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68wm6 p2 hypertens

Hypertension

QuestionAnswer
Hypertension occurs when the BP reaches a sustained elevation of what? *Systolic of 140mmHg 140+ *Diastolic of 90 mmHg 90+ (one or both)
Diagnosis of hypertension is based on the average of what? two separate readings on two separate occasions.
What pressure is the greatest force caused by the contraction of the left ventricle? Systolic BP
What pressure occurs during the relaxation phase between heartbeats? Diastolic BP
What is arterial blood pressure is determined by? the pressure exerted by the blood on the vessel walls
The two primary factors determining pressure exerted in the arteries *Blood flow *Peripheral vascular resistance
What determines peripheral vascular resistance? determined by the diameter of the vessel and viscosity of the blood
Blood flow and peripheral vascular resistance play an important role in regulating what? Blood Pressure
Increased peripheral vascular resistance results from what? vasoconstriction and/or narrowing of the lumen of the peripheral blood vessel
What controls vasoconstriction and vasodilation? *The sympathetic nervous system *The renin-angiotensin system of the renal system
How does the sympathetic nervous system affect cosoconstriction/dilation? Releases epinephrine and norepinephrine that result in vasoconstriction and increased peripheral vascular resistance.
What stimulates the renin-angiotensin system? Low blood flow to the kidneys.
What leads to the formation of angiotensin? Renin
What Stimulates the release of aldosterone (salt/water retaining hormone)? Angiotensin
What causes primary (essential) hypertension? Actual cause is unknown. Theories include: arteriolar changes, sympathetic nervous system, hormonal influence (RAAS). GENETIC FACTORS, HIGH BODY WEIGHT, SEDENTARY LIFESTYLE, INCREASED SODIUM INTAKE, EXCESSIVE ALCHOHOL INTAKE.
Primary (essential) Hypertension constitutes what percentage of cases of hypertension? 90% - 95%
Angiotensin is released from what? The lungs
What are the NON-modifiable risk risk factors of hypertension? *Age *Sex *Race *Family history
What age is at higher risk of hypertension? Age 30+
True or False: African-americans are at a higher risk of hypertension than caucasian americans True. They are at 2x greater risk.
Untreated, prolonged essential hypertension will cause what? *The elastic tissue in the arterioles to be replaced by fibrous tissue. *decreased tissue perfusion resulting in deterioration of major organs.
True or False: Like primary hypertension, secondary hypertension has no definative cause False. Its attributable to an identifiable medical diagnosis
How does renal vascular disease affect secondary hypertension? affects renin and sodium that results in increased vascular volume.
How does primary aldosteronism affect hypertension? causes sodium and water retention. excess secretion of catecholamines increases peripheral vascular resistance.
How does cushings syndrome affect hypertension? increased blood volume.
How does Pheochromocytoma affect hypertension?
Hypertension occurs when the BP reaches a sustained elevation of what? *Systolic of 140mmHg 140+ *Diastolic of 90 mmHg 90+ (one or both)
Diagnosis of hypertension is based on the average of what? two separate readings on two separate occasions.
What pressure is the greatest force caused by the contraction of the left ventricle? Systolic BP
What pressure occurs during the relaxation phase between heartbeats? Diastolic BP
What is arterial blood pressure is determined by? the pressure exerted by the blood on the vessel walls
The two primary factors determining pressure exerted in the arteries *Blood flow *Peripheral vascular resistance
What determines peripheral vascular resistance? determined by the diameter of the vessel and viscosity of the blood
Blood flow and peripheral vascular resistance play an important role in regulating what? Blood Pressure
Increased peripheral vascular resistance results from what? vasoconstriction and/or narrowing of the lumen of the peripheral blood vessel
What controls vasoconstriction and vasodilation? *The sympathetic nervous system *The renin-angiotensin system of the renal system
How does the sympathetic nervous system affect cosoconstriction/dilation? Releases epinephrine and norepinephrine that result in vasoconstriction and increased peripheral vascular resistance.
What stimulates the renin-angiotensin system? Low blood flow to the kidneys.
What leads to the formation of angiotensin? Renin
What Stimulates the release of aldosterone (salt/water retaining hormone)? Angiotensin
What causes primary (essential) hypertension? Actual cause is unknown. Theories include: arteriolar changes, sympathetic nervous system, hormonal influence (RAAS). GENETIC FACTORS, HIGH BODY WEIGHT, SEDENTARY LIFESTYLE, INCREASED SODIUM INTAKE, EXCESSIVE ALCHOHOL INTAKE.
Primary (essential) Hypertension constitutes what percentage of cases of hypertension? 90% - 95%
Angiotensin is released from what? The lungs
What are the NON-modifiable risk risk factors of hypertension? *Age *Sex *Race *Family history
What age is at higher risk of hypertension? Age 30+
True or False: African-americans are at a higher risk of hypertension than caucasian americans True. They are at 2x greater risk.
Untreated, prolonged essential hypertension will cause what? *The elastic tissue in the arterioles to be replaced by fibrous tissue. *decreased tissue perfusion resulting in deterioration of major organs.
True or False: Like primary hypertension, secondary hypertension has no definative cause False. Its attributable to an identifiable medical diagnosis
How does renal vascular disease affect secondary hypertension? affects renin and sodium that results in increased vascular volume.
How does primary aldosteronism affect hypertension? causes sodium and water retention. excess secretion of catecholamines increases peripheral vascular resistance.
How does cushings syndrome affect hypertension? increased blood volume.
How does Pheochromocytoma affect hypertension? excess secretion of catecholamines increases peripheral vascular resistance.
How does Coarctation (narrowing) of the aorta affect hypertension? marked elevation of B/P in upper extremities with decrease perfusion to lower extremities.
What is malignant hypertension? Severe RAPIDLY PROGRESSING elevation in blood pressure (diastolic > 120 mmHg).
What is the most distinguishing feature of malignant hypertension? inflammation of the arterioles in the eyes (arteriolitis)
Who is malignant hypertension most common in? Black males under 40
What does malignant hypertension damage? Small arterioles (Most notably in major organs, heart, kidneys, brain, eyes)
True or False: Unless medical treatment is successful, the course of malignant hypertension is rapidly fatal TRUE
What physiological event is responsible for the most damage to organs with malignant hypertension? Damage to the small arterioles
Hypertension is often asymptomatic until when? vascular changes in the target organs occur
S/S of advanced hypertension *Awakening with a headache. *Blurred vision. *Spontaneous epistaxis.
What is the leading risk factor for hypertension? Smoking
What is Angioedema? facial swelling and dyspnea
What is a potential side effect of ACE inhibitors? Angioedema
A low dietary intake of ______ and ______ may be linked to hypertension Calcium and Magnesium
To prevent hypertension, a man of normal weight should consume no more than how much ethanol a day? What does that amount equivilate to? A woman should limit it to how much? 1 ounce of ethanol a day. That is equivalent to 24 oz of beer, 10 oz of wine and 2 oz of 100 proof whiskey. A woman should limit it to half this amount.
What is the recommended sodium intake per day? 2-4g a day (2000mg - 4000mg)
What is the therapeutic goal of antihypertensive agents? Prevention of end-organ damage
How are antihypertensive drugs classified? By their site of action
What are some precautions to look for prior to administration of antihypertensives? Pregnancy, lactation, and digoxin therapy.
What are the side effects of antihypertensives? CNS: headache. CV: hypotension, bradycardia, tachycardia. GI: nausea, vomiting.
Question: The doctors orders call for you to administer a beta-blocker. The PTs vitals are Resp:15, HR:57, BP:156/98, O2SaT:98%, Temp:98.6.... What is your course of action? Notify the physician of the clients low heart rate. Bradycardia is a side effect of beta-blockers and the drug can make it worse.
list three things that can negate the therapeutic effects of antihypertensives *Antihypertensives. *Antihistamines. *NSAIDs. *Bronchodilators. *Decongestants. *Appetite suppressants. *Antidepressants. *MAO inhibitors *Hypokalemia increases risk of digoxin toxicity.
What antihypertensive my cause an increase in blood glucose and a false positive for coombs? Andrenergics
When is the last dose of the day of clonodine administered? at bedtime
How often should transdermal clonodine be administered? once every 7 days
In the perioperative setting, continue clonidine up to _____ prior to surgery and resume _____ thereafter. 4hrs, As soon as possible
True or False: Transdermal clonodine is the only clonodine you can use during surgury True. Transdermal clonodine should not be interrupted for surgury.
How often should PTs on antihypertensives moniter their BP? Weekly
What controls arrhythmias without appearance of detrimental side effects Beta-blockers
What decreases frequency and severity of angina attacks? Beta-blockers and calcium channel blockers
What are andrenergics used for management of mild to moderate hypertension
What is the action of adrenergics? potent vasodilator; improves myocardial contraction and reduces pulmonary congestion.
Clonodine is a _____ adrenergic antihypertensive
How much clonodine (adrenergic) is eliminated through the kidneys unchanged? 40% - 50%
what are Angiotensin-Converting Enzyme (ACE) Inhibitors used for? *Hypertension. *Management of symptomatic heart failure *Slowed progression of asymptomatic left ventricular dysfunction to overt heart failure
What is the action of ACE inhibitors? *Block the conversion of angiotensin I to the vasoconstrictor angiotensin II. *Prevent the degradation of bradykinin and vasodilatory prostaglandins. *Increase plasma renin levels, reduce aldosterone levels. *NET RESULT IS SYSTEMIC VASODILATION!
Give three examples of ACE inhibitors The 'PRILs': benazepril, captopril, enalapril, fosinopril, Monopril, lisinopril, quinapril, Accupril, Moexipril, vamipril
True or False: ACE inhibitors is the only antihypertensive safe for pregnancy? False. ALL ACE inhibitors cross the placenta.
True or False: ACE inhibitors are commonly used with surgical procedures False. They commonly exaggerate hypotension.
What increases the risk of hyperkalemia when taken with ACE inhibitors? Potassium supplements and potassium sparing diuretics.
What blunts the antihypertensive effects of ACE inhibitors when taken with them? NSAIDs
What can increased levels/consumption of ACE inhibitors cause? Lithium toxicity
: A patient who has just begun taking an ACE inhibitor telephones the nurse and reports feeling very dizzy when standing up and wonders if she should discontinue the medication. How should the nurse respond? b; Dizziness is a common initial side effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling.
What is the use of Angiotensin II Receptor Antagonists? *Hypertension *Tx of type 2 diabetic neuropathy in patients with type 2 diabetes and hypertension. *Management of CHF in PT who cant tolerate ACE inhibitors. *Reduced risk of stroke in PTs with CHF and left ventricular hypertrophy
What is a more preferred antihypertensive for patients with diabetes? Angiotensin II Receptor Antagonists
What is the action of Angiotetan II Receptor Antagonists? blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II at various receptor sites including vascular smooth muscle and the adrenal glands. BLOCKS VASOCONSTRICTION
What are some examples of Angiotetan II Receptor Antagonists? *The 'tans' *iosartan (Cozaar). *irbesartan (Avapro). *valsartan (Diovan).
What blunts the antihypertensive effects of Angiotetan II Receptor Antagonists when taken along side them? NSAIDs
What increases the risk of hyperkalemia when taken with Angiotetan II Receptor Antagonists? Potassium supplements, angiotensin-converting enzyme inhibitors, and potassium sparing diuretics.
What are the uses for Beta-blockers? *Hypertension *Angina pectoris *tachyarrhythmias *Hypertrophic subaortic stenosis *Migraine headache (prophylaxis) *MI (prevention) *Glaucoma (ophthalmic) *CHF *Hyperthyroidism.
What is the action of Beta-blockers? Competes with adrenergic (sympathetic) neurotransmitters for adrenergic receptor sites.
Where are the Beta 1 adrenergic receptor sites that beta-blockers compete for located? located chiefly in the heart where stimulation results in increased heart rate, contractility, and AV conduction.
Are beta blockers Antiarrhythmic or Antihypertensive? Beta-blockers are BOTH Antiarrhythmic and Antihypertensive
What are some examples of beta blockers? *The 'lols' *acebutolol HCI (Sectral). *atenolol (Tenormin). *carvedilol (Coreg). *esmolol HCI (Brevibloc). *metoprolol (Lopressor).
Beta-blockers used with insulin can cause what? Prolongued hypoglycemia
Beta-blockers used with ______ can increase bradycardia Digoxin
Propranolol (Inderal), a beta adrenergic blocker, controls hypertension by: The beta-adrenergic blocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This will result in a decrease in heart rate, cardiac output, and blood pressure.
What are the uses of calcium channel blockers? *Hypertension *Angina pectoris *Vasospastic (Prinzmetal's) angina.
What is the action of calcium channel blockers? inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.
What calcium channel blockers may increase serum digoxin levels and cause toxicity? Verapamil and diltiazem
What increases levels and effects of calcium channel blockers? Grapefruit juice
What are the uses for Beta-blockers? *Hypertension *Angina pectoris *tachyarrhythmias *Hypertrophic subaortic stenosis *Migraine headache (prophylaxis) *MI (prevention) *Glaucoma (ophthalmic) *CHF *Hyperthyroidism.
What is the action of Beta-blockers? Competes with adrenergic (sympathetic) neurotransmitters for adrenergic receptor sites.
Where are the Beta 1 adrenergic receptor sites that beta-blockers compete for located? located chiefly in the heart where stimulation results in increased heart rate, contractility, and AV conduction.
Are beta blockers Antiarrhythmic or Antihypertensive? Beta-blockers are BOTH Antiarrhythmic and Antihypertensive
What are some examples of beta blockers? *The 'lols' *acebutolol HCI (Sectral). *atenolol (Tenormin). *carvedilol (Coreg). *esmolol HCI (Brevibloc). *metoprolol (Lopressor).
Beta-blockers used with insulin can cause what? Prolongued hypoglycemia
Beta-blockers used with ______ can increase bradycardia Digoxin
Propranolol (Inderal), a beta adrenergic blocker, controls hypertension by: The beta-adrenergic blocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This will result in a decrease in heart rate, cardiac output, and blood pressure.
What are the uses of calcium channel blockers? *Hypertension *Angina pectoris *Vasospastic (Prinzmetal's) angina.
What is the action of calcium channel blockers? inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.
What calcium channel blockers may increase serum digoxin levels and cause toxicity? Verapamil and diltiazem
What increases levels and effects of calcium channel blockers? Grapefruit juice
What is the action of aldosterone antagonists? blocks sodium-retaining and potassium excreting properties of aldosterone. (potassium sparing)
What sulfonomide (loop diuretics) acts rapidly for less responsive edema? bumetanide (Bumex)
Why must bumetanide (Bumex) and furosemide (Lasix) be administered in the AM? To prevent nocturia
What sulfonomide (loop diuretic) controls general edema? furosemide (Lasix)
What diuretic is safer for long term use and blocks sodium and water reabsorbtion in the renal tubules? (increases renal secretion of sodium) *Thiazides *chloroTHIAZIDE (Diuril) and hydrochloroTHIAZIDE (Esidrix).
a PT with a Hx of cardiac insufficiency C/O SoB. The nurse auscultates his lungs and notes bilateral crackles throughout both fields and bilateral +2 edema of lower extremities. The nurse anticipates his health care provider will prescribe ______ Diuretic; Diuretics are the mainstays of treatment in heart failure and hypertension (fluid in the lungs and peripheral edema indicate heart failure)
What is the BP range for prehypertension? *120-139mmHg systolic *80-89mmHg diastolic
How does high blood pressure increase the workload of the heart? High blood pressure damages the arteries and causes an increased resistance of the arterioles to the flow of blood
What is a serious side effect of the vasodilator nitroprusside (Nitropress)? Cyanide toxicity
What is the most serious side effect of the vasodilator nesiritide (Natrecor)? Ventricular dysrhythmias
Antihypertensive drug therapy for a stage 1 hypertensive African-American PT would most likely include which? (1 Vasodilators alone) (2 ACE inhibitors alone) (3 Calcium channel blockers with thiazide diuretic)(4 Beta-blockers with thiazide diuretic) c; Calcium channel blockers and diuretics have been shown to be more effective in African Americans than in white patients. Thiazide diuretics are also recommended for newly diagnosed stage 1 hypertension.
Created by: Shanejqb