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163 Cards in this Set
- Front
- Back
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this is the second most common cause of kidney disease
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HTN
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T/F? Most HTN has no cause.
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T - 90%
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the 4 cardiac factors that influence BP are:
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- heart rate
- inotropic state (contraction of heart muscle) - neural - humoral (serum, body fluids) |
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the 3 factors that regulate renal fluid volume control, therefore influencing BP are:
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- renin-angiotensin
- aldosterone - atrial natriuretic factor (a natriuretic peptide) |
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a hormonal substance produced by the right atrium of the heart that stimulates the excretion of sodium and water by the kidneys
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atrial natriuretic factor
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blood pressure = this x this
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blood pressure = cardiac output X systemic vascular resistance
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the 2 factors that affect cardiac output
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- cardiac
- renal fluid volume control |
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the 2 factors that affect systemic vascualr resistance
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- sympathetic nervous system
- humoral |
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the Angiotensin & Norepinephrine are 2 _____ that affect the humoral response
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vasoconstrictors
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vasoconstrictors affect the humoral response, which influences this ...
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systemic vascular resistance
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these receptors are in the sypathetic nervous system & cause vasoconstriction
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alpha-adrenergic receptors
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these receptors are in the sypathetic nervous system & cause vasodilation
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beta-adrenergic receptors
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local regulation of the systemic vascular resistance is influenced by these vasodilators
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- prostaglandins
- EDRF (endothelium derived relaxing factor) |
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local regulation of the systemic vascular resistance is influenced by these vasoconstrictors
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- Endothelin
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- a persistent elevation of SBP >/= 140; and/or
- a DBP >/= 90; and/or - current use of antihypertensive medications |
hypertension
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SBP 120-139 OR
DBP 80-89 |
pre-hypertension
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an increase in aldosterone causes an increase in these 4 physiological areas:
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- sodium reabsorption
- water reabsorption - blood volume - cardiac output |
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these 2 vasoconstrictors influence the humoral response causing changes in systemic vascular resistance
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- angiotensin
- catecholamines |
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SBP < 120 & DBP <80
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Normal BP
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SBP 120-139
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Prehypertension
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DBP 80-89
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prehypertension
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SBP 140-159
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Stg. 1 hypertension
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DBP 90-99
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Stg. 1 hypertension
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SBP >/= 160
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Stg. 2 hypertension
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DBP >/= 100
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Stg. 2 hypertension
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a condition - especially of some elderly, diabetic, & uremic indv'ls - in which an erroneously high blood pressure reading is given by sphygmomanometry, usually due to loss of flexibility of the arterial walls
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pseudohypertension
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a SBP >/= 140
WITH a DBP < 90 |
isolated systolic hypertension
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this catagory of HTN is considered essential or idiopathic
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primary HTN
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this category of HTN has an elevated BP w/out an identifiable cause
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primary HTN
(essential or idiopathic) |
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90-95% of all cases of HTN fall w/in this catagory of HTN
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primary HTN
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contributing factors of primary HTN include:
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- elevated symphathetic nervous sys activity
- increased sodium retaining hormones & vasoconstrictors - diabetes mellitus - above ideal body weight - increased sodium intake - excessive alcohol intake |
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this category of HTN has an elevated BP with a specific cause
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secondary HTN
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5-10% of adult cases of HTN fall within this category of HTN
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secondary HTN
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diseases/disorders that contribute to secondary hypertension include:
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- coarctation of aorta
- renal disease - endocrine disorders - neurologic disorders - cirrhosis - sleep apnea |
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for clients over age 50, which is the more important risk factor for CVD: SBP/DBP?
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SBP
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in client's over age 50, SBP is more significantly elevated due to this _______________
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reduced arterial elasticity
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what is SBP a measure of?
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the "squeeze" - how hard the heart is working
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the risk of developing HTN is what % for persons who are normotensive at 55 y/o?
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90%
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risk factors for primary HTN include:
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- age
- alcohol use - cigarette smoking - diabetes mellitus - elevated serum lipids - excess dietary sodium - gender - family hx - obesity - ethnicity - sedentary lifestyle - socioeconomic status - stress |
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the risk factors for primary HTN that one can change or control include:
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- obesity
- sedentary lifestyle - cigarette smoking - stress - alcohol |
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risk factors that influence primary HTN than one cannot change or control include:
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- family hx
- ethnicity - age - gender |
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this gender is more prone to HTN
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women
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the factors that cause women to have a greater propensity for developing HTN include:
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- more % of body fat
- hormones - emotionally labile |
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the 4 risk factors for primary HTN that one can change/control or possible cannot change/control include:
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- socioeconomic status
- diabetes mellitus - elevated serum lipids - excess dietary sodium |
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in re: the pathophysiology of primary HTN, in most cases - HTN results from the interaction of these 3 factors:
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- environmental
- demographic - genetic |
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these demographics are associated with "salt sensitivity"
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- obesity
- increasing age - Af. American ethnicity - diabetes - renal disease |
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stress and increased SNS activity causes these physiological changes:
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- produces increased vasoconstriction
- elevated HR - increased Renin release |
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this is where high insulin concentration stimulates SNS activity & impairs nitric oxide
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mediated vasodilation
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high plasma renin activity is caused by_____________
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altered renin-angiotensin mechanism
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pathophysiologies of primary HTN include:
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- heredity
- water & sodium retention - stress & increased SNS activity - insulin resistance and hyperinsulinemia - altered renin-angiotensin mechanism - endothelial cell dysfunction |
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why is hypertension referred to as the "silent" killer?
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b/c Ct's are frequently asymptomatic until target organ disease occurs
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symptoms that are often secondary to target organ disease can include:
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- fatigue
- dizziness - palpitations, angina - dyspnea |
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target organ diseases occur most often in the:
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- heart
- brain - peripheral vasculature - kidney - eyes |
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hypertensive heart disease includes:
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- coronary artery disease
- left ventricular hypertrophy - heart failure |
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primary complication of HTN & cerbrovascular disease
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stroke
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the steps to take a proper BP include:
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- Pt. s/b seated for 5 min in chair, w/ feet on the floor
- palpate brachial pulse - use appropriate sized cuff - have arm at level of heart - check BP in both arms * use arm w/ higher reading for subsequent measurements |
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BP is highest at this time of day
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early morning
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BP is lowest at this time of day
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night
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diagnostic studies to use/test with HTN include:
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- urinalysis (creatine clearance)
- serum electrolytes & glucose - BUN & serum creatine - serum lipid panel - ECG - echocardiogram |
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this phenomenon may precipitate the need for ambulatory BP monitoring (ABPM)
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"white coat"
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this type of BP monitoring uses a noninvasive, fully automated sys that measures BP at present intervals over a 24 hr. period
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ambulatory BP monitoring (ABPM)
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the overall goals of treating HTN are:
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- control BP
- reduce CVD risk factors |
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a wt. loss of 22 lb (10 kg) may decrease SBP by approx how many mmHg?
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5-20
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the letters in the D-A-S-H eating plan stand for what?
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D - dietary
A - approaches to S - stop H - hypertension |
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To control HTN, one should reduce their sodium to what amt./day?
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< 2.4 g/day
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the 7 S's
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- soups
- sauces - snacks - smoked meats - sauerkraut - seasonings - sodium processed cold cuts |
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to control HTN, one should participate in what kind/how much physical activity
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aerobic activity - "most" days of the week
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what are the 2 primary actions of drugs used to treat HTN?
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- reduce systemic vascular resistence (SVR)
- reduce volume of circulating blood |
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what are the 5 main classifications of drugs used to treat HTN?
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- diuretics
- adrenergic inhibitors - direct vasodilators - angiotensin inhibitors - calcium channel blockers |
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when teaching Ct's a/b their HTN drug therapy, what should you discuss?
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- orthostatic hypotension
- sexual dysfunction - dry mouth - frequent urination |
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subjective data that you should assess w/ HTN Ct's should include:
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- past health hx
- medications - functional health patterns |
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some NDs of HTN include:
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- ineffective health maintenance
- anxiety - sexual dysfunction - ineffective therapeutic regimen mgmt. - disturbed body image - ineffective tissue perfusion |
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this is the most common form of HTN in indv'ls >50 y/o
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isolated systolic hypertension (ISH)
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this form of HTN is present in a/b 2/3 of people over 50 w/ a dx of HTN
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isolated systolic hypertension (ISH)
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this form of HTN is defined as a SBP >/= 140 and a DBP < 90
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isolated systolic hypertension (ISH)
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a wide gap between the 1st Korotkoff sound and subsequent beats is called the ___________, and failure to inflate the cuff high enough may result in underestimating the SBP
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auscultatory gap
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failure to inflate the cuff high enough to hear (this) may result in underestimating the SBP
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auscultatory gap
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older adults have varying degrees of impaired ________ , w/ orthostatic hypotension occuring frequently, especially in Ct's w/ ISH
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baroreceptor reflex mechanisms
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the function of (this) reflex is short-term regulation of BP
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baroreceptor reflex
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baroreceptor reflex is what kind of feedback mechanism? (positive/negative)
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negative
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these are stretch-sensitive receptors in the carotid sinus and aortic arch
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baroreceptors
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stimulation of these receptors occurs at certain pressures, which stretch the receptors in the vessel walls
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baroreceptors
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nerve impulses from these receptros are sent to cardio-vascular control centre
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baroreceptors
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a severe, abrupt increase in DBP: >/= 140 mmHG
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hypertensive crisis
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with this form of HTN, the rate of increase in BP is more important that the absolute value
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hypertensive crisis
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this form of HTN often occurs in Ct's w/ hx of HTN, who have failed to comply with meds or who have been undermedicated
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hypertensive crisis
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evidence of acute areget organ damage is this form of HTN
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hypertensive emergency
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hypertensive encephalopathy & cerebral hemorrhage are 2 examples of this manisfestation
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hypertensive emergency
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this HTN manifestation can result in acute renal failure, MI, & heart failure w/ pulm. edema
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hypertensive emergency
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activation of this increases heart rate, increases cardiac contractility, produces widespread vasoconstriction in the peripheral arterioles, & promotes the release of renin from the kidneys
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sympathetic nervous system
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when BP is increased, these receptors send impulses to brainstem, resulting in decreased HR, decreased force of contraction, and vasodilation in peripheral arterioles
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baroreceptors
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what are the 5 body systems that regulate BP?
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- nervous
- cardiovascular - endothelial - renal - endocrine |
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a decrease in BP leads to activation of the SNS, resulting in what physiological changes?
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- decreased HR
- decreased force of contraction - vasodilation in peripheral arterioles |
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kidneys contribute to BP regulation by controlling what 2 things?
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- sodium excretion
- extracellular fluid (ECF) volume |
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sodium retention results in ______, which causes ______
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- water retention
- increased ECF volume |
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what stimulates the adrenal cortex to release aldosterone
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angiotensin II
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what stimulates the kidneys to retain sodium & water
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aldosterone
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retention of sodium & water _____ BP by increasing ______
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- increases
- cardiac output |
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do not drink grapefruit jc w/in 2 hrs. of these meds
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calcium channel blockers (CCBs)
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grapefruit jc. increases the _______ of CCBs
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blood level
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Norvasc, Procardia are examples of this type of med
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CCBs
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these meds inhibit the formation of Angio II
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ACE inhibitors
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these meds block aldosterone
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ACE inhibitors
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these meds work on peripheral resistance (SVR)
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ACE inhibitors
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these meds work "like a diuretic", facilitating the excretion of Na+ & H2O - causing K+ to be retained
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ACE inhibitors
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these meds end in "-pril"
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ACE inhibitors
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these meds can produce the side effect of coughing in 10-20% of Pts.
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ACE inhibitors
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these meds can cause increased K+ levels
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ACE inhibitors
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these meds can cause hypotension w/ 1st dose
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ACE inhibitors
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Priniril, Accupril, Captopril, & Benazepril are common meds in this classification
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ACE inhibitors
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ACE inhibitors do not work well in these 2 populations
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- Af. Americans (unless given w/ a diuretic)
- elderly |
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this classification of meds are similar to ACE inhibitors
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Angiotensin Receptor Blockers (ARBs)
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this classification of meds blocks angio-II at the receptor sites in tissues
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Angiotensin Receptor Blockers (ARBs)
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this classification of meds prevents the release of aldosterone
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Angiotensin Receptor Blockers (ARBs)
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a common side effect of ARBs is _______
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angioedema
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this is the Na+ retaining hormone
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aldosterone
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Cozaar (losartan K+), Diovan (Valsartan), Avapro (irbesartan), Atacand (candesartan) are common names of this classification of drugs
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Angiotensin Receptor Blockers (ARBs)
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this classification of meds are less effective in Af. Americans
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Angiotensin Receptor Blockers (ARBs)
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this classification of med promotes vasodilation
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CCBs
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this classification of med decreases SVR, contractility, & BP
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CCBs
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this classification of med lowers BP in Af. Americans better than other med catagories
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CCBs
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Cardizem, Norvasc, Syscor, & Verapamile are common meds in this classification
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CCBs
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Side effects of CCBs can include:
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- flushing
- HA - dizziness - bradycardia - AV block |
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how long does it take for a person's total blood vol. to pass through the kidneys for cleaning?
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1&1/2 hrs.
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these meds work at the distal convoluted tubule to get rid of Na+, Cl, & H2O
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thiazides & related diuretics
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these meds are used to treat HTN & edema
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thiazides & related diuretics
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these meds cannot be used in Pts. w/ renal failure
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thiazides & related diuretics
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thiazides & related diuretics have what side effects?
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- hypokalemia
- hypomagnesemia - hyperlididemia - hypercalcemia - hyperglycemia - bicarb loss |
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a common name of a thiazides & related diuretics
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HCTZ
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these meds inhibit the body's ability to reabsorb Na+ at the ascending loop of Henle
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loop diuretics
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this classification of meds leads to the retention of H2O in the urine
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loop diuretics
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these meds cause a substantial diuresis - - have a "high ceiling"
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loop diuretics
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this form of diuretic is less effective for HTN
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loop diuretics
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can use this form of diuretic for ESRD (end stage renal disease)
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loop diuretics
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these are a potent diuretic
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loop diuretics
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this diuretic has what speed of effects?
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fast
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what is the most common form of loop diuretic
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lasix (furosemide)
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what diuretic can you never combine with another loop diuretic
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lasix (furosemide)
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side effects of loop diuretics include:
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- F&E imbalances
(decreased K+, Na+, Ca+, Cl, Mg) - metabolic alkalosis - orthostatic hypotension |
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these diuretics work on the collecting distal duct, facilitating Na+ & H2O loss & K+ retention
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K+ sparing diuretics
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these diuretics are weaker than thiazide & loop diuretics
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K+ sparing diuretics
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K+ sparing diuretics have what side effects?
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- hyperkalemia
- decreased excretion of H+, Ca+, Mg - N/V - diarrhea - rash - dizziness - headache - weakness - dry mouth |
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Aldactone (spironalactone), Midamor (amiloried HCL), Inspra (epleronone), Dyazle, Maxzide (triameterene & HCTZ)
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K+ sparing diuretics
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K+ sparing diuretics have what speed of effects
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slow
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Are K+ sparing diuretics potent?
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not potent
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these diuretics cause the kidney's to get rid of extra Na+ & H2O & hold onto K+
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aldosterone receptor blockers
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these diuretics inhibit the action of aldosterone
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aldosterone receptor blockers
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these are K+ diuretics
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aldosterone receptor blockers
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this form of K+ diuretic has fast effects & is potent
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aldosterone receptor blockers
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this form of K+ diuretic has fast effects, but is not potent
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K+ sparing
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side effects of aldosterone receptor blockers include:
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- hyperkalemia
- N/V - leg cramps - dizziness |
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Inspra & Aldactone are common drugs in this classification
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aldosterone receptor blockers
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beta-1 receptors are found here:
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mainly in the heart and in the kidneys
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beta-2 receptors are located here:
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lungs; GI tract; liver; uterus; vascular smooth & skeletal muscle
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beta-3 receptors are located here:
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fat cells
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this classification of meds reduce the effect of excitment/physical exertion on the heart rate & force of contraction
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beta blockers
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this classification of meds reduce the force of contraction
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beta blockers
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this classification of meds reduce the dilation of blood vessels & opening of bronchi
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beta blockers
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this classification of meds reduce tremors
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beta blockers
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this classification of meds reduce breakdown of glycogen
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beta blockers
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Af. Americans do not respond well to this classification of meds b/c they typically have low ____ levels
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- beta blockers
- renin |
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you cannot use beta blockers in these types of patients
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- COPD
- 2nd & 3rd degree heart block - CHF - bradycardia |
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you cannot stop beta blockers because ________ will happen
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rebound hypertension
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