Term
| The 2 main systems related to hypertension include the? |
|
Definition
1. Sympathetic Nervous System
2. Renin-Angiotensin-Aldosterone System |
|
|
Term
| To treat hypertension and lower blood pressure you must lower the _____ _____ ______ or _______ _______. |
|
Definition
Systemic Vascular Resistance or
Cardiac Output. |
|
|
Term
Blood Pressure equals _____ _____ _____
X ______ ________. |
|
Definition
Systemic Vascular Resistance X
Cardiac Output. |
|
|
Term
Cardiac Output is ______ ______ X
_______ _______ _______. |
|
Definition
| Heart Rate X Systemic Vascular Resistance. |
|
|
Term
| The majority of hypertension seen in the United States today is _______ hypertension. |
|
Definition
| Essential - the cause is unknown |
|
|
Term
| The Sympathetic Nervouse System controls ______ ______ & __________. |
|
Definition
| Heart Rate and Contractility |
|
|
Term
| Beta-Adrenergic Stimulation via epinephrine causes increased _______ ______ in the heart muscle. |
|
Definition
|
|
Term
| Beta-Blockers decrease ______ _______ thereby lowering _______ _______. |
|
Definition
Stroke Volume thereby lowering
Blood Pressure. |
|
|
Term
| An example of a Beta-Blocker is? |
|
Definition
|
|
Term
| Calcium Channel Blockers ______ the entry of calcium into the ______ ______ or _______ _______ ______ ______ causing a _______ in contractility, a decrease in heart rate and __________. |
|
Definition
| Block the entry of calcium into myocaridial cells or vascular smooth muscle cells ......decrease in heart rate and vasodilation. |
|
|
Term
| An example of a Calcium Channel Blocker is? |
|
Definition
|
|
Term
| How does Nifedipine stop preterm labor? |
|
Definition
| It blocks calcium from entering the smooth muscle cells of the uterus and prevents it from contracting. |
|
|
Term
| Centrally Acting Drugs _______ cardiac output and ________ peripherial resistence. |
|
Definition
| decrease cardiac output and decreases peripherial resistence |
|
|
Term
| Centrally Acting Drugs affect the vasomotor center in the brain by limiting the ________ ________ to the _______ and ________ ________. |
|
Definition
| the sympathetic outflow to the heart and blood vessels. |
|
|
Term
| An example of a Centrally Acting Drug is? |
|
Definition
|
|
Term
| Vascular Tone is effected by ________. |
|
Definition
|
|
Term
| Vasodilators are Alpha-Adrenergic ________ that cause direct __________. |
|
Definition
| Blockers that cause direct Vasodilation. |
|
|
Term
| An example of a Vasodilator is? |
|
Definition
|
|
Term
| Vascular Volume is effected by _______, _____ _____ ______ _____, and ______ _______ ________. |
|
Definition
| Diuretics, Angiotensin Enzyme Inhibitors (ACE) and Angiotensin Receptor Blockers. |
|
|
Term
| __________ decrease blood volume and sodium levels. |
|
Definition
|
|
Term
| The different types of diuretics are classified by what anatomic site within the _______ _______ they exert their influence. |
|
Definition
|
|
Term
| What are three types of Diuretics? |
|
Definition
1. Thiazide Diuretics
2. Loop Diuretics
3. Potassium Sparing Diuretics |
|
|
Term
| What does ACEI stand for? |
|
Definition
| Angiotensin Coverting Enzyme Inhibitor |
|
|
Term
| ACE Inhibitors inhibit the conversion of _________ __ into _________ __ thereby decreasing ________ _________. |
|
Definition
| angiotensin I into angiotensin II therby decreasing Arterial Pressure. |
|
|
Term
| An example of an ACE Inhibitor is? |
|
Definition
|
|
Term
| An example of an Angiotensin Receptor Blocker is? |
|
Definition
|
|
Term
| _______ to generica names are helpful in catorgorizing antihypertnedive medications. |
|
Definition
Suffixes
olol = Beta Blocker
sartin = Angiotensin Receptor Blocker
pine = Calcium Channnel Blocker
pril = Angiotensin Converting Enzyme Inhibitor |
|
|
Term
| Beta Blockers decrease _______ output be decreasing the ____, _____, and ____ velocity of the heart. |
|
Definition
| Cardiac Rate, Contractility, and Conduction |
|
|
Term
| Beta Blockers have a ______ ionotropic effect and should be used with extreme caution in patients with _____ ______. |
|
Definition
|
|
Term
| How are Beta Blockers catagorized acccording to their selectivity? |
|
Definition
Beta 1 & Beta 2
Beta 1 selective, with less effect on Beta 2 receptors and intrinsic sympathomimetic activity. (ISA) |
|
|
Term
| Beta Blockers target Beta _________ on all smooth muscles in the body. |
|
Definition
|
|
Term
| Beta Receptors allow stress hormones (endogenous catacholamines) like ________ and __________ to work. |
|
Definition
| Epinephrine and Norepinephrine |
|
|
Term
| Beta Receptors are part of the _______ ________ __________ throughout the body. |
|
Definition
| Synpathetic Nervous System |
|
|
Term
| Beta Blockers bind with the Beta Receptors in lieu of the stress hormones, _________ their response on the body. |
|
Definition
|
|
Term
| _________ is a Beta Blocker that should be avoided. |
|
Definition
|
|
Term
| Beta Blockers are ____ __ effective in preventing cardiovascular events in patients with HTN in spite of the effectiveness in lowering blood pressure. |
|
Definition
|
|
Term
| For patients who have heart failure and those patients who have had a heart attack should be given ______ ______ for 2-3 years after the heart attack to improve cardiovascular outcomes. |
|
Definition
|
|
Term
| What are the two most effective Beta Blockers that improve cardiovascular outcomes? |
|
Definition
| Carvedilol and Metoprolol ER |
|
|
Term
| Beta Blockers acheive their effects by competing for adrenergic receptor binding sites. Beta 1 receptors are found predominately in the _______ _____ Beta 2 receptors are found in the _____ and ____ _____ _____, and the _____. |
|
Definition
Beta 1 - Cardiac Tissue
Beta 2 - Bronchial and Vascular Smooth Muscles, and in the liver. |
|
|
Term
| Examples of Beta 1 Selective Beta Blockers are? |
|
Definition
Metoprolol (Lopressor)
Timolol (Betim)
Propranolol (Indreal)
***Atenolol is Nonselective*** |
|
|
Term
| Beta Blockers are _______ line treatment for uncomplicated hypertension. |
|
Definition
|
|
Term
| Calcium Channel Blockers should not be used in patients with ___ ____. |
|
Definition
|
|
Term
| What is the major side effect of Calcium Channel Blockers? |
|
Definition
| They have a tendency to cause peripheral edema and reflex tachycardia. |
|
|
Term
| What specific population does Calcium Channel Blockers work well with? |
|
Definition
|
|
Term
| Calcium Channel Blockers (CCB's) major actions are what? (5 things) |
|
Definition
Decreased Myocardial Contractility
Slowed Rate of Ventricular Contractions
Coronary Artery Dilation
Peripheral Artery Dilation
Reduce Peripheral Resistance |
|
|
Term
| There are 2 types of CCB's. What are they and which one is the largest? |
|
Definition
Dihydropyridines - the largest
non-Dihydropyridines |
|
|
Term
| Dhydropyridines (DHP)which are CCB's do not affect the ________ _______ ________ and thus are not used for cariac arrhythmias. |
|
Definition
| Cardiac Conduction System |
|
|
Term
2 examples of dihydropyridines are?
*****Remember these are CCB's***** |
|
Definition
nifedipine (Procardia)
amlodipine (Norvasc) |
|
|
Term
| Non-Dihydropyridines (which are CCB's) are used for both hypertension and _______. |
|
Definition
|
|
Term
| 2 examples of non-dihydropyridines (CCB's) are? |
|
Definition
Verapamil (Calan)
Diltiazem (Cardiazem) |
|
|
Term
| Diuretics are the _____ drugs used for treating hypertension and Thiazide Diuretics are generally used first. |
|
Definition
|
|
Term
| Diuretics are distinguished by where they take effect in the renal tubule, which results in different reabsorption patterns of _____, _____, and ________. |
|
Definition
| Sodium, Calcium, and Potassium |
|
|
Term
| Thiazides (diuretic)inhibits ______ reabsorption in the distal tubule. |
|
Definition
|
|
Term
| Thiazides (diuretic) deplete sodium and ________ while conserving ______. |
|
Definition
| Potassium while conserving Calcium |
|
|
Term
| An important adverse side effect of taking Thiazides is _______ which can be particularly dangerous in persons with heart disease. |
|
Definition
| Hypokalemia - low potassium |
|
|
Term
| Thiazides are the first drug of choice and are especialy useful for women with ________ because of the calcium sparing effects |
|
Definition
|
|
Term
| What is an example of a Thiazide Diuretic? |
|
Definition
| Hydrochlorothiazide (Microzide) |
|
|
Term
| ACE Inhibitors prevent the conversion of angiotensin I to II in the kidney, thus preventing _____ of the renal vessels. |
|
Definition
|
|
Term
| Ace Inhibitors effect ____ and _____ loss but tend to spare potassium making them very effective when combined with potassium sparing diuretics because of their potential for hyperkalemia. |
|
Definition
|
|
Term
| ACE Inhibitors effect the release of _________, a vasodilator which also enhances insulin sensitivity. Thus ACE inhibitors are excellant choices for patients with diabetes mellitus. |
|
Definition
|
|
Term
| An important thing to remember -- ACE Inhibitors and Angiotensin Receptor Blockers have a smaller effect on what population? |
|
Definition
|
|
Term
| A side effect of ACE Inhibitors is a nonproductive _______ caused by the increase production of _________. |
|
Definition
|
|
Term
| A less common but more serious side effect of taking ACE Inhibitors is __________. Patients should be cautioned to immediately report any unexplained swelling of the face, mouth, tongue, or persistant _____ _____ and the drug should be stopped. |
|
Definition
|
|
Term
| Loop Diuretics are the most efficient diuretic but are reserved for clients with ________ _________. |
|
Definition
|
|
Term
| Loop Diuretics deplete _____, _____, _____, and ______ in the distal tubule. |
|
Definition
| Sodium, Potassium, Magnesium, and Calcium |
|
|
Term
| An important adverse side effect of Loop Diuretics is ________ which can be particularly dangerous for clients with heart disease. |
|
Definition
|
|
Term
| An example of a Loop Diuretic is? |
|
Definition
|
|
Term
| Potassium Sparing Diuretics inhibits _____ reabsorption in the collecting duct, thereby sparing the postassium depletion that occurs when sodium is not ______ distally. |
|
Definition
|
|
Term
| Most serious adverse effect for those taking Potassium Sparing Diuretics is ______ which is especially dangerous in clients on ACE Inhibitors or in clients with diabetes or ____ ____. |
|
Definition
Hyperkalemia
Renal Impairment |
|
|
Term
| Potassium Sparing Diuretics are primarily used in conjunction with Thiazide Diuretics to counter the _____ loss. |
|
Definition
|
|
Term
| An example of a Potassium Sparing Diuretic is? |
|
Definition
| Spironolactone (Aldactone) |
|
|
Term
| Patients on ACE Inhibitors or Angiotensin Receptor Blockers should avoid _______ as they can reduce the efficacy of those drugs. |
|
Definition
|
|
Term
| Angiotensin Receptor Blocker are thought to have many of the advantages of ACE Inhibitors without the side effect of the ______. |
|
Definition
|
|
Term
| An example of a Direct Vasodilator is? |
|
Definition
|
|
Term
| An example of an Alpha Blocker is? |
|
Definition
|
|
Term
| An example of an Alpha 2 Agonists is? |
|
Definition
|
|
Term
| For a patient who takes 3 or more blood pressure medications have the patient take one at ________. |
|
Definition
Bedtime
early 2012 evidence suggested that taking at least one antihypertensive medication at bedtime may improve blood pressure control and reduce cardiovascular events in some patients. |
|
|
Term
| If the blood pressure is lowered too much at night there is an increased risk for _________. |
|
Definition
|
|
Term
| Should a diuretic be prescribed for taking at nighttime? |
|
Definition
| No - a patient taking a diuretic at bedtime would not be getting the rest that is needed because of having to go to the bathroom all night. |
|
|
Term
| If the patient is experiencing fatigue or dizziness with an antihypertensive the dosing can be changed to __________ __________. |
|
Definition
|
|
Term
| According to JNC 7 the first agent to be used to treat hypertension is generally a ________. |
|
Definition
|
|
Term
| ________ diuretics are used more often than Loop or Potassium Sparing diuretics. |
|
Definition
|
|
Term
| If the diuretic alone is not effective ______ ______ may be added. |
|
Definition
|
|
Term
| If systolic blood pressure is > 160 or diastolic is > 100 the patient will be started on _____ _______. |
|
Definition
Two Agents
This protocol is follwed unless there is a compelling indication for other type therapies. |
|
|
Term
| The JNC 7 acknowledges additional benefit of _______ agents for treating other conditions or complications and recommends therapy accordingly. |
|
Definition
|
|
Term
Condition Indicated Drug Therapy
Diabetes Mellitus I with proteinuria |
|
Definition
|
|
Term
Condition Indicated Drug Therapy
Diabetes Mellitus II with proteinuria |
|
Definition
| Angiotensin Receptor Blockers |
|
|
Term
Condition Indicated Drug Therapy
Heart Failure |
|
Definition
ACE Inhibitors
Beta Blockers
Aldosterone Receptor Antagonists
Angiotensin Receptor Blockers |
|
|
Term
Condition Indicated Drug Therapy
Isolated systolic hypertension in older adults |
|
Definition
Diuretics
Calcium Channel Blockers
(Long Acting Dihydropyridines such as Procardia and Norvasc) |
|
|
Term
Condition Indicated Drug Therapy
Nondiabetic Renal Disease |
|
Definition
|
|
Term
Condition Indicated Drug Therapy
Post Myocardial Infarction |
|
Definition
Bata Blockers (non-ISA Beta 1 such as Metoprolol (Lopressor)because they work on cardiac tissue)
ACE Inhibitors (when systolic function is present) |
|
|
Term
May Affect Comorbid Conditions Favorably:
Angina |
|
Definition
Beta Blockers
Calcium Channel Blockers |
|
|
Term
May Affect Comorbid Cond. Favorably
Atrial Fibrillatin and Tachycardia |
|
Definition
Beta Blockers
Calcium Channel Blockers (nondihydropyridines such as Verapamil and Diltiazem) |
|
|
Term
May Affect Comorbid Cond. Favorably
Dylipidemia |
|
Definition
| Alpha Blockers such as Doxazosin (Cardura) |
|
|
Term
May Affect Comorbid Cond. Favorably
Hyperthyroidism |
|
Definition
|
|
Term
May Affect Comorbid Cond. Favorably
Migraine |
|
Definition
Beta Blockers (non cardioseletive such as a Beta 2)
Calcium Channel Blockers (nonhydropyridines such as Verapamil (Calan) and Diltiazem (Cardiazem) |
|
|
Term
May Affect Comorbid Cond. Favorably
Myocardial Infarction |
|
Definition
|
|
Term
May Affect Comorbid Cond. Favorably
Osteoporosis |
|
Definition
|
|
Term
Contraindicated May Adversely Affect
Bronchospastic Disease |
|
Definition
|
|
Term
Contraindicated May Adversely Affect
Depression |
|
Definition
Beta Blockers
Alpha Antagonist
Reserpine |
|
|
Term
Contraindicated May Adversely Affect
Diabetes Mellitus Type I and II |
|
Definition
Beta Blockers
High Dose Diuretics |
|
|
Term
Contraindicated May Adversely Affect
Dyslipidemia |
|
Definition
Beta Blockers (non ISA Beta 2)
High Dose Diuretics |
|
|
Term
Contraindicated May Adversely Affect
Gout |
|
Definition
|
|
Term
Contraindicated May Adversely Affect
Heart Block |
|
Definition
Beta Blockers
Calcium Channel Blockers (nonhydropyridines such as Verapamil and Diltiazem) |
|
|
Term
Contraindicated May Adversely Affect
Heart Failure |
|
Definition
Alpha Blockers
Calcium Channel Blockers (except amlodipine and feloipine) |
|
|
Term
Contraindicated May Adversely Affect
Peripheral Vascular Disease |
|
Definition
|
|
Term
Contraindicated May Adversely Affect
Pregnancy |
|
Definition
Beta Blockers
ACE Inhibitors
Angiotensin Receptor Blockers |
|
|
Term
Contraindicated May Adversely Affect
Renal Insuffiency |
|
Definition
Potassium Sparing Diuretics
Calcium Channel Blockers (especially the dihydropyridines such as Nifedipine [Procardia] and Amiodipine [Norvasc]) |
|
|
Term
Contraindicated May Adversely Affect
Renovascular Disease |
|
Definition
ACE Inhibitors
Angiotensin Receptor Blockers |
|
|
Term
| ACE Inhibitors are twice as likely to cause a noxious ______ in women as men. |
|
Definition
|
|
Term
| Thiazides are more likely to cause _____ in mean and ______ or ______ in women. |
|
Definition
Gout
Hyponatremia or Hypokalemia |
|
|
Term
| African Americans typically do not respond well to ACE Inhibitors but have an increased response to _______ diuretics. |
|
Definition
|
|
Term
| NSAIDS can cause an increase in ______ ______ particularly when combined with ACE Inhibitors and Angiotensin Receptor Blockers |
|
Definition
|
|
Term
| NSAIDS can also worsen ____ _____ and should be avoided. |
|
Definition
|
|
Term
| Clients with hypertension should be counseled not to use ____ ____, _____, ______, _____ _____, __ _____, ______, or _______. |
|
Definition
Devil's Claw
Ginseng
Goldenseal
Black Licorice
Ma Huang
Squill
Yohimbe |
|
|
