cardiovascular

  1. hypertention defined
    • ≥140/≥90
    • or
    • use of antihypertensive meds
  2. values for
    normal
    prehypertension
    stage 1 hypertension
    stage 2 hypertension
    • 120/80
    • 120-139/ 80-89
    • 140-159/ 90-99
    • ≥160/≥100
  3. isolated systolic hypertension defined as
    ≥140/< 90
  4. isolated systolic hypertension factors
    • -top number is elevated
    • -more common in elderly people
  5. pseudohypertension
    -hardened arteries wont squeeze down so BP is not actually high
  6. HTN is a risk factor for
    • CAD
    • CHF
    • Stroke
    • Renal failure
  7. what two ethnicities have lower rates of BP control
    Mexican americans and native americans
  8. what ethnicity has the highest prevalence of HTN
    African americans
  9. causes of isolated HTN
    cause unknown
  10. modifiable rrisk factors
    • A: alcohol
    • B: body weight
    • C: Cig smoking
    • D: diet
    • E: excersise
  11. what is MAP
    • avg of the BP
    • 60 is the cut off
  12. cardiac factors that influence BP
    • HR
    • INotropic state
    • neural
    • humoral

    • WE CAN CONTROL THESE
    • they effect CO
  13. renal factors that effect fluid volume that effect BP
    • renin angiotensin
    • aldosterone
    • atrial natriuretic factors

    WE CAN CONTROL THESE
  14. BP equation
    CO x SVR
  15. CO equation
    HR x SV
  16. what do these effect

    renin angiotensin
    aldosterone
    atrial natriuretic factors
    HR
    INotropic state
    neural
    humoral
    cardiac output
  17. SNS factors that influence BP
    • a adrenergenic receptors(contrict)
    • b adrenergenic receptor(dialate)
  18. humoral factors that influence BP
    vasoconstrictors angiotensisn and catecholameines
  19. local regulation that effects BP
    • -vasodialators prostaglandins and EDRF
    • -vasoconstrictors endothelin
  20. what do these effect in regards to BP

    -a adrenergenic receptors(contrict)
    -b adrenergenic receptor(dialate)
    -vasoconstrictors angiotensisn and catecholameines
    -vasodialators prostaglandins and EDRF
    -vasoconstrictors endothelin
    systemic vascular resistance (SVR)
  21. trick to remember bblock I vs II
    • I- heart
    • II- lungs
  22. primary or idiopathic HTN is
    • -elevated BP without a cause
    • -most common
  23. secondary htn is
    -elevated BP with a specific cause
  24. examples of secondary HTN
    • renal disease
    • cirrhosis
    • apnea
    • neuro
    • narroeing of aortas
    • endocrine
  25. primary HTN or idiopathic HTN contributing factors
    • increase SNS
    • increase RAAS
    • endothelial cell dysfunction
    • DMbody weight
    • increase sodium
    • alcohol
  26. once over 50, is SBP or DBP more important and why
    • SBP
    • it is a CVD risk factor
  27. risk factors for salt sensitivity
    • obese
    • elderly
    • African American
    • diabetic
    • renal disease
  28. how does stress and increased SNS activity effect primary HTN
    • increased vascoconstriction
    • increased HR
    • increased renin release
  29. how does insulin resistance and hyperinsulinemia effect primary HTN
    • -high insulin stimulates SNS and impairs nitric oxide mediated vasodialation
    • -altered renin-angiotensin(high plasma renin activity)
    • -endothelial cell dysfunction
  30. how is HTN discoverd
    random testing
  31. what are the symptoms of HTN
    normally asymptomatic
  32. secondary symptoms of HTN
    • fatigue
    • dizzy
    • palpatations
    • angina
    • dyspena
  33. target organ disease most often occurs in
    • heart
    • brain
    • periph vascular
    • kidney
    • eyes
  34. examples of hypertensive heart disease
    • CAD
    • left ventricular hypertrophy
    • heart failure
  35. HTN diagnostics tests
    • -urine, creatine, bun and serum creatine= renal involvement
    • -serum electrolytes like potassium= detect hyperaldosteronism
    • -lipid profile= risk factors r/t atherosclerosis and cvd
    • -ECG= baseline of heart status
    • -echocardiogram= if LVF is suspected
  36. if white coat phenomenom is suspected
    use ambulatory blood pressure monitoring, which non invasively monitors bp over a 24 hour period
  37. benefits of lowering bp
    • reduce:
    •  
    • stroke
    • myocardial infarction
    • HF
  38. weight loss of __ kg may decrease ___ bp by __ to __ Hg
    • 10
    • SBP
    • 5 to 10
  39. recommended sodium reduction
    less than 2.3 g of sodium/day
  40. recomended salt intake
    2300 mg
  41. recomended alcohol consumption
    • men 2 drinks/day
    • women 1 drink/day
  42. what is the primary action of the drugs that are used to treat HTN
    • reduce SVR
    • reduce volume of circulating blood
  43. diuretics are used to treat
    • mild to moderate HTN
    • HF or kidney disease
  44. which drug is often the first choice to treat htn
    diuretics
  45. diuretics promote____ and reduce _____
    • sodium and water excretion
    • plasma volume, and vascular response to catecholamines
  46. loop or high celling dieuretics
    • -reduce edema ass. w/ CHF
    • -increase UO even if flow to kidney is diminished
    • -MOST EFFECIENT
  47. loop or high celling dieuretics meds
    • Lasix
    • demadex
    • burmex
  48. dieuretic thiazidides
    • -most widely prescribed
    • -not first choice for diabetics
    • -mild to moderate htn
  49. biggest dieuretic side effect
    • hypokalemia
    • cardiac arythmya
  50. potassium sparing dieuretics
    • -prevent hypokalemia
    • -mild htn
    • -no supplement needed
    • -watch for hyperkalemia
  51. if on pot sparing diuretic, use with caution on pt that take
    ace inhibitors or angio II blockers
  52. nursing considerations for pt on dieuretics
    • -ortho hypotension
    • -dry mouth, irritation
    • -electrolyte imbalance=hypokalemia=potassium less than 3.5
    • -disorientation
  53. best time to administer dieuretics
    AM
  54. calcium channel blockers
    increase sodium excretion and cause arteriolar vasodialation by preventing the movement of extracellular calcium into cells
  55. what is the result of calcium chanell blockers
    decrease demand for o2 and decrease PVR which relaxes the arteriols
  56. group of meds ending in ipine, amil or azem
    calcium chan blockers
  57. acronym for calcium chan blockers
    • A= amlodipine
    • Very= verapamil
    • Nice= nifedipine
    • Drug= diltiazem
  58. "dipine"
    "azem"
    • -tend to not dip hr
    • -dips hr
  59. what drug would calcium channel blockers be used as an alternative to and why
    b blockers if pt has hx of asthma
  60. calcium chan blockers can also be used for
    arrythmias
  61. calcium chan blocker side effect
    • decrease bp
    • bradycardia
    • a-v block
    • headache
    • abdom discomfort
    • periph edema
  62. angiotensin converting enzyme inhibitors
    "ACE"
    prevent the conversion of angio I to angio II and reduce angio II mediated vasoconstriction and sodium and water retention
  63. ACE inhibitors end in
    pril
  64. ace inhibitors decrease___ without _____
    • -peripheral vascular resistance
    • -increasing CO, cardiac rate and cardiac contractillity
  65. use___ for pt with hx of diabetes
    ACE
  66. advantages of ACE
    • less orthostatic hypotension
    • lack of aggravation on pulmonary and DM
    • increase renal blood flow
    • less effect on HR
  67. ACE side effects
    • COUGH
    • headache
    • gi distress
  68. diuretics end in
    thiazidide, done, one
  69. what enhances the effects of ACE
    • dieuretics
    • alcohol
    • beta blockers
  70. adrenergenic receptors

    alpha 1
    alpha 2
    beta 1
    beta 2
    • constrict
    • dialate
    • increase HR
    • bronchodialate
  71. angiotensin receptor blockers end in
    sartan
  72. angio II receptor blockers
    prevent action of aII and produce vasodialation and increased sodium and water excretion
  73. which 2 should not be used together and why
    • ACE and ARB
    • adverse renal effects
  74. beta blockers
    inhibit cardiac response to sympathetic nerve stimulation by blocking beta receptors
  75. beta blockers end result
    decrease HR, CO and BP
  76. beta blockers end in
    olol
  77. beta blocker

    selective
    non selective
    • beta 1 atenolol
    • beta 1 and 2 propanolol
  78. beta blocker selective vs non selective
    • selective: cardioselective and only block beta 1
    • nonselective; block beta 1 and 2
  79. nursing intervention unique to beta blockers
    • can not be stoped abruptly
    • check baseline bp
    • check hx of respitory bronchoconstriction
  80. beta blocker side effect
    • brady
    • bronchospasm and wheezing
    • DIABETIC HYPOGLYCEMIA
    • heart failure related s/s like edema, dyspnea, rhales, fatigue, drowsy
  81. alpha 1 adrenergenic blockers
    block postsynaptic alpha 1 adrenergenic receptors to produce arteriolar and venous vasodialation
  82. alpha 1 adrenergenic blockers result
    reduce peripheral vascular resistance
  83. alpha 1 blockers end in
    osin
  84. which drug is low on the list because of its strength
    alpha 1 blockers
  85. alpha 1 blockers side effects
    • drowsy
    • headache, vertigo
    • tachy
    • weak
    • sexual dysfunction
    • other antihypertensives enhance effects
  86. which drugs side effects are more prevalent with the first dose
    alpha 1 blockers
  87. most common alpha 1 blockers
    • doxizosin***
    • prazosin
    • terazosin
  88. centrally acting alpha 2 agonists
    stimulate a2 receptors in brainstem and reduce sympathetic outflow from cns
  89. centrally acting alpha 2 agonists result
    decreases HR, SBP and DBP
  90. centrally acting alpha 2 agonists meds
    • clonidine-catapres
    • methyldopa-aldomet
  91. direct acting vasodialators
    direct arteriolar smooth muscle relaxation, decreasing PVR
  92. direct acting vasodialators uses
    • htn
    • renal dx
    • more of a PRN drug
  93. direct acting vasodialators meds
    apresoline, minoxidil, hydralazine
  94. direct acting vasodialators side effects
    • tachy
    • ORTHO HYPO
    • dizzy
    • nausea
    • fluid retention
  95. ABCD rule
    • AB pairs and CD pairs
    • AB often first choice for younger pt
    • CD often first choice for African americans

    Ace and Arbs go with Beta blockers

    Calcium chan block go with diuretics
  96. ACE and ARB considerations
    • diabetic
    • CRF
  97. beta blocker considerations
    MI
  98. CHF considerations
    do not use calcim channel blockers
  99. ethinicity considerations
    C and D
  100. first line of drug therapy
    thiazadines "dieuretics"
  101. auscultatory gap
    wide gap between the first korotkoff sound and subsequent beat

    older patients have this
  102. what is the cause for orthostatic hypotension in  older adults
    varying degrees of impaired bareoreceptor reflex mechanism
  103. hypertensive crisis is a
    severe abrubt increase in DBP >140
  104. hypertensive crisis often occurs when
    pt with a hx of HTN who have failed to comply with meds or have been under medicated
  105. hypertensive urgency vs emergency
    • urgency=no target organ damage
    • emergency= target organ damage
  106. examples of hypertensive emergency
    • HTN encephalopy
    • cerebral hemorage
    • acute renal failure
    • MI
    • HF w/ pulm edema
  107. lipids should be checked____
    ECG should be done___
    • yearly
    • every 2-4 years
  108. resistant HTN
    failure to reach target BP after on a 3 drug treatment that includes a diuretic
  109. which fills and which one pushes out
    • systolic pushes out
    • diastolic fills
  110. right side HF
    • -things back up
    • edema
    • jvd
    • fatigue
    • large liver and spleen
    • gi stress
  111. left sided HF
    • where most HF starts
    • lungs
    • edema
    • cough
    • sob
Author
ChelseaL
ID
339610
Card Set
cardiovascular
Description
cardiovascular
Updated