receptor Blockers side effects

Back 73

Drowsiness, lethargy, headache, hyperkalemia, diarrhea and other GI symptoms, gynecomastia

Front 74

Aldosterone Receptor Blockers nursing consideration

Back 74

Monitor for hyperkalemia if given with ACE inhibitor or angi-otensin receptor blocker.

Diarrhea and other GI symptoms—administer medication after meals.

Avoid the use of potassium supplements or salt substitutes.Educate patients, families, and caregivers about the signs and symptoms of hyperkalemia.

Spironolactone may cause gynecomastia

Front 75

Central Alpha2-Agonists and Other Centrally Acting Drugs

Back 75

reserpine (Harmonyl)

methyldopa (Aldomet)

clonidine (Catapres)

clonidine patch (Catapres-TTS)

guanfacine (Tenex)

Front 76

reserpine (Harmonyl) mechanism of action

Back 76

Impairs synthesis and reuptake of norepinephrine

Front 77

reserpine (Harmonyl) advantage

Back 77

Slows pulse, which counteracts tachycardia of hydralazine

Front 78

reserpine (Harmonyl) contraindication

Back 78

Contraindications:History of depression, psychosis, obesity, chronic sinusitis, peptic ulcer

Front 79

reserpine (Harmonyl) nursing consideration

Back 79

May cause severe depression; report manifestations, as this may require that drug be discontinued.

Nasal congestion

Use with caution if history of gallbladder, renal, or cardiac disease, or seizure disorder.

Front 80

reserpine (Harmonyl) gerontologic consideration

Back 80

Gerontologic considerations:Depression and postural hypotension is common in older adults.

Front 81

methyldopa (Aldomet) action

Back 81

Dopa decarboxylase inhibitor; displaces norepinephrine from storage sites

Front 82

methyldopa (Aldomet) advantage

Back 82

Drug of choice for pregnant women with hypertension

Useful in patients with renal failure or prostate disease

Does not decrease cardiac output or renal blood flow

Does not induce oliguria

Front 83

methyldopa (Aldomet) contraindication

Back 83

Contraindications: Liver disease

Front 84

methyldopa (Aldomet) side effects

Back 84

Drowsiness, dizziness

Dry mouth; nasal congestion (troublesome at first but then tends to disappear)

Front 85

methyldopa (Aldomet) nursing consideration

Back 85

Use with caution with renal disease.

Front 86

methyldopa (Aldomet) gerontologic consideration

Back 86

Gerontologic considerations:May produce mental and behavioral changes in the older adult.

Front 87

clonidine (Catapres)

clonidine patch (Catapres-TTS)

action

Back 87

Exact mode of action is not understood, but acts through the central nervous system, apparently through centrally mediated alpha-adrenergic stimulation in the brain, producing blood pressure reduction.

Front 88

clonidine (Catapres)

clonidine patch (Catapres-TTS) advantage

Back 88

Little or no orthostatic effect; moderately potent, and sometimes is effective when other medications fail to lower blood pressure.

Front 89

clonidine (Catapres)

clonidine patch (Catapres-TTS)

contraindication

Back 89

Contraindications: Severe coronary artery disease, pregnancy

Front 90

clonidine (Catapres)

clonidine patch (Catapres-TTS)

side effects

Back 90

Dry mouth, drowsiness, sedation, and occasional headaches and fatigue. Anorexia, malaise, and vomiting with mild disturbance of liver function have been reported.

Front 91

clonidine (Catapres)

clonidine patch (Catapres-TTS)

nursing consideration

Back 91

Rebound or withdrawal hypertension is relatively common; monitor blood pressure when stopping medication.

Front 92

clonidine (Catapres)

clonidine patch (Catapres-TTS)

geronologic consideration

Back 92

Common side effects include dry mouth, dizziness, sleepiness, fatigue, headache, constipation, and impotence.

Front 93

guanfacine (Tenex) action

Back 93

Stimulates central alpha2-adrenergic receptors

Front 94

guanfacine (Tenex) advantage

Back 94

Reduces heart rate and causes vasodilation. Serious adverse reactions are uncommon

Front 95

guanfacine (Tenex) contraindication

Back 95

Use with caution in persons with diminished liver function, recent myocardial infarction, or known cardiovascular disease.

Front 96

Beta-Blockers drug list

Back 96

atenolol (Tenormin)

betaxolol (Kerlone)

bisoprolol (Zebeta)

metoprolol (Lopressor)

metoprolol extended release (Toprol-XL)

nadolol (Corgard)

propranolol (Inderal)

propranolol long acting (Inderal LA)

timolol (Blocadren)

Front 97

Beta-Blockers action

Back 97

Block the sympathetic nervous system (beta-adrenergic receptors), especially the sympathet-ics to the heart, producing a slower heart rate and lowered blood pressure

Front 98

Beta-Blockers and Beta-Blockers With Intrinsic Sympathomimetic Activity advantages

Back 98

Reduce pulse rate in patients with tachycardia and blood pressure elevation

Indicated for patients who also have stable angina pectoris and silent ischemia

Front 99

Beta-Blockers and Beta-Blockers With Intrinsic Sympathomimetic Activitycontraindication

Back 99

Contraindications:

Bronchial asthma, allergic rhinitis, right ventricular failure from pulmonary hypertension, heart failure, depression, diabetes, dyslipi–demia, heart block, peripheral vascular disease, heart rate <60 bpm

Front 100

Beta-Blockers side effects

Back 100

Mental depression manifested by insomnia, lassitude, weakness, and fatigue

Lightheadedness and occasional nausea, vomiting, and epigastric distres

Front 101

Beta-Blockers nursing consideration

Back 101

Avoid sudden discontinuation.

Check heart rate before giving.

Risk of toxicity is increased for older adult patients with decreased renal and liver function.

Take blood pressure in 3 positions, and observe for hypotension.

Front 102

Beta-Blockers With Intrinsic Sympathomimetic Activity drug list

Back 102

acebutolol (Sectral)

penbutolol (Levatol)

pindolol (Visken)

Front 103

Beta-Blockers With Intrinsic Sympathomimetic Activity action

Back 103

Block both cardiac beta-1 and beta-2 receptors

Also have antiarrhythmic activity by slowing atrioventricular conduction

Front 104

Beta-Blockers With Intrinsic Sympathomimetic Activity nursing consideration

Back 104

Avoid sudden discontinuation.

Withhold if bradycardia or heart block is present.

Use with caution with COPD, diabetes.Similar to beta-blockers

Front 105

Beta-Blocker With Cardioselective and Vasodilatory Activity drug

Back 105

Nebivolol (Bystolic)

Front 106

Beta-Blocker With Cardioselective and Vasodilatory Activity action

Back 106

Blocks beta-1 adrenergic receptors

Front 107

Beta-Blocker With Cardioselective and Vasodilatory Activity advantage

Back 107

Similar to other beta-blockers with additional capacity for vasodilation

Front 108

Beta-Blocker With Cardioselective and Vasodilatory Activity contraindication

Back 108

Contraindications:Similar to beta-blockers but with greater risk of severe bradycardia, heart block, cardiogenic shock, decom-pensated cardiac failure, sick sinus syndrome, severe hepatic impairment

Front 109

Beta-Blocker With Cardioselective and Vasodilatory Activity nursing consideration

Back 109

Avoid sudden discontinuation. FDA warns that drug has not been shown to be more effective than any other beta-blocker.

Front 110

Alpha1–Blockers drug list

Back 110

doxazosin (Cardura)

prazosin hydrochloride (Minipress)

terazosin (Hytrin)

Front 111

Alpha1–Blockers action

Back 111

Peripheral vasodilator acting directly on the blood vessel; similar to hydralazine

Front 112

Alpha1–Blockers advantage

Back 112

Act directly on the blood vessels and are effective agents in patients with adverse reactions to hydralazine

Front 113

Alpha1–Blockers contraindication

Back 113

Contraindications:Angina pectoris and coronary artery disease; induces tachycardia if not preceded by administration of propranolol and a diuretic

Front 114

Alpha1–Blockers side effects

Back 114

Occasional vomiting and diarrhea, urinary frequency, and cardiovascular collapse, especially if given in addition to hydralazine without lowering the dose of the latter. Patients occasionally experience drowsiness, lack of energy, and weakness.

Front 115

Combined Alpha- and Beta-Blockers drug list

Front 116

Combined Alpha- and Beta-Blockers action

Back 116

Block alpha- and beta-adrenergic receptors; cause peripheral dilation and decrease peripheral vascular resistance

Front 117

Combined Alpha- and Beta-Blockers advantage

Back 117

Contraindications:Asthma, cardio-genic shock, severe tachycardia, heart block

Front 118

Combined Alpha- and Beta-Blockers contraindication

Back 118

Contraindications:Asthma, cardio-genic shock, severe tachycardia, heart block

Front 119

Combined Alpha- and Beta-Blockers side effects

Back 119

Orthostatic hypotension, tachycardia

Front 120

Vasodilators drug list

Back 120

fenoldopam mesylate (Corlopam)

hydralazine (Apresoline)

minoxidil (Loniten)

sodium nitroprusside (Nitropress) nitroglycerin

Front 121

Vasodilator: fenoldopam mesylate (Corlopam) action

Back 121

Stimulates dopamine and alpha2-adrenergic receptors

Front 122

Vasodilator: fenoldopam mesylate (Corlopam) advantage

Back 122

Given IV for hypertensive emergencies

Front 123

Vasodilator: fenoldopam mesylate (Corlopam) side effects

Back 123

Headache, flushing, hypotension, sweating, tachycardia caused by vasodilation

Front 124

Vasodilator: fenoldopam mesylate (Corlopam) nursing consideration

Back 124

Observe for local reactions at the injection site.

use with caution in patients with glaucoma, recent stroke (brain attack), asthma, hypokalemia, or diminished liver function.

Front 125

Vasodilator: hydralazine (Apresoline) action

Back 125

Decreases peripheral resistance but concurrently elevates cardiac output

Acts directly on smooth muscle of blood vessels

Front 126

Vasodilator: hydralazine (Apresoline) advantage

Back 126

Not used as initial therapy; used in combination with other medicationsUsed also in pregnancy-induced hypertension

Front 127

Vasodilator: hydralazine (Apresoline) contraindication

Back 127

Contraindications:Angina or coronary disease, heart failure, hypersensitivity

Front 128

Vasodilator: hydralazine (Apresoline) nursing consideration

Back 128

Headache, tachycardia, flushing, and dyspnea may occur—can be prevented by pretreating with reserpine.

Peripheral edema may require diuretics.

May produce lupus erythemato-sus–like syndrome

Tachycardia, angina pectoris, ECG changes, edema

Front 129

Vasodilator: minoxidil (Loniten) action

Back 129

Direct vasodilatory action on arte-riolar vessels, causing decreased peripheral vascular resistance; reduces systolic and diastolic pressures

Front 130

Vasodilator: minoxidil (Loniten) advantage

Back 130

Hypotensive effect more pronounced than with hydralazine

No effect on vasomotor reflexes, so does not cause postural hypotension

Front 131

Vasodilator: minoxidil (Loniten) contraindication

Back 131

Contraindications:Pheochromocytoma

Front 132

Vasodilator: minoxidil (Loniten) side effects

Back 132

Causes hirsutismDizziness, headache, nausea, edema, tachycardia, palpitations

Front 133

Vasodilator: minoxidil (Loniten) nursing consideration

Back 133

Take blood pressure and apical pulse before administration.

Monitor intake and output and daily weights.

Front 134

Vasodilator: sodium nitroprusside (Nitropress) nitroglycerin action

Back 134

Peripheral vasodilation by relaxation of smooth muscle

Front 135

Vasodilator: sodium nitroprusside (Nitropress) nitroglycerin advantage

Back 135

Fast acting

Used only in hypertensive emergencies

Front 136

Vasodilator: sodium nitroprusside (Nitropress) nitroglycerin contraindication

Back 136

Contraindications:Sepsis, azotemia, high intracranial pressure

Front 137

Vasodilator: sodium nitroprusside (Nitropress) nitroglycerin side effect

Back 137

Can cause thiocyanate and cyanide intoxication

Front 138

ACE Inhibitors drug list

Back 138

benazepril (Lotensin)

captopril (Capoten)

enalapril (Vasotec)

enalaprilat (Vasotec IV)

fosinopril (Monopril)

lisinopril (Prinivil, Zestril)

moexipril (Univasc)

perindopril (Aceon)

quinapril (Accupril)

ramipril (Altace)

trandolapril (Mavik)

Front 139

ACE Inhibitors action

Back 139

Fewer cardiovascular side effects

Can be used with thiazide diuretic and digitalis

Front 140

ACE Inhibitors advantage

Back 140

Fewer cardiovascular side effects

Can be used with thiazide diuretic and digitalis

Hypotension can be reversed by fluid replacement.

Front 141

ACE Inhibitors contraindication

Back 141

Contraindications: Renal impairment, pregnancy

Front 142

ACE Inhibitors side effects

Back 142

Angioedema is a rare but potentially life-threatening complication.

Front 143

ACE Inhibitors nursing consideration

Back 143

Gerontologic considerations:Require reduced dosages and the addition of loop diuretics when there is renal dysfunction

Front 144

Angiotensin II Receptor Blockersn drug list

Back 144

Azilsartan medoxomil (Edarbi)

candesartan (Atacand)

eprosartan (Teveten)

irbesartan (Avapro)

losartan (Cozaar)

olmesartan (Benicar)

telmisartan (Micardis)

valsartan (Diovan)

Front 145

Angiotensin II Receptor Blockers action

Back 145

Block the effects of angiotensin II at the receptorReduce peripheral resistance

Front 146

Angiotensin II Receptor Blockers advantage

Back 146

Minimal side effects

Front 147

Angiotensin II Receptor Blockers contraindication

Back 147

Contraindications:Pregnancy, lactation, renovascular disease, hypersensitivity reaction to other ARBs

Front 148

Angiotensin II Receptor Blockers nursing consideration

Back 148

Monitor for hyperkalemia.

Front 149

Calcium Channel Blockers classes

Back 149

Nondihydropyridines

Dihydropyridines

Front 150

Calcium Channel Blockers: Nondihydropyridines drug list

Back 150

diltiazem extended release (Cardizem CD, Dilacor XR, Tiazac)

diltiazem long acting (Cardizem LA)

verapamil immediate release (Calan, Isoptin)

verapamil long acting (Calan SR, Isoptin SR)

verapamil (Covera-HS, Verelan PM)

Front 151

Calcium Channel Blockers: Nondihydropyridines

-diltiazem action

Back 151

Inhibit calcium ion influx Reduce cardiac afterload

Front 152

Calcium Channel Blockers: Nondihydropyridines-diltiazem advantage

Back 152

Inhibit coronary artery spasm not controlled by beta-blockers or nitrates

Front 153

Calcium Channel Blockers: Nondihydropyridines-diltiazem contraindication

Back 153

Contraindications: Sick sinus syndrome, AV block, hypotension, heart failure

Front 154

Calcium Channel Blockers: Nondihydropyridines-diltiazem nursing consideration

Back 154

Do not discontinue suddenly.

Observe for hypotension.

Report irregular heartbeat, dizziness, edema.

Instruct on regular dental care because of potential gingivitis.

Front 155

Calcium Channel Blockers: Nondihydropyridines - verapamil action

Back 155

Inhibit calcium ion influx

Slow velocity of conduction of cardiac impulse

Front 156

Calcium Channel Blockers: Nondihydropyridines - verapamil advantage

Back 156

Effective antiarrhythmicRapid IV onsetBlock SA and AV node channels

Front 157

Calcium Channel Blockers: Nondihydropyridines - verapamil contraindication

Back 157

Contraindications: Sinus or AV node disease, severe heart failure, severe hypotension

Front 158

Calcium Channel Blockers: Nondihydropyridines - verapamil nursing consideration

Back 158

Administer on empty stomach or before meal.

Do not discontinue suddenly.

Depression may subside when medication is discontinued.

To relieve headaches, reduce noise, monitor electrolytes

Decrease dose for patients with liver or renal failure.

Front 159

Calcium Channel Blockers: Dihydropyridines

- amlodipine action

Back 159

Inhibit calcium ion influx across membranes

Vasodilatory effects on coronary arteries and peripheral arteriole

Decrease cardiac work and energy consumption, increase delivery of oxygen to myocardium

Front 160

Calcium Channel Blockers: Dihydropyridines- amlodipine advantage

Back 160

Rapid action

Effective by oral or sublingual route

No tendency to slow SA nodal activity or prolong AV node conduction

Isolated systolic hypertension

Front 161

Calcium Channel Blockers: Dihydropyridines- amlodipine containdication

Back 161

Contraindications: None (except heart failure for nifedipine)

Front 162

Calcium Channel Blockers: Dihydropyridines- amlodipine nursing consideration

Back 162

Administer on empty stomach.

Use with caution in patients with diabetes.

Small frequent meals if nausea

Muscle cramps, joint stiffness, sexual difficulties may disappear when dose decreased.

Report irregular heartbeat, constipation, shortness of breath, edema.

May cause dizziness

Front 163

Calcium Channel Blockers: Dihydropyridines - clevidipine (Cleviprex) action

Back 163

Calcium channel antagonist causing rapid vasodilation

Front 164

Calcium Channel Blockers: Dihydropyridines - clevidipine (Cleviprex) advantages

Back 164

Rapid acting with additional capacity for vasodila-tion; given IV

Front 165

Calcium Channel Blockers: Dihydropyridines - clevidipine (Cleviprex) contraindication

Back 165

Contraindications:Allergies to soybeans, soy products, eggs or egg products; impaired lipid metabolism as might be seen with pancreatitis and other hyperlipidemias; severe aortic stenosis

Front 166

Calcium Channel Blockers: Dihydropyridines - clevidipine (Cleviprex) nursing consideration

Back 166

Monitor carefully for hypotension and tachycardia; there is risk of rebound hypertension, so careful monitoring after cessation of treatment is indicated.

Front 167

Direct Renin Inhibitors drug list

Back 167

aliskiren (Tekturna)

Front 168

Direct Renin Inhibitors action

Back 168

Blocks the conversion of angi-otensinogen to angiotensin I by inhibiting the activity of the enzyme renin

Front 169

Direct Renin Inhibitors advantage

Back 169

Given once daily for mild to moderate high blood pressure with minimal side effects

Headaches, dizziness, and diarrhea are most frequent side effects.

Angioedema is a rare but potentially life-threatening complication.

Front 170

Direct Renin Inhibitors contraindication

Back 170

Contraindicated in pregnancy; has not been studied in persons with diminished renal function

Front 171

Direct Renin Inhibitors nursing consideration

Back 171

Monitor for hyperkalemia and hypotension.

Front 172

target organ

Back 172

Manifestations of ____________ damage may include angina; shortness of breath; alterations in speech, vision, or balance; nosebleeds; headaches; dizziness; or nocturia.

Front 173

Hypertension Nursing Disagnoses

Back 173

Deficient knowledge regarding the relation between the treatment regimen and control of the disease process

• Noncompliance with therapeutic regimen related to side effects of prescribed therapy Collaborative Problems/Potential Complications Potential complications may include the following:

• Left ventricular hypertrophy

• Myocardial infarction

• Heart failure

• TIA

• Cerebrovascular accident (stroke or brain attack)

• Renal insufficiency and failure

• Retinal hemorrhage

Front 174

major goals

Back 174

The____________ for the patient include understanding of the disease process and its treatment, participation in a self-care program, and absence of complications.

Front 175

Nurse's role

Back 175

The _______ ____ is to support and educate the patient about the treatment regimen, including making lifestyle changes, taking medications as prescribed, and scheduling regular follow-up appointments with the patient’s primary provider to monitor progress or identify and treat any complications of disease or therapy.

Front 176

2 to 3 months

Back 176

Explaining that it takes _______months for the taste buds to adapt to changes in salt intake may help the patient adjust to reduced salt intake.

Front 177

Hypertension modifiable risk factors

Back 177

smoking

obesity

alcohol intake

high dietary intake of saturated fats or sodium

sedentary lifestyle

stress

diabetes mellitus

Front 178

Hypertension non-modifiable risk factors

Back 178

age

gender

heredity

ethnicity

Front 179

Heart failure initial therapy option

Back 179

thiaz

BB

ACE-I

ARB

ALDO ANT

Front 180

port Myocardial infarction option

Back 180

BB

ACE-I

ALDO ANT

Front 181

HIGH CARDIOVASCULAR DISEASE RISK option

Back 181

THIAZ

BB

ACE-I

CCB

Front 182

diabetes option for hypertension

Back 182

THIAZ

BB

ACE-I

CCB

ACE-I and ARB

Front 183

Chronic kidney disease

Back 183

ACE-I,

ARB

Front 184

recurrent stroke prevention

Back 184

THIAZ

ACE-I

Front 185

thiazide diuretic

Back 185

A ____________ may be used initially alone or with another drug; it will cause a depletion of extracellular fluid.

Front 186

morning

Back 186

The client may be instructed to take this medication in the _________ so that sleep will not be disrupted due to frequent urination.

Front 187

thiazide diuretic

Back 187

a _____________ may not be given to those patients who have diabetes mellitus because it may elevate blood glucose levels.

Front 188

angiotensin converting inhibitor (ACE inhibitor)

Back 188

this drug blocks the conversion of aniotensin I to angiotensin II, which is a potent vasoconstrictor

Front 189

beta-adrenergic blocker

Back 189

This drug blocks the sympathetic nervous system, slowing the heart rate and decreasing the blood pressure.

Front 190

Angiotensin II receptor blocker(ARB)

Back 190

decrease peripheral vascular resistance and block angiotensin II.

Front 191

direct arteriole dilators

Back 191

Cause peripheral dilation and decrease peripheral vascular resistance

Front 192

calcium channel blockers

Back 192

reduce afterload and inhibit calcium ion reflux