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40 Cards in this Set
- Front
- Back
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What is the formula for blood pressure?
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BP = CO * TPR
CO (cardiac output) TPR (total peripheral resistance) |
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What is secondary HTN?
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results from a known, specific underlying pathology
*treat the pathology to treat the HTN* |
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What is primary/essential HTN?
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lower the BP itself because there is no known cause
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What is HTN?
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sustained, reproducible increase in BP
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What is CO?
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cardiac output
- total blood ejected/cardiac contraction |
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What is TPR?
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total peripheral resistance
- resistance of all systemic vasculature (depends on the radius of the BVs) |
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What are 5 ways to treat essential/primary HTN?
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1. diuretics
2. sympatholytic drugs (adrenergic antagonists) 3. vasodilators 4. renin-angiotensin system inhibitors 5. calcium channel blockers |
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What is a diuretic?
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drug that increases formation and excretion of urine
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What are the 3 major types of diuretics?
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1. thiazide (hydrochlorothiazide or HCTZ, Esidrix)
2. Loop (furosemide, Lasix) 3. Potassium sparing (spironolactone, Aldactone) |
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What is the function of Thiazide? How does it accomplish this function?
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Thiazide inhibits Na+ reabsportion
- causes water to be retained in NEPHRON - result = increased water and Na+ excretion |
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What is the function of Loop diuretics? What does it cause?
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- Loop diuretics inhibit Na+ reabsorption
- causes increased water excretion |
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What is the first line of defense for HTN? (2)
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1. reduce the volume
2. reduce the pressure in the vessels |
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What is the function of potassium (K+) sparing diuretics?
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allows Na+ to remain in the nephron (thus being excreted) but prevents K+ from being secreted from the body into the nephron (K+ remains IN THE BODY)
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When taking potassium sparing diuretics, what should a person avoid?
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avoid using other aldosterone antagonists (ACE inhibitors, angiotensin receptor antagonists
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What are 2 mechanisms for developing hypokalemia?
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1. increased Na+ along the loop causes the K+/Na+ pump to become more active, which allows K+ out of the body
2. increased flow rate causes the electrochemical gradient to be altered to favor K+ secretion |
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What are 3 adverse effects of diuretics?
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1. volume depletion
2. electrolyte inbalance 3. impaired glucose metabolism |
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What makes volume depletion an adverse effect of diuretics?
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cause reflex increase in CO/TPR (via baroreflex) or activates the renin-angiotensin system putting an increased demand on cardiac muscle
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What makes electrolyte imbalance an adverse effect of diuretics?
HINT: electrolyte = potassium |
- hypokalemia can result from Thiazide and loop diuretic use
- hyperkalemia can result from K+ sparing diuretic use (avoid K+ supplements and high K+ foods such as salt substitutes) |
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What makes impaired glucose metabolism an adverse effect of diuretics?
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thiazide diuretics may cause patients with DM to have hyperglycemia
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What is a vasodilator?
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drug that vasodilates peripheral vasculature
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How does a vasodilating drug decrease blood pressure?
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by decreasing peripheral vasculature resistance, it decreased blood pressure (BP = CO * TPR)
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What is the mechanism of vasodilators?
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directly inhibits vascular smooth muscle
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What are examples of vasodilating drugs?
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Minoxidil (Loniten): used for maintanence
Nitroprusside (Nipride, Nitropres): for emergent use |
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When are vasodilators used?
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a person has HTN for a period of time and it is not coming down
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Are vasodilators a popular choice for treating HTN?
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they are not a first choice
1. added later if diuretics/beta blockers aren't effective 2. used emergently |
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What are adverse effects of vasodilators?
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- reflex tachycardia
- dizziness - hypotension - weakness - nausea - fluid retention - HA |
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What are 2 examples of renin-angiotensin system inhibitors?
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1. angiotensin - converting enzyme (ACE) inhibitors
2. angiotensin II inhibitors (angII receptor blockers) |
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What are examples of ACE inhibitors?
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"-pril"
lisinopril Zestril |
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What are examples of Ang II receptor blockers?
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losartan
Cozaar |
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What is the mechanism of action for the antiotensin II inhibitors?
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inhibit renin-angiotensin system
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What is the advantage of using an AngII receptor blocer of other anti-HTN meds?
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lower incidence of adverse effects (reflex tachycardia, orthostatic hypotension) than other anti-HTN drugs
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Do Ang II receptor blockers have side effects?
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cause minor side effects but serious adverse effects are rare
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What are renin-angiotensin system inhibitors good for?
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heart failure and essential HTN
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What are 2 ways (looking at the renin-angiotensin system chart) to inhibit this system?
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1. stop the conversion of angiotensinogen to ang 1
2. stop the conversion of ang 1 to ang 2 |
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What is a calcium channel blocker?
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a drug that selectively blocks Ca+ engry into smooth muscle cells
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What happens with a calcium channel blocker?
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- inhibits vascular contraction (leads to vasodilation and decreased vascular resistance)
- inhibits cardiac contraction (decreased HR and contraction force which decreased BP) |
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What are conditions other than HTN that calcium channel blocker are used for?
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arrhythmias
angina |
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What are some adverse effects of calcium channel blockers?
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associated with increased risk of MI
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What are PT considerations for anti-HTN drugs? (4)
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1. primary side effects to watch for during mobility/exercise: hypotension, orthostatic hypotension
2. be careful with treatments that produce widespread vasodilation if patient is on vasodilator drugs (systemically applied heat) 3. beta blockers blunt increase HR normally seen with exercise -- use other methods to gauge exercise intensity 4. PT encourages compliance in meds and non-pharm treatments of HTN |
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What are examples of non-pharm treatments for HTN?
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- diet
- cease smoking - stress management - exercise |
