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57 Cards in this Set
- Front
- Back
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5 points of the cardiovascular system
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Closed system
highest pressure-left ventricle lowest pressure- right atrium maintenance pressure system controled by brain and hormones help patient maintain blood pressure within normal limits |
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*elements determining blood pressure
3 physiological elements that effect blood pressure |
heart rate
stroke volume -amount of blood that is pumped out out of the ventricle with each heartbeat total peripheral resistance -resistance of the muscular arteries to the blood being pumped through them |
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Barateceptors
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aorta
carotid arteries send information to the brain -Vasodilation or vasoconstriction continual monitoring to maintain blood pressure |
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Renin-Angiotensin-Aldosterone System
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Compensatory system – kidneys
Renin released in kidney Converted to angiotensin I in liver Converted to angiotensin II in lung Raises peripheral resistance and BP Converted to antiotensin III on the way to adrenal gland Stimulates release of aldosterone in the adrenal gland Leads decrease in renin |
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Categories Rating the Severity of Hypertension
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normal <120 and<80
prehypertension 120-139 or 80-89 stage 1 hypertension 140-159 or90-99 stage 2 hypertension 160 or 100 |
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Risks for Coronary Artery Disease Related to Hypertension
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Thickening of the heart muscle
Increased pressure generated by the muscle on contraction Increased workload on the heart |
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*Conditions Related to Untreated Hypertension
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CAD(coronary artery desease) and cardiac death
Stroke Renal failure Loss of vision ED |
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why isHypertension a Silent Killer
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No s/s
All drugs used to treat have adverse effects Factors that increase blood pressure May have to be on more than one med Compliance is often problem |
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Potential Causes of Hypotensive States
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Heart muscle is damaged and unable to pump effectively
Severe blood loss; blood volume drops dramatically Extreme stress when body’s level of norepinephrine is depleted Body is unable to respond to stimuli to raise blood pressure |
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Stepped Care Approach to Treating Hypertension
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Step 1: lifestyle modifications are instituted
Step 2: drug therapy is added if the measures in step 1 are insufficient Step 3: drug dose or class may be changed or another drug added if the patient’s response is inadequate Step 4: includes all of the above measures with the addition of more antihypertensive agents until blood pressure is controlled |
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*Types of Drugs Used to Control Blood Pressure
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* first choice Diuretic: decreases serum sodium levels and blood volume
Beta-blocker: leads to a decrease in heart rate and strength of contraction as well as vasodilation ACE inhibitor: blocks the conversion of angiotensin I to angiotensin II; an angiotensin II receptor blocker; blocks effects of angiotensin on blood vessels Calcium channel blocker: relaxes muscle contraction or other autonomic blockers |
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ACE Inhibitors action
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(in lungs)Block ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss
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ACE Inhibitors indications
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Treatment of hypertension, CHF, diabetic nephropathy, and left ventricular dysfunction following an MI
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ACE Inhibitors Pharmacokinetics
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Well absorbed, widely distributed, metabolized in the liver, and excreted in the urine and feces
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ACE Inhibitors Contraindications
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Allergies
Impaired renal function Pregnancy and lactation |
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ACE Inhibitors Caution
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CHF(conjestive heart failure)
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ACE Inhibitors Adverse effects
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Related to the effects of vasodilation and alterations in blood flow
GI irritation Renal insufficiency Cough |
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ACE Inhibitors Drug-to-drug interaction
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Allopurinol
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Angiotensin II Receptor Blockers Action
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Selectively bind with angiotensin II receptor sites in vascular smooth muscle and in the adrenal gland to block vasoconstriction and the release of aldosterone
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Angiotensin II Receptor Blockers Indications
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Hypertension, CHF, slow progression of renal disease in patients with hypertension, and type 2 diabetes
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Angiotensin II Receptor Blockers Pharmacokinetics
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Well absorbed and undergo metabolism in the liver
Excreted in the urine and feces |
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Angiotensin II Receptor Blockers Contraindications
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Allergy, pregnancy, and lactation
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Angiotensin II Receptor Blockers Cautions
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Hepatic or renal dysfunction and hypovolemia
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Angiotensin II Receptor Blockers Adverse effects
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Headache, dizziness, syncope, and weakness
GI complaints Skin rash and dry skin |
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Angiotensin II Receptor Blockers Drug-to-drug interaction
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Phenobarbital
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Calcium Channel Blocker Action
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Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption
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Calcium Channel Blocker Pharmacokinetics
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Well absorbed, metabolized in the liver, and excreted in the urine
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Calcium Channel Blocker Indication
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Treatment of essential hypertension in the extended release form
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Calcium Channel Blocker Contraindications
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Allergy, heart block or sick sinus syndrome, renal or hepatic dysfunction, pregnancy, and lactation
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Calcium Channel Blocker Adverse effects
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Related to effects on cardiac output
GI symptoms Cardiovascular symptoms |
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Calcium Channel Blocker Contraindications
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Allergy, heart block or sick sinus syndrome, renal or hepatic dysfunction, pregnancy, and lactation
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Calcium Channel Blocker Adverse effects
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Related to effects on cardiac output
GI symptoms Cardiovascular symptoms |
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Calcium Channel Blocker Drug-to-drug interaction
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Cyclosporine
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Vasodilators Diazoxide (Hyperstat)
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increases blood glucose levels; used IV for hospitalized patients with severe hypertension
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Vasodilators Hydralazine (Apresoline)
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maintains increased renal blood flow
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Vasodilators Minoxidil (Loniten)
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used only for severe and unresponsive hypertension
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Vasodilators Nitroprusside (Nitropress)
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maintains hypertension during surgery; used for hypertensive crisis
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Vasodilators Action
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Act directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation and drop in blood pressure
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Vasodilators Indication
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Severe hypertension
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Vasodilators Pharmacokinetics
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Rapidly absorbed and widely distributed, metabolized in the liver, and primarily excreted in the urine
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Vasodilators Contraindications
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Allergy, pregnancy, lactation, and cerebral insufficiency
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Vasodilators Cautions
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Peripheral vascular disease, CAD, CHF, and tachycardia
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Vasodilators Adverse effects
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Related to changes in blood pressure
GI upset Cyanide toxicity |
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Vasodilators Drug-to-drug interactions
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Based on individual drugs
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Diuretic agents
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Increase excretion of sodium and water from kidney
Often first line treatment |
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Ganglionic blocker
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Blocks effect of acetylcholine
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Renal inhibitor – 2007
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Directly inhibits renin
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Sympathetic Nervous System Blockers
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Beta-blockers
Alpha-blockers Alpha-adrenergic blockers Alpha1-blockers Alpha2-agonists |
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Midodrine – Anti-Hypotensive Action
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Activates alpha-receptors in arteries and veins to enhance vascular tone and increase blood pressure
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Midodrine – Anti-Hypotensive Indication
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Symptomatic treatment of orthostatic hypotension
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Midodrine – Anti-Hypotensive Pharmacokinetics
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Absorbed from the GI tract, metabolized in the liver, and excreted in the urine
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Midodrine – Anti-Hypotensive Contraindications
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Supine hypertension, CAD, pheochromocytoma, and urinary retention
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Midodrine – Anti-Hypotensive Cautions
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Pregnancy and lactation
Visual problems |
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Midodrine – Anti-Hypotensive Adverse effect
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Related to stimulation of alpha-receptors
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Midodrine – Anti-Hypotensive Drug-to-drug interactions
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Cardiac glycosides, beta blockers, alpha-adrenergic agents, and corticosteroids
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Sympathetic Adrenergic Agonists or Vasopressors
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Treat hypotension or shock
Dobutamine (Dobutrex) Dopamine (Intropin) Ephedrine Epinephrine (Adrenalin) Isoproterenol (Isuprel) Norepinephrine (Levophed) Phenylephrine (Neo-Synephrine) |
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Alpha-Specific Adrenergic Agents
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Midodrine (ProAmatine)
Treats orthostatic hypotension Don’t use if have supine hypertension, CAD or pheochromocytoma |
