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24 Cards in this Set

  • Front
  • Back
There are two broad categories for hypertension primary and secondary. What is the difference between the two?

How are both treated?
Primary hypertension (essential hypertension), defined as hypertension with no identifiable cause, is the most common form of hypertension. Primary hypertension can lead to significant morbidity.

Secondary hypertension is defined as an elevation of BP brought on by an identifiable primary cause. Secondary hypertension, which usually occurs as a consequence of another disease process, also can lead to significant morbidity.

Both are treated with antihypertensives and diuretics
Untreated hypertension can lead to ___ ____, ____ ____, or __________.
heart disease
kidney disease
• Evaluation of patients with hypertension has two major objectives. Specifically, we must assess for
1) identifiable causes of hypertension, and (2) factors that increase cardiovascular risk. To aid evaluation, diagnostic tests are required.
The ultimate goal in treating hypertension is to reduce _______and ____ morbidity and mortality.
The goal for hypertensive patients in therapy (used to decrease mortalitity and morbidity)

what BP's want to maintained both for a normal person and for a diabetic?
maintaining BP below 140/90 mm Hg or below 130/80 mm Hg for those with diabetes or chronic kidney disease.
With aging, ______blood pressure tends to rise. The primary cause of this is a ______ in compliance and an ______ in stiffness of the large arteries.
Physiological factors that affect BP control include:
Cardiac output
peripheral vascular resistance
baroreceptor reflex, kidneys, and RAAS system
How does Cardiac output affect BP?
An increase in HR, contractlility, blood volume, or venous return to heart will increase BP.
In reference to peripheral resistance
arteriole constriction is going to increase BP so what is given to decrease?
baroreceptor reflex kidneys, and RAAS system can oppose our attempts to lower BP with drugs.

how these be corrected?
We can counteract the baroreceptor reflex with a beta blocker

the kidneys with a diuretic

the RAAS with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), direct renin inhibitor (DRI), or aldosterone antagonist.
As an antihypertensive how can beta blockers be used to decrease BP?

What AE is possible with this beta blockade if ther is already an AV block?
(eg, propranolol) appear to lower BP primarily by reducing peripheral vascular resistance; the mechanism is unknown. They may also lower BP by decreasing myocardial contractility and suppressing reflex tachycardia (through beta1 blockade in the heart) and by decreasing renin release (through beta1 blockade in the kidney). Because of beta1 receptor blockade, use of beta blockers can result in reduced atrioventricular conduction or could intensify already existing AV block.
Clonidine (Catapres) is a centrally acting Alpha 2 agonist, can cause dry mouth, drowsiness (sedation), and constipation.

What are the more serious AE's it can cause?
Clonidine can also cause severe rebound hypertension.

Because it causes vasodilation of the skin, it can also cause flushing.
Thiazide diuretics (eg, hydrochlorothiazide) and loop diuretics (eg, furosemide) reduce BP in two ways: they reduce blood volume (by promoting diuresis), and they reduce arterial resistance (by an unknown mechanism). Both loops and thiazides are potassium ________ and can exacerbate hypokalemia. Thiazides can elevate blood glucose.
Loop diuretics should be reserved for two situations what are they?
1) patients who need greater diuresis than can be achieved with thiazides and (2) patients with a low glomerular filtration rate (GFR) (because thiazides don’t work when GFR is low).
ACE Inhibitors may cause hyperkalemia and are contraindicated with ______ _______ ________, which also cause hyperkalemia. ACE Inhibitors may be given with thiazide diuretics to help eliminate some of the potassium in the body. ACE Inhibitors may also be given with beta blockers and calcium channel blockers, because these are not contraindicated.
potassium sparing diuretics
_______ can affect blood pressure by blunting the effect of antihypertensive medications.
________ diuretics are preferred drugs for initial therapy of uncomplicated hypertension in order to reduce blood volume and arterial resistance (as long as the patient does not have renal failure
Patients with comorbid conditions, such as renal _______and ______, require special considerations regarding drugs selection. See Tables 46-7 and 46-8.
renal disease

Although all antihypertensive drugs are effective in older adults, only two kinds (______ ______ and _____) have been shown in controlled trials to reduce morbidity and mortality.
beta blockers and diuretics
Why are beta blockers cardio protective?
they decrease heart rate and contractility
Thiazide diuretics tend to be effective in______ ____ as antihypertensive agents.

Alpha 1, alpha/beta, and alpha 2 blockers should not be used in older adults
older adults
What is considered a hypertensive emergency in terms of diastolic BP and ongoing end-organ damage.
120 mm Hg Diastolic
What is the DOC for hypertensive emergencies?
Nitroprusside (Nitropress)
__________ is a drug of choice for treating chronic hypertension of pregnancy. . The drug of choice for lowering blood pressure in a woman with severe pre-eclampsia is _______.
Methyldopa (Aldomet)