A&P > HT > Flashcards

HT Flashcards

(64 cards)

Study These Flashcards
1
Q

risks

A

Damage to kidney, heart, and brain:

Risk doubles starting at 115/75 and doubles with each increment of 20/10

Risk is higher with higher elevation

Higher risk in African Americans and Males

Smoking, obesity, dyslipidemia, physical activity, and family history increase risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

etiology

A

Most commonly caused by increase resistance to flow of blood

Genetic factors (30%), psychological stress, environmental and dietary factors (increased salt and decreased potassium or calcium intake).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PE

A

Monitor BP at home routinely

Report side effects

Do not skip doses or stop without MD

Rise slowly from reclining position

Caution operating cars/machinery

Caution with alcohol- dizziness, weakness, sleepiness, and confusion

Stop Smoking

Avoid hot tubs and hot showers

Exercise within limits

Take extended release products whole unless instructed otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

regulation of BP

A

Arterioles

Postcapillary Venules

Heart

Kidneys

Vasoactive substances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

diuretics

A

Deplete sodium and reduce blood volume

mild-moderate HT

Initially reduce cardiac output and may increase peripheral vascular resistance

After 6-8 weeks, cardiac output and vascular resistance return closer to normal

May help control sodium retention caused by sympathoplegic and vasodilator drugs

thiazides, loop diuretics, potassium sparing diuretics, osmotic agents

take before 6 PM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

blocked angiotension

A

Reduce peripheral vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

direct vasodilators

A

Relax smooth muscle and decrease resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

sympathoplegic

A

Reduce peripheral resistance, inhibit cardiac function, and increase venous pooling in capacitance vessels (reducing cardiac output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

thiazides

A

Chlorthalidone is more effective than hydrochlorothiazide because of the longer duration of action

Most frequently used diuretic
Increase excretion of HOH, Na, Cl, K

Uses:
Edema (Loop diuretic more common with Hypertension

Prophylaxis of calculus (stone) formation for patients with hypercalciuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

loop diuretics

A

More powerful than thiazides

Used in severe hypertension with multiple drugs with sodium retaining properties are used

Renal insufficiency (GFR less than 30-40 mL/min

Cardiac failure or cirrhosis- if sodium retention is high

act in loop of Henle in the kidney to inhibit Na and Cl reabsorption which inhibits waster reabsorption which increases urine formation

More rapid action than Thiazides with greater diuresis (but do not lower BP as well)

Uses:
Edema associated with impaired renal function, heart failure, or hepatic disease

Pulmonary Edema

Ascites caused by malignancy or cirrhosis

Hypertension- if thiazides are ineffective, usually combined with other antihypertensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

potassium sparing diuretics

A

Spironolactone and triamterene

Used when K depletion can be dangerous

May counteract increased glucose and uric acid levels (from thiazides/loops)

Diuretic of choice for cirrhosis

Seldom used alone, usually combined with thiazide

When used in combo K supplement is usually not needed

Still check electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diuretic toxicity

A

Potassium depletion (not K+ sparing)

Hazardous for patient on digoxin, patients with arrythmias, acute MI, or left ventricular dysfunction

Loss is coupled to reabsorption of Na+ so restriction Na+ may minimize K+ loss

Magnesium Depletion

Impair glucose tolerance

Increase serum lipid concentrations

Increase uric acid concentrations and gout

Hyperkalemia (increase K+) if K+ sparing

Renal insufficiency

ACE inhibitors and ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

thiazide SE

A

Hypokalemia, hyponatremia, hypercalcemia

Muscle weakness or spasm

GI- anorexia, nausea, vomiting, diarrhea

Postural hypotension, vertigo, headache

Fatigue, weakness, lethargy

Hyperglycemia and increased uric acid levels (gout)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

thiazides PC

A

Diabetes- may cause hyperglycemia and glycosuria

History of Gout

Severe renal disease

Impaired liver function

Prolonged use requires periodic electrolyte checks

Sulfonamide hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

thiazide PE

A

Diet to include posassium (bananas, OJ, ect) or supplements

Low sodium diet if for hypertension

Take with food if upset stomach

Take in AM to prevent nighttime bathroom trips

Rise slowly to prevent postural hypotension

Testing will be needed to monitor electrolytes

Photosensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

thiazide i/a

A

NSAIDs- reduces BP control

Corticosteroids- increase K loss

Lithium- causes lithium toxicity

Digoxin- increased risk of digoxin toxicity

Probenecid- blocks uric acid retention

Diabetic medication- loss of diabetic control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

loop diuretics SE

A

Fluid and electrolyte imbalance, dehydration, chest pain

Decreases K and Calcium

Hypotension

GI- anorexia, nausea, vomiting, diarrhea

Hyperglycemia and increased uric acid

Tinnituds, hearing impairment, blurred vision

Headache, muscle cramps (can indicate low potassium levels), confusion, dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

loop diuretic PC

A

Cirrhosis and liver disease

Kidney impairment

Alkalosis/dehydration

Allergy to sulfonamides

Diabetes

History of Gout

Pregnancy and Lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

loop diuretics i/a

A

Corticosteroids- K loss

Lithium

Digoxin

Salicylates

Aminoglycodsides- increase chance of deafness

Indomethacin- Decreases diuretic effect

Anticonvulsants can reduct effect (phenytoin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

potassium sparing diuretics SE

A

Usually mild and respond to withdrawal of drug

Hyperkalemia which may cause arrhythmias

Dehydration/weakness

GI-

Fatigue, lethargy, profound weight loss

Hypotension

Gynecomastia- with spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

potassium sparing diuretics PC

A

Renal insufficiency

Cirrhosis and liver disease

Pregnancy and Lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

potassium sparing diuretics i/a

A

Potassium supplements

ACE Inhibitors/ARBS

NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

potassium sparing diuretics PE

A

Avoid potassium rich diet and salt substitutes

Report signs of excessive dehydration

Report GI symptoms

Report persistent HA and confusion

Report irregular heart beat

Monitor weigh loss for sudden excessive loss

Rise slowly from reclining positions

Take medication after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

osmotic agents

A

Usually used to decrease intracranial or intraocular pressure

Extreme Caution for kidney failure, heart failure, severe pulmonary edema, or pregnancy and lactation

Only given under close medical supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
osmotic agents SE
Fluid/electrolyte imbalance HA, vertigo, confustion GI Tachycardia, hypertension, hypotension Allergic reactions Severe Pulmonary Edema
26
baroreflexes
Moment to moment adjustments Stimulated by stretch of vessel walls Activation inhibits central sympathetic discharge Reduction of stretch increased sympathetic discharge Example transition from laying to standing Blood pools below heart triggering activation of sympathetic discharge Increased vascular resistance (constrict arterioles) and cardiac output (direct stimulation and constriction of capacitance vessels)
27
renal response
Long Term control Controls blood volume Reduced perfusion causes increase water and salt reabsorption Stimulated renin production which increases angiotensin II Constriction of vessels Stimulation of aldosterone synthesis Increased renal sodium absorption and intravascular blood volume
28
Available in combination with HCTZ (thiazide)
Aldactazide- spironolactone Maxzide (tablet)/Dyazide (capsule)- triamterene
29
angiotensin inhibitors
Renin release from kidney cortex is stimulated by reduced renal arterial pressure, sympathetic neural stimulation, and reduced sodium delivery or increased sodium concentration in the distal renal tubule Renin causes production of angiotensin I Angiotensin I is converted by endothelial ACE to Angiotensin II (vasoconstrictor and sodium retention and aldosterone release) Angiotensin II is converted to angiotensin III (aldosterone release) in the adrenal gland
30
angiotensin inhibitor classes
ACE inhibitors Angiotensin receptor blockers (ARBS)- competitive inhibitors of angiotensin at its receptors Renin antagonist Spironolactone and Beta-Blockers can reduce renin secretion also
31
ACE inhibitors
blocks conversion of angiotensin I to angiotensin II and also blocks bradykinin from being metabolized to inactive metabolites Does not change cardiac output or heart rate Use for kidney protection for chronic kidney disease and diabetes Recommended for all diabetics even without hypertension Considered 1st or 2nd line agents in treatment of hypertension Also used with diuretics and calcium channel blockers for synergy More effective in younger white populations and less effective in African American patients (higher doses and with diuretic)
32
ACE inhibitor SE
Photosensitivity Loss of taste/ metallic taste Acute renal failure Severe hypotension can occur after initial doses- more common if hypovolemic, salt restricted, or GI fluid loss Dry cough sometimes with wheeze Hyperkalemia- more common if renal insufficiency or diabetic Drug interaction with potassium or potassium sparing diuretics
33
ACE inhibitors PC
Angioedema Contraindicated in pregnancy All except fosinopril and moexipril are eliminated by kidneys so doses should be reduced in patients with renal insufficiency Lupus or Scleroderma
34
ACE inhibitors i/a
NSAIDS may block bradykinin vasodilation which may decrease affect Diuretics (hypotension) Vasodilators (hypotension) Hyperkalemia- more common if renal insufficiency or diabetic Drug interaction with potassium or potassium sparing diuretics Antacids- decrease absorption Digoxin and Lithium- toxicity of dig or lith
35
ARB
block angiotensin II at the receptor No effect on bradykinin Do not affect heart rate More complete inhibition of angiotensin vs ACE inhibitors (Angiotensin II is generated by other enzymes) Same adverse effects and toxicities as ACE Inhibitors, except for cough NOT recommended any longer with ACE inhibitors due to toxicities in studies
36
renin inhibitors
Inhibit clevage of angiotensinogen by renin which inhibits the formation of Angiotensin I Currently only one on the market Aliskiren (Tekturna)
37
renin inhibitors P/C
Contraindicated in pregnancy No effect on bradykinin No cough Prevents rise in renin activity caused by ACEI, ARB, and diuretics Has been used with ACEI and ARBs but dual blockades have not been studied
38
direct vasodilators
decrease systemic vascular resistance Does not cause orthostatic hypotension or sexual dysfunction Work best in combination with other HBP drugs that oppose the compensatory cardiovascular responses
39
minoxidil
Opens potassium channels in smooth muscle membranes which stabilizes the membrane and makes contraction less likely Dilates arterioles but not veins Alternative to Hydralazine if patient does not respond Must be used with beta blocker AND loop diuretic to reduce reflex sympathetic stimulation and sodium and fluid retention Toxicity- tachycardia, palpitations, angina, and edema when doses of beta blocker and diuretic is inadequate
40
sodium nitroprusside
Dilates both arterial and venous vessels IV only for hypertensive emergency Rapid BP lowering, effects disappear within 1-10 minutes after DC Light sensitive, cover with foil and change regularly (several hours) Toxicity- High rates of infusion increase toxicity Accumulation of cyanide as a result of metabolism may cause metabolic acidosis, arrythmias, and death Administer sodium thiosulfate to facilitate metabolism of cyanide or hydroxocobalamin to combine with cyanide to form cyancobalamin Thiocyanate toxicity is possible- weakness, disorientation, psyuchosis, muscle spasms, aand convulsions. Rarely delayed hypothyroidism due to inhibition of iodide uptake by the thyroid
41
CCB
reduce peripheral resistance by inhibiting calcium influx into arterial smooth muscle Most effective in African Americans, older patients, and patients with higher BP Good option if patient has obstructive airway disease 3 Types: Dihydropyridines Benzothiazepines Phenylalkylamines
42
CCB SE
Hypotension Dizziness, HA, flushing Brady cardia with heart block Edema Constipation, nausea, and abdominal discomfort
43
CCB P/C
Heart block, heart failure, angina Hepatic and renal failure Pregnancy and lactation Hypotension with heart block Arrhythmias with severe heart failure
44
hydralazine
Increases HR and cardiac output Causes release of nitric oxide Dilates arterioles but not veins Dosing BID-TID Side Effects: HA, nausea, palpitations, sweating, flushing, Tachycardia, orthostatic hypotension, edema Lupus Erythemastosus-Like Syndrome 10-20% of patients on doses over 400mg/day Arthralgia, myalgia, skin rash, fever Reversed by DC of hydralazine Usually contraindicated in pregnancy, but used for preeclampsia cause significant decrease in peripheral vascular resistance but cause compensatory tachycardia and sale and water retention. This almost completely reverses the effect on BP. Add beta blocker to prevent tachycardia and a diuretic to prevent salt and water retention.
45
dihydropyridines
Act on vascular smooth muscle, peripheral vasodilating
46
Phenylalkylamine and Benzothiazepines
Less specific for peripheral smooth muscle, more active in the myocardium and cardiac conductive tissues
47
verapamil i/a
Beta blockers- bradycardia/hypotension Digoxin- increase digoxin by 1/3
48
diltiazem
Beta blockers- may decrease metabolism of beta blockers and have additive effects (hypotension and bradycardia) Statins- lovastatin, atorvastatin, simvastatin- levels may be increased which can cause SE from statins May increase tacrolimus levels
49
nifedipine
Barbiturates decrease nifedipine Cimetidine increases nifedipine May increase tacrolimus levels
50
clonidine
antiadrenergic Central acting alpha 2-adrenergic blocker Comes in patches (7 Day), tablets (BID), and injection MOA- reduce sympathetic outflow, slows heart rate and relaxes capacitance vessels Side Effects- Dry mouth, sedation Do not use if at risk for mental depression Stop gradually- hypertensive crisis
51
alpha 1 blocker
Selectively block alpha 1 receptors in arterioles and venules. Selectively allows norepinephrine to exert unopposed negative feedback on its own release Also used to BPH to relax smooth muscle in bladder neck and prostate Cardiac Alpha 1 inhibitors: Doxazosin (Cardura)-> most common Terazosin (Hytrin) Prazosin (Minipress)
52
alpha 1 blockers SE
Dizziness, HA, nasal congestion Orthostatic hypotension Decreased libido, impotence First dose phenomenon hypotension First few doses, may include sudden loss of consciousness Patient should be resting for first dose
53
alpha 1 blocker P/C
Cause Na and water retention Best when paired with thiazide or beta blocker Monitor weight for edema Shown in trials to 25% increase risk of cardiovascular events when used alone vs diuretics, amlodipine, and lisinopril. Study was stopped!
54
alpha 1 blocker P/C
CCBs Additive with other antihypertensive drugs
55
BB
inhibit sympathetic nerve receptors Decreases cardiac output Inhibits release of renin Cardioselective Beta 1- primarily found in the heart. When stimulated they increase rate and force of contraction Beta 2- Primarily in the lungs. When stimulated cause bronchodilation and vasodilation. ***Beta blockers cause opposite*** decrease HR and contraction in heart Intrinsic sympathetic activity Metoprolol and atenolol are most commonly used (both are cardioselective) Cardioselectivity is advantageous for treating patients with asthma, diabetes, or peripheral vascular disease Atenolol has been found to be less effective than metoprolol in preventing complication of hypertension
56
BB SE
Hypotension, vertigo, syncope Bradycardia May aggravate intermittent claudication Dizziness, confusion, nightmares, weakness, sleepiness, fatigue GI- N/V/D/C Bronchospasm (selectivity is not absolute) Hypoglycemia Insulin release and glycogenolysis adrenergically mediated- blocking Beta 2 may predispose to hyperglycemia or blunt response to hypoglycemia
57
BB P/C
DC slowly (2 weeks)- may cause rebound hypertension Diabetes Renal and hepatic impairment Asthma Bradycardia Pregnancy and lactation COPD
58
light sensitive meds
kept in bags for protection
59
BB i/a
Adrenergic (epinepherine) NSAIDs- decrease BB effect Cimetidine- slows metabolism of drug Antiarrhythmic drugs- potentiate toxic effects Digoxin adenosine Alcohol, muscle relaxants, and sedatives may precipitate hypotension, dizziness, confusion, and sedation
60
nebivolol
Is Beta selective Has vasodilating properties Vascular resistance is lowered as opposed to increased with older agents Efficacy is similar to other agents but studies suggest less side effects
61
resistant HT
Some patients require two or more drugs If unresponsive to 2 agents patient is considered to have resistant hypertension Choose drugs that compliment each other Choose drugs that show long term benefits- Ex. ACE Inhibitors for diabetics Other causes: Compliance Dietary sodium intake NSAID use Stimulant drugs (legal or not) Secondary hypertension
62
propranolol
used to prevent migraines taken daily
63
beta 1 selective drugs
metoprolol acebutolol alprenolol atenolol betaxolol celiprolol esmolol nebivolol
64
HT in pregnancy
Labetalol Nifedipine Hydralazine
A&P
flashcards
Decks in class (57)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions