Pharmacology of Blood Pressure Regulation

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Questions and Answers

Which drug category is NOT directly involved in regulating blood pressure?

  • ACE inhibitors
  • Calcium channel blockers
  • Antibiotics (correct)
  • Diuretics

Which of the following drugs directly blocks the conversion of angiotensin I to angiotensin II?

  • Aliskiren
  • Captopril (correct)
  • Losartan
  • Bosentan

Which of the following drugs targets the angiotensin receptor on blood vessels, preventing angiotensin II from binding?

  • Enalapril
  • Treprostinil
  • Amlodipine
  • Valsartan (correct)

What is the primary action of renin inhibitors, such as aliskiren?

<p>Inhibit the release of renin (D)</p> Signup and view all the answers

Which drug class acts primarily by causing blood vessel dilation, specifically targeting endothelin receptors?

<p>Endothelin receptor antagonists (B)</p> Signup and view all the answers

Which of the following medications is NOT directly involved in regulating blood pressure through the RAAS?

<p>Amlodipine (B)</p> Signup and view all the answers

What is the primary purpose of fixed-combination drugs for hypertension?

<p>To simplify medication regimens for patients (C)</p> Signup and view all the answers

Which of the following fixed-combination drugs does NOT contain a diuretic?

<p>Exforge (B)</p> Signup and view all the answers

Which of the following drugs is approved for the treatment of pulmonary arterial hypertension?

<p>Bosentan (D)</p> Signup and view all the answers

What is the mechanism of action for sildenafil (Revatio) in treating pulmonary arterial hypertension?

<p>Inhibition of cyclic guanosine monophosphate (cGMP) (D)</p> Signup and view all the answers

Which of the following drugs is administered by continuous subcutaneous infusion?

<p>Treprostinil (B)</p> Signup and view all the answers

What is a potential side effect of bosentan (Tracleer) that requires close monitoring?

<p>Liver toxicity (B)</p> Signup and view all the answers

Which of the following drugs is considered pregnancy category X?

<p>Ambrisentan (B)</p> Signup and view all the answers

What is the primary difference between treprostinil (Remodulin) and treprostinil (Orenitram)?

<p>Route of administration (C)</p> Signup and view all the answers

What is the primary reason patients with pulmonary arterial hypertension might be prescribed sildenafil (Revatio)?

<p>To improve exercise tolerance (A)</p> Signup and view all the answers

Which drug is commonly used for erectile dysfunction but also approved for pulmonary arterial hypertension?

<p>Sildenafil (C)</p> Signup and view all the answers

Epoprostenol (Flolan) is a prostaglandin that causes blood vessel dilation and relieves pulmonary pressure. What is the route of administration for this drug?

<p>Intravenous (C)</p> Signup and view all the answers

What is the primary function of the vasomotor center?

<p>To regulate blood pressure and blood flow (D)</p> Signup and view all the answers

During stressful situations, how does the vasomotor system respond to increase blood pressure?

<p>Increases both cardiac output and peripheral vascular resistance (A)</p> Signup and view all the answers

What is the role of baroreceptors in blood pressure regulation?

<p>They detect changes in blood pressure and send signals to the brain to adjust heart rate and blood vessel diameter (C)</p> Signup and view all the answers

Which of the following is NOT a mechanism involved in the baroreceptor reflex?

<p>Release of renin from the kidneys (A)</p> Signup and view all the answers

What is the primary function of the renin-angiotensin-aldosterone system (RAAS)?

<p>To maintain blood volume and pressure (B)</p> Signup and view all the answers

Which of the following is a direct effect of angiotensin II?

<p>Vasoconstriction of blood vessels (C)</p> Signup and view all the answers

How does aldosterone contribute to blood pressure regulation?

<p>It causes the kidneys to retain sodium and water, increasing blood volume (C)</p> Signup and view all the answers

What is the difference between essential hypertension and secondary hypertension?

<p>Essential hypertension has no known cause, while secondary hypertension is caused by an underlying medical condition (A)</p> Signup and view all the answers

Which of the following conditions can cause secondary hypertension?

<p>All of the above (D)</p> Signup and view all the answers

What is a potential consequence of chronic hypertension?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is a key difference between baroreceptors and chemoreceptors?

<p>Baroreceptors sense changes in blood pressure, while chemoreceptors sense changes in blood oxygen levels and pH (C)</p> Signup and view all the answers

How does the body compensate for a sudden drop in blood pressure when standing up?

<p>The baroreceptors signal the medulla to increase heart rate and constrict blood vessels (D)</p> Signup and view all the answers

What is the role of the juxtaglomerular cells in the RAAS?

<p>They release renin in response to low blood pressure or reduced blood flow to the kidneys (B)</p> Signup and view all the answers

Which of the following is NOT a factor that can contribute to essential hypertension?

<p>Underlying medical conditions (D)</p> Signup and view all the answers

Why is hypertension a serious health concern?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary mechanism of action for endothelin receptor antagonists in the treatment of pulmonary arterial hypertension?

<p>Block receptor sites for endothelin, allowing vessels to relax and dilate (B)</p> Signup and view all the answers

Which of the following drugs is NOT a treatment option for pulmonary arterial hypertension?

<p>Losartan with hydrochlorothiazide (Hyzaar) (B)</p> Signup and view all the answers

Which of the following is a potential adverse effect of Bosentan (Tracleer) therapy?

<p>Peripheral vasodilation, including flushing, headache, hypotension, and palpitations (C)</p> Signup and view all the answers

What is the recommended starting dose of Tracleer for adults?

<p>62.5 mg PO b.i.d. for 4 weeks (B)</p> Signup and view all the answers

Which of the following drugs requires a continuous subcutaneous infusion?

<p>Treprostinil (Remodulin) (D)</p> Signup and view all the answers

What is the mechanism of action of sildenafil (Revatio) in the treatment of pulmonary arterial hypertension?

<p>Directly dilates the pulmonary vascular bed by inhibiting cyclic guanosine monophosphate (cGMP) (B)</p> Signup and view all the answers

Which of the following medications is NOT categorized as pregnancy category X?

<p>Treprostinil (Remodulin) (A)</p> Signup and view all the answers

Which of the following drugs is approved for the treatment of pulmonary arterial hypertension and erectile dysfunction?

<p>Sildenafil (Revatio) (A), Tadalafil (Adcirca) (D)</p> Signup and view all the answers

Which drug requires close monitoring for the development of liver toxicity?

<p>Bosentan (Tracleer) (C)</p> Signup and view all the answers

What is the primary way that Iloprost (Ventavis) reduces pressure in the pulmonary vascular system?

<p>Directly dilates the pulmonary vascular bed (B)</p> Signup and view all the answers

What is the major difference between Treprostinil (Remodulin) and Treprostinil (Orenitram)?

<p>Remodulin is administered subcutaneously, while Orenitram is administered orally. (A)</p> Signup and view all the answers

Which of the following drugs has a boxed warning regarding severe liver injury?

<p>Ambrisentan (Letairis) (B)</p> Signup and view all the answers

What is the most common adverse effect associated with Treprostinil (Remodulin) therapy?

<p>Headache and injection site pain (A)</p> Signup and view all the answers

Which of the following is NOT a recommended practice for patients using Iloprost (Ventavis)?

<p>Ingest the drug or get it on the skin (D)</p> Signup and view all the answers

What type of drug is used to affect the RAAS and decrease blood pressure?

<p>Angiotensin-converting enzyme (ACE) inhibitors (B)</p> Signup and view all the answers

Which of the following medications is an inhaled synthetic prostacyclin used to treat pulmonary arterial hypertension?

<p>Iloprost (Ventavis) (D)</p> Signup and view all the answers

Which of the following adverse effects is NOT commonly reported with the use of Iloprost (Ventavis)?

<p>Muscle aches (A)</p> Signup and view all the answers

What is the primary mechanism of action for Iloprost (Ventavis) in treating pulmonary arterial hypertension?

<p>Directly dilating the pulmonary vascular bed (B)</p> Signup and view all the answers

Which of the following drug categories directly affects the Renin-Angiotensin-Aldosterone System (RAAS)?

<p>ACE inhibitors (C)</p> Signup and view all the answers

What is the key difference between ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) in their mechanism of action?

<p>ACE inhibitors block the production of angiotensin II, while ARBs block the action of angiotensin II. (C)</p> Signup and view all the answers

What is the main purpose of fixed-combination drugs in managing hypertension?

<p>To achieve better control of blood pressure with fewer medications (C)</p> Signup and view all the answers

Why should patients using Iloprost (Ventavis) be advised to change positions slowly?

<p>To prevent a sudden drop in blood pressure (C)</p> Signup and view all the answers

Which of the following drugs is NOT a fixed-combination drug for the treatment of hypertension?

<p>Treprostinil (Remodulin) (B)</p> Signup and view all the answers

What is the primary concern related to the use of endothelin receptor antagonists in the treatment of pulmonary arterial hypertension?

<p>Severe liver injury (C)</p> Signup and view all the answers

Which of the following is an appropriate route of administration for treprostinil in the treatment of pulmonary arterial hypertension?

<p>Subcutaneous (D)</p> Signup and view all the answers

What is a potential consequence of abruptly discontinuing treprostinil treatment?

<p>Rebound worsening of the condition (D)</p> Signup and view all the answers

Which of the following situations would NOT be a reason to discontinue treprostinil?

<p>Patient reports minor side effects such as headache (A)</p> Signup and view all the answers

Which of the following is NOT a common side effect of treprostinil?

<p>Muscle weakness (D)</p> Signup and view all the answers

In the context of hypertension management, what does the term "fixed-combination drug" refer to?

<p>A combination of two or more medications in a single dosage form (A)</p> Signup and view all the answers

Which of the following medications is NOT an endothelin receptor antagonist used in the treatment of pulmonary arterial hypertension?

<p>Iloprost (Ventavis) (A)</p> Signup and view all the answers

What is the primary benefit of using fixed-combination drugs for hypertension over single-drug therapy?

<p>Improved patient adherence (B)</p> Signup and view all the answers

Which of the following factors can contribute to an increase in mean arterial pressure (MAP)?

<p>Increased total peripheral resistance (PVR) (A)</p> Signup and view all the answers

What is the primary function of the cardiovascular system?

<p>To transport oxygen and nutrients to tissues and remove waste. (D)</p> Signup and view all the answers

Which part of the autonomic nervous system primarily lowers blood pressure?

<p>Parasympathetic nervous system (B)</p> Signup and view all the answers

What is the effect of angiotensin II receptors in the cardiovascular system?

<p>Vasoconstriction and increased aldosterone release (C)</p> Signup and view all the answers

What is the role of the baroreceptors in regulating blood pressure?

<p>They detect changes in blood pressure and stimulate the sympathetic nervous system accordingly. (A)</p> Signup and view all the answers

What is the mechanism of action of ACE inhibitors in treating hypertension?

<p>They block the conversion of angiotensin I to angiotensin II. (B)</p> Signup and view all the answers

What is the relationship between cardiac output (CO) and mean arterial pressure (MAP)?

<p>CO is directly proportional to MAP; as CO increases, MAP increases. (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of shock?

<p>Increased blood flow to vital organs (D)</p> Signup and view all the answers

Which of the following medications directly acts on the renin-angiotensin-aldosterone system (RAAS) to lower blood pressure?

<p>Angiotensin-converting enzyme (ACE) inhibitors (C)</p> Signup and view all the answers

What is the main effect of vasodilators on blood pressure?

<p>Dilate blood vessels, decreasing peripheral resistance (C)</p> Signup and view all the answers

How do calcium channel blockers (CCBs) affect blood pressure?

<p>They block calcium channels, decreasing muscle contraction and leading to vasodilation. (A)</p> Signup and view all the answers

Which of the following medications specifically blocks angiotensin II receptors?

<p>Angiotensin II receptor blockers (D)</p> Signup and view all the answers

What is the main mechanism of action of beta-blockers in treating hypertension?

<p>They reduce heart rate and contractility, lowering cardiac output. (C)</p> Signup and view all the answers

What is the relationship between stroke volume and mean arterial pressure (MAP)?

<p>Stroke volume is directly proportional to MAP; a higher stroke volume leads to a higher MAP. (A)</p> Signup and view all the answers

Which of the following medications would NOT be considered an antihypertensive agent?

<p>Digoxin (positive inotropic agent) (C)</p> Signup and view all the answers

What is the primary reason why antihypertensive medications are utilized to manage essential hypertension?

<p>To reduce the risk of stroke (C)</p> Signup and view all the answers

What is the main mechanism by which ACE inhibitors lower blood pressure?

<p>Blocking the conversion of angiotensin I to angiotensin II (A)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect associated with antihypertensive medications?

<p>Increased appetite (B)</p> Signup and view all the answers

Which of the following classes of antihypertensive drugs are mentioned as potentially suitable for first-line therapy?

<p>Diuretics (D)</p> Signup and view all the answers

What is the primary approach to managing hypertension?

<p>Adjusting the body's regulatory mechanisms (B)</p> Signup and view all the answers

Which of the following is NOT a factor that can contribute to a patient's unique response to antihypertensive medications?

<p>Blood type (D)</p> Signup and view all the answers

What is the potential benefit of fixed-combination antihypertensive medications?

<p>They simplify medication adherence for patients. (B)</p> Signup and view all the answers

What is the primary goal of hypertension treatment?

<p>To maintain normal blood pressure levels (A)</p> Signup and view all the answers

Which of the following drug classes directly affects the Renin–Angiotensin–Aldosterone System (RAAS)?

<p>Angiotensin II receptor blockers (ARBs) (D)</p> Signup and view all the answers

Which of the following is an example of an ACE inhibitor medication?

<p>Lisinopril (B)</p> Signup and view all the answers

What is the potential consequence of long-term, uncontrolled hypertension?

<p>Increased risk of heart disease (C)</p> Signup and view all the answers

Which of the following is an example of a long-acting thiazidelike diuretic mentioned as a potential first-line therapy?

<p>Chlorthalidone (A)</p> Signup and view all the answers

In the context of hypertension management, what does 'stepped care' refer to?

<p>Starting with lifestyle modifications and progressing to medication if needed (C)</p> Signup and view all the answers

What is the primary function of angiotensin II in the body?

<p>To constrict blood vessels (D)</p> Signup and view all the answers

Which of the following accurately describes the role of aldosterone antagonists in hypertension management?

<p>They block the action of aldosterone, reducing sodium and water retention (C)</p> Signup and view all the answers

What is a potential interaction that may occur when diltiazem is taken with cyclosporine?

<p>Increased serum levels and toxicity of cyclosporine (C)</p> Signup and view all the answers

Which of the following is a possible outcome of the calcium-channel blockers when consumed with grapefruit juice?

<p>Toxic levels of calcium-channel blockers (A)</p> Signup and view all the answers

What is the primary action of diltiazem in managing hypertension?

<p>Inhibits calcium ion movement across cell membranes (D)</p> Signup and view all the answers

For which condition is diltiazem specifically indicated in its extended-release form?

<p>Essential hypertension (A)</p> Signup and view all the answers

What adverse effect is commonly associated with the use of calcium-channel blockers like diltiazem?

<p>Bradycardia (B)</p> Signup and view all the answers

What should a nurse prioritize when a patient is started on a calcium-channel blocker?

<p>Regular blood pressure checks (C)</p> Signup and view all the answers

Which of the following is NOT a common side effect of diltiazem?

<p>Tachycardia (B)</p> Signup and view all the answers

Which lifestyle change might B.R. be encouraged to adopt before starting medication for hypertension?

<p>Implement regular exercise (D)</p> Signup and view all the answers

What is the half-life of diltiazem when taken orally in the extended-release form?

<p>5 to 7 hours (C)</p> Signup and view all the answers

What is one reason B.R. might be hesitant to start diuretic therapy?

<p>Worry about increased bathroom visits (D)</p> Signup and view all the answers

How long should B.R. attempt lifestyle changes before considering medication, according to the scenario?

<p>3 weeks (B)</p> Signup and view all the answers

Which factor can potentially impact B.R.'s job security as a business executive having hypertension?

<p>Insurance implications regarding the diagnosis (D)</p> Signup and view all the answers

What is the recommended onset time for oral, extended-release diltiazem to take effect?

<p>30-60 minutes (C)</p> Signup and view all the answers

What is a primary therapeutic action of calcium-channel blockers?

<p>Blocking calcium ion movement across membranes (C)</p> Signup and view all the answers

What can result from the combination of hypertension treatment and lifestyle changes in B.R.'s situation?

<p>Improvement in overall patient control of BP (B)</p> Signup and view all the answers

Which type of calcium-channel blocker primarily affects blood vessels with minimal impact on cardiac contractility?

<p>Dihydropyridine calcium-channel blockers (C)</p> Signup and view all the answers

Which of the following is an adverse effect associated with calcium-channel blockers?

<p>Bradycardia (A)</p> Signup and view all the answers

In what situation would the use of nondihydropyridine calcium-channel blockers be contraindicated?

<p>Patients with heart block (B)</p> Signup and view all the answers

How do calcium-channel blockers affect blood pressure and myocardial oxygen consumption?

<p>Decrease both (D)</p> Signup and view all the answers

Which of the following medications is commonly prescribed during pregnancy for hypertension?

<p>Nifedipine (D)</p> Signup and view all the answers

What is a significant interaction that patients on calcium-channel blockers should be aware of?

<p>Increased toxicity with grapefruit juice (A)</p> Signup and view all the answers

Which of the following calcium-channel blockers is available solely in intravenous form for short-term management?

<p>Clevidipine (D)</p> Signup and view all the answers

What is the primary metabolism route for most calcium-channel blockers?

<p>Hepatic metabolism (D)</p> Signup and view all the answers

Which calcium-channel blocker is indicated for treating tachyarrhythmias?

<p>Verapamil (D)</p> Signup and view all the answers

What is a potential CNS adverse effect of calcium-channel blockers?

<p>Dizziness (A)</p> Signup and view all the answers

Which of the following factors do NOT contraindicate the use of calcium-channel blockers?

<p>Hypotension (C)</p> Signup and view all the answers

Which of the following adverse effects can be attributed to the gastrointestinal system from calcium-channel blockers?

<p>Nausea (A)</p> Signup and view all the answers

What is a primary indication for the use of diltiazem?

<p>Tachyarrhythmias (C)</p> Signup and view all the answers

What type of calcium-channel blockers primarily act on blood vessels?

<p>Dihydropyridine (D)</p> Signup and view all the answers

Which of the following is a contraindication for nondihydropyridine calcium-channel blockers?

<p>Heart failure (D)</p> Signup and view all the answers

What is a potential adverse effect associated with calcium-channel blockers?

<p>Bradycardia (B)</p> Signup and view all the answers

What is the main mechanism of action of sildenafil in treating pulmonary arterial hypertension?

<p>Increasing cyclic guanosine monophosphate (A)</p> Signup and view all the answers

Which of the following food interactions should be avoided with calcium-channel blockers?

<p>Grapefruit juice (A)</p> Signup and view all the answers

What is the mechanism of action for diltiazem?

<p>Inhibits calcium movement across cell membranes (B)</p> Signup and view all the answers

How often should sildenafil (Revatio) be administered for pulmonary arterial hypertension?

<p>Three times a day (A)</p> Signup and view all the answers

Which medication is commonly administered during pregnancy to treat high blood pressure?

<p>Nifedipine (A)</p> Signup and view all the answers

Which drug is delivered via a continuous infusion through a central venous line?

<p>Epoprostenol (B)</p> Signup and view all the answers

Which group of patients should avoid nondihydropyridine calcium-channel blockers?

<p>Patients with sick sinus syndrome (B)</p> Signup and view all the answers

What is a common adverse effect associated with iloprost (Ventavis)?

<p>Dizziness (B)</p> Signup and view all the answers

What is a common CNS effect of calcium-channel blockers?

<p>Headache (D)</p> Signup and view all the answers

Which type of calcium-channel blocker is known to primarily act on blood vessels with less negative inotropic effect?

<p>Dihydropyridine (A)</p> Signup and view all the answers

Which adverse effect is most commonly associated with calcium-channel blockers?

<p>Peripheral edema (A)</p> Signup and view all the answers

Which of the following drugs is available in IV form for short-term use?

<p>Nicardipine (D)</p> Signup and view all the answers

Why might calcium-channel blockers be contraindicated in patients with heart block?

<p>They slow cardiac impulse formation (B)</p> Signup and view all the answers

Which calcium-channel blocker can potentially worsen heart failure?

<p>Diltiazem (D)</p> Signup and view all the answers

What unique delivery method is used for clevidipine?

<p>Intravenous infusion (C)</p> Signup and view all the answers

What is the primary reason calcium-channel blockers may cause hypotension?

<p>Dilation of arterioles (A)</p> Signup and view all the answers

What should patients be advised against while using iloprost?

<p>Changing positions quickly (A)</p> Signup and view all the answers

What common gastrointestinal side effect can occur with calcium-channel blockers?

<p>Constipation (D)</p> Signup and view all the answers

Which of the following is a common method for administering antihypertensive medications?

<p>Orally (C)</p> Signup and view all the answers

Which of the following statements is true regarding the administration of some drugs used to treat hypertension?

<p>They should not be crushed to prevent rapid release (A)</p> Signup and view all the answers

What is a notable effect of nondihydropyridine calcium-channel blockers on cardiac function?

<p>Decrease heart rate (C)</p> Signup and view all the answers

What requirement is often necessary for patients taking long-acting calcium-channel blockers?

<p>Specific lifestyle changes (D)</p> Signup and view all the answers

What should patients be educated about regarding the use of sildenafil for pulmonary arterial hypertension?

<p>It may cause severe hypotension (A)</p> Signup and view all the answers

Which drug has the potential to exacerbate heart failure due to its conductive tissue effects?

<p>Diltiazem (B)</p> Signup and view all the answers

Calcium-channel blockers are primarily used to manage which condition?

<p>Hypertension (D)</p> Signup and view all the answers

What are some common adverse effects associated with droxidopa therapy?

<p>Nausea and visual disturbances (A), Dizziness and arrhythmias (C)</p> Signup and view all the answers

Which condition is droxidopa primarily indicated for?

<p>Symptomatic neurogenic orthostatic hypotension (C)</p> Signup and view all the answers

What is a significant consideration when prescribing midodrine?

<p>Caution is necessary with cardia glycosides. (B)</p> Signup and view all the answers

What effect does droxidopa have on blood pressure?

<p>Raises blood pressure through vasoconstriction (A)</p> Signup and view all the answers

Which of the following is contraindicated for patients taking droxidopa?

<p>History of allergy to the drug (C)</p> Signup and view all the answers

What is the half-life of droxidopa?

<p>2.5 hours (D)</p> Signup and view all the answers

Which of the following statements is true regarding drug-drug interactions with midodrine?

<p>It may enhance effects of alpha-adrenergic agents. (D)</p> Signup and view all the answers

What are potential nursing considerations when assessing patients for antihypotensive medications?

<p>Any history of allergy to medications (C)</p> Signup and view all the answers

Which of the following options describes the pharmacokinetics of droxidopa?

<p>Reaches peak levels after 1 to 4 hours (A)</p> Signup and view all the answers

What is one of the nursing conclusions when patients are receiving antihypotensive drug therapy?

<p>Expected outcomes can include altered tissue perfusion. (B)</p> Signup and view all the answers

What is the most concerning aspect of B.R.'s reluctance to take a diuretic?

<p>It might interfere with his business schedule (A)</p> Signup and view all the answers

What is the primary reason for delaying drug therapy for B.R. for two weeks?

<p>To assess the effectiveness of lifestyle changes alone (C)</p> Signup and view all the answers

What does the content suggest regarding the accuracy of blood pressure measurements?

<p>Inaccurate measurements can lead to wrong diagnoses and inappropriate treatments (C)</p> Signup and view all the answers

Which aspect of B.R.'s lifestyle should be addressed to manage his hypertension?

<p>His heavy reliance on fast food (D)</p> Signup and view all the answers

What additional teaching point could be beneficial for B.R. regarding hypertension?

<p>The long-term effects of uncontrolled hypertension (A)</p> Signup and view all the answers

What is the primary reason for initiating a calcium-channel blocker instead of a diuretic for B.R.?

<p>Calcium-channel blockers are more convenient for B.R.'s busy schedule (A)</p> Signup and view all the answers

What is the primary reason for recommending a fitness program and stress reduction techniques for B.R.?

<p>To manage his stress levels and improve his blood pressure (D)</p> Signup and view all the answers

Why is it important for B.R. to receive regular follow-up and frequent blood pressure checks?

<p>To prevent complications from uncontrolled hypertension (D)</p> Signup and view all the answers

What is the main implication of B.R.'s hypertension diagnosis regarding his insurance and job security?

<p>It could potentially lead to higher insurance premiums (B)</p> Signup and view all the answers

What could be a potential consequence of B.R.'s reluctance to take medication for hypertension?

<p>He might develop a more serious health condition (B)</p> Signup and view all the answers

What is the primary goal of teaching B.R. about the effects of calcium-channel blockers?

<p>To enable him to better manage the medication's impact on his life (A)</p> Signup and view all the answers

Why is it important to consider B.R.'s autonomy when making treatment decisions?

<p>To respect B.R.'s wishes and empower him in his care (A)</p> Signup and view all the answers

Which factor could potentially hinder B.R.'s adherence to his prescribed medication?

<p>His busy work schedule (C)</p> Signup and view all the answers

What is the primary reason why it is important to focus on the safe administration of calcium-channel blockers?

<p>To prevent accidental overdose (A)</p> Signup and view all the answers

What is a common nursing conclusion related to drug therapy for hypertension?

<p>Altered skin integrity related to dermatological effects (D)</p> Signup and view all the answers

What is the primary mechanism by which diltiazem lowers blood pressure?

<p>By inhibiting the movement of calcium ions into muscle cells (D)</p> Signup and view all the answers

Which intervention is appropriate for enhancing the effectiveness of antihypertensive therapy?

<p>Recommending weight loss and smoking cessation (A)</p> Signup and view all the answers

Which adverse effect should be monitored closely during antihypertensive therapy?

<p>Hypotension (C)</p> Signup and view all the answers

What characterizes diuretic agents in treating hypertension?

<p>They promote sodium and water excretion (C)</p> Signup and view all the answers

Beta-blockers control hypertension through which mechanism?

<p>Blocking sympathetic nervous system effects (A)</p> Signup and view all the answers

Which of the following diuretics is a potassium-sparing agent?

<p>Spironolactone (A)</p> Signup and view all the answers

What is a key aspect of patient teaching regarding drug therapy?

<p>Patients should be informed about potential adverse effects. (D)</p> Signup and view all the answers

What is one potential side effect of alpha-adrenergic blockers?

<p>Reflex tachycardia (B)</p> Signup and view all the answers

Which assessment is crucial for evaluating the response to antihypertensive therapy?

<p>Maintaining blood pressure within normal limits (C)</p> Signup and view all the answers

Which measure can help relieve discomfort associated with drug therapy?

<p>Providing access to bathroom facilities (B)</p> Signup and view all the answers

What is a key consideration when taking vasodilators to manage severe hypertension?

<p>They should be avoided if there is known allergy to the drug. (B)</p> Signup and view all the answers

What is a common adverse effect of beta-blockers that may influence adherence?

<p>Loss of libido (A)</p> Signup and view all the answers

Which adverse effect is associated with the use of nitroprusside?

<p>Cyanide toxicity (D)</p> Signup and view all the answers

Why should patients taking vasodilators be cautious about dehydration?

<p>It may lead to an increased risk of lightheadedness or dizziness. (B)</p> Signup and view all the answers

What advantage do thiazide diuretics offer in managing hypertension?

<p>First-line use in mild hypertension (A)</p> Signup and view all the answers

Which of the following is a recommended practice for managing mouth sores associated with vasodilator therapy?

<p>Implement frequent mouth care. (A)</p> Signup and view all the answers

Which of the following statements accurately describes alpha1-blockers?

<p>They promote vasodilation and lower blood pressure. (B)</p> Signup and view all the answers

What should patients do before taking over-the-counter medications while on vasodilators?

<p>Consult with their health care provider. (D)</p> Signup and view all the answers

What action is important while taking hydralazine for hypertension?

<p>Monitor for signs of reflex tachycardia. (D)</p> Signup and view all the answers

Why might nitroglycerin be prescribed during severe hypertension?

<p>To rapidly decrease blood pressure. (B)</p> Signup and view all the answers

What is a potential risk when combining grapefruit juice with a calcium-channel blocker?

<p>Increased absorption of the drug leading to toxicity. (B)</p> Signup and view all the answers

Which statement is true regarding the pharmacokinetics of nitroprusside?

<p>It is administered IV with a rapid onset. (D)</p> Signup and view all the answers

What complication should be reported to a health care provider while on vasodilators?

<p>Swelling of feet and hands. (A)</p> Signup and view all the answers

What condition could contraindicate the use of vasodilators?

<p>Cerebral insufficiency. (D)</p> Signup and view all the answers

What is a common adverse effect experienced by patients taking minoxidil?

<p>Abnormal hair growth. (C)</p> Signup and view all the answers

How is nitroglycerin commonly administered?

<p>Through intravenous and various forms. (A)</p> Signup and view all the answers

What long-term monitoring might be necessary for patients on nitrates, such as nitroglycerin?

<p>Liver function tests. (D)</p> Signup and view all the answers

What physiological response do vasodilators trigger in blood vessels?

<p>Relaxation of vascular smooth muscle. (B)</p> Signup and view all the answers

What effect do Alpha2-agonists have on blood pressure?

<p>Inhibit sympathetic outflow from the CNS (D)</p> Signup and view all the answers

Which of the following medications is SPECIFICALLY used to treat orthostatic hypotension?

<p>Midodrine (A)</p> Signup and view all the answers

Which adverse effect is commonly associated with sympathomimetic drugs?

<p>Nausea and constipation (D)</p> Signup and view all the answers

What is the primary therapeutic action of sympathomimetic drugs in treating shock?

<p>Increase strength of cardiac muscle contraction (C)</p> Signup and view all the answers

How do ACE inhibitors primarily lower blood pressure?

<p>By inhibiting the conversion of angiotensin I to angiotensin II (A)</p> Signup and view all the answers

What is a critical consideration when using midodrine for treatment?

<p>It can lead to supine hypertension (B)</p> Signup and view all the answers

Which of the following describes the action of calcium-channel blockers?

<p>They lead to vasodilation by interfering with calcium influx (C)</p> Signup and view all the answers

What is a primary consequence of untreated hypertension?

<p>Damage to blood vessels and organs (D)</p> Signup and view all the answers

Which class of drug directly acts on adrenergic receptors to treat hypotension or shock?

<p>Sympathomimetic agents (A)</p> Signup and view all the answers

Which drug class is associated with decreased renal blood flow when used inappropriately?

<p>Sympathomimetics (A)</p> Signup and view all the answers

What mechanism do renin inhibitors employ to lower blood pressure?

<p>Inhibition of renin release (A)</p> Signup and view all the answers

What serious adverse effect could occur with excessive use of sympathomimetic drugs?

<p>Tachyarrhythmias (A)</p> Signup and view all the answers

Which of the following conditions is a contraindication for midodrine use?

<p>Pheochromocytoma (B)</p> Signup and view all the answers

What is the best purpose of antihypertensive medications?

<p>Change normal reflexes controlling blood pressure (B)</p> Signup and view all the answers

What is a possible adverse effect of calcium-channel blockers?

<p>Hypotension (D)</p> Signup and view all the answers

Which of the following conditions would be a contraindication for administering a calcium-channel blocker?

<p>Heart failure (C)</p> Signup and view all the answers

Which medication is mentioned in the provided content as an example of a calcium-channel blocker available in intravenous (IV) form?

<p>Clevidipine (A)</p> Signup and view all the answers

How do calcium-channel blockers primarily decrease blood pressure?

<p>By inhibiting vasoconstriction (D)</p> Signup and view all the answers

What is the primary reason B.R., a patient with hypertension, is reluctant to take a diuretic?

<p>Discomfort with frequent bathroom breaks (C)</p> Signup and view all the answers

What teaching point should be emphasized to B.R. regarding hypertension?

<p>Hypertension is a serious condition that can lead to complications. (D)</p> Signup and view all the answers

What nursing intervention would be most beneficial for B.R. before making a treatment decision?

<p>Providing education on hypertension and treatment options (C)</p> Signup and view all the answers

What is the primary mechanism of action for calcium-channel blockers?

<p>Inhibiting the movement of calcium ions across cell membranes (D)</p> Signup and view all the answers

Why are calcium-channel blockers effective in the treatment of angina?

<p>They decrease cardiac workload and myocardial oxygen consumption. (C)</p> Signup and view all the answers

Which of the following drugs is an example of a calcium-channel blocker available in oral formulations?

<p>Nifedipine (Procardia XL) (D)</p> Signup and view all the answers

What is a potential concern for B.R. regarding his insurance and job security after being diagnosed with hypertension?

<p>He may be denied employment or insurance due to a perceived health risk. (B)</p> Signup and view all the answers

What is the primary purpose of the nursing care guide for B.R. regarding calcium-channel blockers?

<p>To provide comprehensive assessment and education related to calcium-channel blockers. (B)</p> Signup and view all the answers

Which of the following nursing considerations should be addressed during the assessment of B.R. before administering calcium-channel blockers?

<p>Evaluating the patient's renal function (B)</p> Signup and view all the answers

What is the main goal of initiating drug therapy for B.R. with a calcium-channel blocker?

<p>To reduce the risk of stroke. (A)</p> Signup and view all the answers

Which statement best reflects the importance of monitoring B.R.'s blood pressure after he starts taking calcium-channel blockers?

<p>To ensure effective treatment and adjust dosage as needed. (A)</p> Signup and view all the answers

What additional teaching points should be covered with B.R. regarding calcium-channel blockers?

<p>Limit consumption of grapefruit juice. (C)</p> Signup and view all the answers

What lifestyle changes are recommended to help B.R. manage hypertension more effectively?

<p>Weight loss and regular physical activity (B)</p> Signup and view all the answers

What may be a primary concern for B.R. regarding diuretic therapy as a busy business executive?

<p>Frequent bathroom stops during work hours (D)</p> Signup and view all the answers

What is indicated if B.R.'s blood pressure remains elevated after two weeks of lifestyle changes?

<p>Pharmaceutical intervention should be considered (C)</p> Signup and view all the answers

Which teaching point is crucial for B.R. when taking calcium-channel blockers?

<p>It must not be crushed or chewed (A)</p> Signup and view all the answers

What potential effects of drug therapy should B.R. be aware of?

<p>Adverse effects like dizziness and hypotension (C)</p> Signup and view all the answers

How does the diagnosis of hypertension affect B.R.'s job security?

<p>Employers may view it as a health risk (C)</p> Signup and view all the answers

What might B.R. consider to help manage stress without medication?

<p>Biofeedback and relaxation techniques (C)</p> Signup and view all the answers

What is the significance of accurately measuring blood pressure for B.R.?

<p>Inaccurate measurements can lead to improper treatment (A)</p> Signup and view all the answers

What should B.R. do if experiencing adverse effects from the antihypertensive medication?

<p>Consult a healthcare provider to discuss alternatives (A)</p> Signup and view all the answers

What is a recommended approach for B.R. regarding the monitoring of blood pressure?

<p>Regular follow-ups and frequent checks are important (D)</p> Signup and view all the answers

What should be included in the patient teaching program for B.R. regarding antihypertensive therapy?

<p>The importance of adherence to medication and safety precautions (D)</p> Signup and view all the answers

What might B.R. experience as a common adverse effect of calcium-channel blockers?

<p>Dizziness and lightheadedness (A)</p> Signup and view all the answers

Why is it important for B.R. to take medication consistently even if feeling well?

<p>Skipping doses can lead to a significant increase in blood pressure (B)</p> Signup and view all the answers

What can help increase B.R.'s adherence to hypertensive drug therapy?

<p>Discussing potential side effects and management strategies (C)</p> Signup and view all the answers

Flashcards

Blood Pressure Control

The physiological mechanisms regulating blood pressure levels in the body.

Antihypertensive Drugs

Medications used to lower high blood pressure.

Captopril

A prototype ACE inhibitor used to treat hypertension.

Diltiazem

A calcium channel blocker that relaxes blood vessels to decrease blood pressure.

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Contraindications

Reasons or conditions under which a drug should not be used.

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Vasomotor Center

A brain region regulating blood vessel diameter and heart activity.

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Baroreceptors

Specialized receptors in arteries that sense blood pressure.

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Chemoreceptors

Receptors that respond to changes in blood gas levels.

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Cardiac Output (CO)

The volume of blood the heart pumps per minute.

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Peripheral Vascular Resistance (PVR)

Resistance blood encounters as it flows through vessels.

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Mean Arterial Pressure (MAP)

Average pressure in a person's arteries during one cardiac cycle.

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Renin-Angiotensin-Aldosterone System (RAAS)

Hormonal system regulating blood pressure and fluid balance.

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Angiotensin II

A potent vasoconstrictor increasing blood pressure.

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Aldosterone

Hormone that increases sodium and water retention.

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Baroreceptor Reflex

A mechanism to maintain stable blood pressure.

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Hypertension

Sustained high blood pressure above normal levels.

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Essential Hypertension

High blood pressure with no identifiable cause.

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Secondary Hypertension

High BP due to a specific underlying condition.

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Autonomic Nervous System

Part of the nervous system that regulates involuntary functions.

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Vasodilation

Widening of blood vessels to decrease blood pressure.

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ACE Inhibitor

Drug that blocks ACE, reducing vasoconstriction and aldosterone.

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Cardiovascular Center

Area in the medulla activating the sympathetic nervous system.

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Primary Hypertension

Sustained high blood pressure with no discernible cause.

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Peripheral Resistance (PVR)

Resistance to blood flow in vessels, affecting blood pressure.

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Stroke Volume

Amount of blood pumped by the ventricle per heartbeat.

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Sympathetic Nervous System

Part of the autonomic nervous system increasing heart rate and BP.

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Vasodilators

Drugs that relax blood vessels to lower blood pressure.

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Diuretics

Medications that promote urine production to lower blood volume.

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Shock

Severe hypotension leading to inadequate blood flow.

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Atherosclerotic Vascular Disease

A condition characterized by the buildup of plaques in arteries, leading to reduced blood flow.

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Chronic Hypertension

A long-term condition where blood pressure is consistently elevated, increasing health risks.

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Left Ventricular Hypertrophy

Thickening of the heart's left ventricle due to increased workload from hypertension.

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Visual Impairment

Loss of vision due to damage of tiny blood vessels in the retina caused by hypertension.

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Renal Dysfunction

Impaired kidney function due to damaged blood vessels in the glomeruli from high blood pressure.

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Ischemic Heart Disease

Heart condition resulting from reduced blood supply, often due to atherosclerosis.

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Blood Pressure Management

The process of maintaining blood pressure within normal limits to prevent damage.

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Combination Therapy

Using multiple medications to treat hypertension effectively by targeting different mechanisms.

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Renin–Angiotensin–Aldosterone System (RAAS)

A hormone system regulating blood pressure and fluid balance.

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Angiotensin II Receptor Blockers (ARBs)

Drugs that block angiotensin II receptors to lower blood pressure.

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Calcium-Channel Blockers (CCBs)

Medications that relax blood vessels by inhibiting calcium entry into cells.

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Fixed-Combination Drugs

Medications that combine two or more antihypertensives into one pill for convenience.

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Beta-blockers

Drugs that reduce heart rate and blood pressure by blocking beta-adrenergic receptors.

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RAAS Altering Drugs

Drugs that affect the Renin-Angiotensin-Aldosterone System, impacting blood pressure.

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ARB

Angiotensin Receptor Blockers that prevent angiotensin II from binding to receptors.

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Renin Inhibitor

A drug that inhibits renin, the enzyme that starts RAAS action.

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Aldosterone Antagonists

Drugs that block aldosterone, reducing sodium and water retention.

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Bosentan

First endothelin receptor antagonist for pulmonary arterial hypertension treatment.

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Ambrisentan

Endothelin receptor antagonist, taken once daily for pulmonary hypertension.

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Epoprostenol

Prostaglandin administered via infusion that dilates blood vessels.

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Sildenafil (Revatio)

Drug for pulmonary hypertension that increases blood vessel relaxation.

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Tadalafil (Adcirca)

Oral medication for pulmonary hypertension, also used for ED treatment.

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Exercise Tolerance Improvement

Increase in patient's ability to perform physical activities on medication.

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Hydrochlorothiazide Combinations

Drugs combining HCTZ with other antihypertensive agents.

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Infusion Pump Learning

Training required for patients receiving continuous drug infusions.

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Pregnancy Category X

Drugs not safe for use during pregnancy due to risk factors.

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Combination Drug: Tekturna HCT

A combination of aliskiren and hydrochlorothiazide used for hypertension.

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Combination Drug: Lotrel

A combination of amlodipine and benazepril for lowering blood pressure.

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Combination Drug: Azor

A combination of amlodipine and olmesartan for hypertension treatment.

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Combination Drug: Exforge

Combines amlodipine and valsartan for hypertension management.

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Bosentan (Tracleer)

First endothelin receptor antagonist approved for pulmonary arterial hypertension.

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Ambrisentan (Letairis)

An oral endothelin receptor antagonist for pulmonary hypertension, taken once daily.

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Epoprostenol (Flolan)

A prostaglandin given as a continuous infusion to dilate blood vessels.

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Iloprost (Ventavis)

Inhaled synthetic prostacyclin that reduces pressure in the pulmonary vascular system.

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Hydrochlorothiazide

A diuretic often combined with other drugs to treat high blood pressure.

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Candesartan with hydrochlorothiazide (Atacand HCT)

A medication combining candesartan and hydrochlorothiazide for hypertension.

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Atenolol with chlorthalidone (Tenoretic)

A combination medication for treating hypertension.

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Telmisartan with amlodipine (Twynsta)

A combination drug for hypertension treatment that includes telmisartan and amlodipine.

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Pulmonary Arterial Hypertension

A condition characterized by high blood pressure in the arteries of the lungs.

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Iloprost

An inhaled synthetic prostacyclin for pulmonary arterial hypertension.

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RAAS

Hormonal system regulating blood pressure and fluid balance in the body.

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Angiotensin Receptor Blockers (ARBs)

Drugs that block receptors for angiotensin to lower blood pressure.

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Combining Antihypertensives

Using multiple drugs to effectively lower blood pressure.

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Common Adverse Effects of Iloprost

Dizziness, headache, nausea, and syncope after using Iloprost.

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Easing Pulmonary Hypertension Symptoms

Iloprost and endothelin blockers relax pulmonary vessels.

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Treprostinil

Prostacyclin for pulmonary hypertension, delivered via pump or inhalation.

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Injection Site Pain

Common adverse effect of treprostinil, relieved by analgesics.

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Side Effects of Renin-Angiotensin Drugs

Headache, hypotension, and flushing possible with these medications.

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Monitoring for Drug Interactions

Essential for patients on bosentan, ambrisentan, and treprostinil.

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Calcium-Channel Blockers

Drugs that relax blood vessels, reducing BP and myocardial oxygen consumption.

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Dihydropyridine CCBs

Type of calcium-channel blockers primarily affecting blood vessels, not heart contraction.

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Nondihydropyridine CCBs

Calcium-channel blockers that can affect heart rhythm and reduce heart rate.

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Adverse Effects of CCBs

Common side effects include dizziness, hypotension, and peripheral edema.

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Contraindications of CCBs

Not safe for patients with heart block or severe heart failure.

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Epoprostenol Administration

Given through central line; patients need teaching on infusion pump use.

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Calcium-Channel Blocker Effects

They depress myocardial contractility and dilate arteries to lower BP.

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Common Side Effects of Epoprostenol

Headache, nausea, vomiting are frequent adverse effects.

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Drug Administration Warnings

Some hypertension drugs can’t be cut or crushed, must be intact.

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Drug-Drug Interaction

How one drug affects the activity or side effects of another drug.

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Cyclosporine & Diltiazem Interaction

Taking diltiazem can increase serum levels and toxicity of cyclosporine.

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Grapefruit Juice Interaction

Grapefruit juice can increase concentrations of calcium-channel blockers, risking toxicity.

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Indications for Diltiazem

Used for essential hypertension, angina, and tachyarrhythmias in extended-release form.

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Diltiazem Actions

Inhibits calcium movement across membranes, decreasing myocardial contractility and lowering BP.

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Adverse Effects of Diltiazem

Can cause headaches, dizziness, bradycardia, and hypotension.

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Patient Teaching for CCBs

Advise patients on the risks of interactions, especially with grapefruit juice.

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Hypertension Patient Case

B.R. showed high BP and needed lifestyle changes before starting medication.

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Lifestyle Changes for BP

Weight loss, diet modification, exercise, and reducing alcohol can help control hypertension.

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Critical Thinking for Hypertension

Consider risks and lifestyle factors before starting medication for BP management.

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Continuation of Lifestyle Changes

Encouraging further lifestyle adjustments before medication implementation.

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Nursing Considerations for CCBs

Monitor patients for adverse effects and adherence to therapy.

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Medical Record Implications

Hypertension can affect job security and insurance accessibility.

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Adverse Effects of Calcium-Channel Blockers

Common side effects include dizziness, headache, and hypotension.

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Uses of Calcium-Channel Blockers

Primarily used to treat angina and hypertension.

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Effects on Myocardial Function

They decrease myocardial contractility and affect heart impulse formation.

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B.R.'s Initial BP Reading

B.R. had a blood pressure of 164/102 mm Hg during examination.

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Lifestyle Changes Encouraged for B.R.

Diet, salt and alcohol reduction, exercise, and smoking cessation.

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Follow-Up Appointment for B.R.

Scheduled after three weeks to monitor weight loss and BP changes.

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Calcium-Channel Blocker Medication Names

Includes amlodipine, diltiazem, felodipine, and others.

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Impact of Diuretics on Daily Life

Diuretics can cause frequent bathroom visits affecting work routines.

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Renal Dysfunction Risk

Risk of renal issues in patients using calcium-channel blockers.

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Potential Need for Drug Therapy

Delay drug treatment for two weeks to focus on lifestyle changes first.

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Teaching Points for B.R.

Educate on hypertension risks, drug effects, and lifestyle modifications.

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Calcium-Channel Blocker Mechanism

Inhibits calcium entry, relaxing arteries and lowering BP.

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Common Calcium-Channel Blockers

Oral options include amlodipine, diltiazem, and nifedipine.

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Critical Thinking Scenario

B.R. had a BP evaluation leading to lifestyle and potential medication changes.

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Dihydropyridine

A type of calcium-channel blocker primarily affecting blood vessels.

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Nondihydropyridine

Calcium-channel blockers that also affect the heart's conduction system and heart rate.

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Therapeutic Actions

Calcium-channel blockers relax blood vessels, lowering blood pressure and myocardial oxygen demand.

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Pharmacokinetics

Refers to how drugs are absorbed, metabolized, and excreted in the body.

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Adverse Effects

Negative effects of calcium-channel blockers include dizziness, hypotension, and swelling.

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Drug–Drug Interactions

Interactions that can increase serum levels and toxicity of other medications, like cyclosporine with diltiazem.

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Calcium Movement

Calcium-channel blockers inhibit calcium ions' movement across cell membranes, affecting contractions.

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Nifedipine in Pregnancy

Nifedipine is commonly safe for use during pregnancy to control high blood pressure.

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CNS Effects

Central nervous system side effects of calcium-channel blockers may include dizziness and headache.

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Peripheral Edema

Swelling in the body's tissues as an adverse effect of calcium-channel blockers.

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IV Form Usage

Calcium-channel blockers like nicardipine and clevidipine are used intravenously for short-term treatment.

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Therapy Adherence

Incorporating drug effects into lifestyle to enhance patient compliance with therapy.

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Hypertension Implications

Hypertension may impact insurance and job security, causing risk concerns.

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Diuretic Therapy Concerns

Diuretic therapy can lead to frequent bathroom visits, affecting a busy lifestyle.

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Patient Autonomy

Respecting a patient's wishes in treatment decisions, such as delaying medication for lifestyle changes.

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Insurance View of Hypertension

Historically, hypertension has been seen as a hiring risk by insurers and employers.

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BP Measurement Importance

Two accurate BP measurements are required for diagnosing hypertension.

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Adverse Effects Awareness

Patients must be aware of possible side effects of hypertension medications like dizziness and fatigue.

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Monitoring Blood Pressure

Regular BP checks are critical to ensure hypertension management and treatment effectiveness.

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Patient Teaching Importance

Patients should understand their medication, potential side effects, and when to seek help.

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Stress Reduction Techniques

Methods like biofeedback and fitness programs help reduce stress and improve BP control.

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Medication Adherence

Taking prescribed medication consistently is vital for effective hypertension management.

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High Blood Pressure Consequences

Untreated hypertension can lead to serious health issues like heart attack and stroke.

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Side Effects of Calcium-Channel Blockers

Common side effects include dizziness, lightheadedness, and swelling.

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Follow-Up Importance

Regular follow-up is essential to adjust treatment and monitor blood pressure effectively.

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Dihydropyridine Calcium-Channel Blockers

Class of drugs primarily affecting blood vessels with less impact on the heart.

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Nondihydropyridine Calcium-Channel Blockers

Calcium-channel blockers that also treat cardiac tachyarrhythmias.

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Common Adverse Effects

Dizziness, nausea, bradycardia, and peripheral edema linked to calcium-channel blockers.

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Contraindications for Nondihydropyridines

Unsafe in heart block, sick sinus syndrome, or acute MI with pulmonary edema.

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Oral Administration of Calcium-Channel Blockers

Most are well absorbed when taken orally and metabolized in the liver.

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Nifedipine Use in Pregnancy

Nifedipine can be prescribed during pregnancy for high blood pressure control.

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Drug-Food Interaction

Grapefruit juice increases calcium-channel blocker levels, risking toxicity.

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Adverse CNS Effects

Effects like dizziness and headache associated with calcium-channel blockers.

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Gastrointestinal Side Effects

Calcium-channel blockers can cause nausea and constipation.

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Calcium-Channel Blockers Pharmacokinetics

Administered orally with effects starting within 30-60 minutes.

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IV Calcium-Channel Blockers

Nicardipine and clevidipine are given IV for short-term needs.

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Hypotension from Calcium-Channel Blockers

These drugs can cause low blood pressure as a side effect.

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Calcium-Channel Blockers Action

Inhibit calcium movement, reducing contraction in the heart and blood vessels.

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Pharmacokinetics of Diltiazem

Diltiazem has a half-life of 5-7 hours, lowering blood pressure.

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Nausea and Vomiting

Common side effects of certain medications that may ease by eating small, frequent meals.

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Skin Rash

A potential side effect requiring frequent mouth care and proper skin maintenance to improve.

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Drug Interactions

Potential negative effects when combining vasodilators with other medications or grapefruit juice.

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Nitroprusside

A vasodilator used intravenously for severe hypertension and controlled hypotension during anesthesia.

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Adverse Effects of Nitroprusside

Includes headache, nausea, vomiting, and potential cyanide toxicity.

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Cyanide Toxicity

A serious risk from nitroprusside, causing symptoms like headache, dizziness, or loss of consciousness.

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Hydralazine

An oral and injectable vasodilator used for hypertension, effective in severe cases.

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Minoxidil

An oral vasodilator primarily used for severe or refractory hypertension; can cause hair growth.

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Mouth Sores

An adverse effect that can occur, managed by good oral hygiene and reporting to a provider if severe.

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Breastfeeding Caution

Use of vasodilators may necessitate alternative feeding methods due to potential adverse effects on the infant.

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Renin-Angiotensin System

A hormonal system that regulates blood pressure and fluid balance in the body.

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Assessment Prior to Vasodilators

Evaluate for allergies, kidney or liver function, and cardiovascular issues before starting medication.

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Treatment of Severe Hypertension

Use of vasodilators like nitroprusside is indicated when other treatments fail to control blood pressure effectively.

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Adverse Effects of Midodrine

Common side effects include piloerection, chills, rash, hypertension, bradycardia, dizziness, and urination issues.

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Drug Interactions with Midodrine

Increased effects and toxicity when taken with cardiac glycosides, beta-blockers, and corticosteroids.

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Droxidopa

A BP-raising agent for treating neurogenic orthostatic hypotension by converting to norepinephrine.

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Droxidopa Mechanism

Metabolized to norepinephrine causing vasoconstriction and increasing blood pressure.

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Droxidopa Pharmacokinetics

Absorbed through the GI tract, peak level in 1-4 hours, half-life of 2.5 hours.

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Droxidopa Contraindications

Not suitable for patients with allergies to the drug, cardiovascular problems, or renal issues.

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Common Adverse Effects of Droxidopa

Side effects include supine hypertension, headache, dizziness, nausea, and arrhythmias.

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Drug Interactions with Droxidopa

Risk of amplified effects if combined with dopa decarboxylase inhibitors.

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Nursing Assessment for Antihypotensive Drugs

Assess for allergies, kidney/liver function, pregnancy, and cardiovascular history.

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Nursing Conclusions for Drug Therapy

Monitor tissue perfusion, sensory perception, and comfort related to drug effects.

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Altered Tissue Perfusion

Condition where blood flow to tissues is inadequate due to changes in cardiac output.

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Altered Skin Integrity

Compromised condition of the skin due to drug side effects.

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Impaired Comfort

Discomfort experienced by the patient due to side effects of drugs.

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Thiazide Diuretics

A class of diuretics often used as first-line treatment for hypertension.

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Alpha-1 Blockers

Medications that lower blood pressure by blocking alpha-1 receptors and causing vasodilation.

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Monitoring Adverse Effects

Regularly checking for negative reactions to drugs, like hypotension or GI distress.

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Support Measures for Patients

Comfort strategies to help patients cope with drug effects, such as providing meals and environmental controls.

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Sympathetic Nervous System Blockers

Drugs that mitigate the body's stress responses by blocking sympathetic influx.

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Combination Antihypertensives

Drugs that combine two or more antihypertensive agents for effective treatment.

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Comfort Measures

Approaches to enhance patient comfort while receiving drug therapy.

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Evaluation of Drug Response

Assessing patient reactions to medication, including BP status and side effects.

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Alpha2-Agonists

Drugs that stimulate alpha2-receptors in the CNS to lower BP.

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Clonidine

An alpha2-agonist used to treat hypertension.

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Essential Hypertension Causes

Unknown reasons for high blood pressure that is persistent.

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Hypotension Treatment

Management strategies for dangerously low blood pressure.

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Midodrine

An alpha-specific adrenergic agent used to treat orthostatic hypotension.

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Sympathomimetic Drugs

Agents that mimic the sympathetic nervous system to increase BP.

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Adverse Effects of Sympathomimetics

Side effects include nausea, increased heart rate, and potential gangrene.

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Pharmacokinetics of Midodrine

Rapid absorption with peak effect in 1-2 hours, half-life of 3-4 hours.

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Contraindications of Midodrine

Not used in supine hypertension or severe cardiac conditions.

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Risk Factors for Hypertension

Factors that increase the likelihood of developing high blood pressure, such as obesity, lack of exercise, and stress.

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Hypertension Effects

Potential damages caused by high blood pressure, including heart disease, kidney damage, and stroke.

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Lifestyle Changes

Modifications in daily habits aimed at reducing blood pressure, such as diet, exercise, and quitting smoking.

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Diuretic Therapy

Treatment involving medications that increase urine production to lower blood volume and blood pressure.

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Importance of BP Monitoring

Regularly checking blood pressure to assess hypertension management and treatment effectiveness.

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Treatment Initiation Delay

A temporary postponement of starting medication to allow for lifestyle changes and observe their effects.

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Hypertension Diagnosis Criteria

Two elevated blood pressure readings are required for diagnosing hypertension.

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Emotional Stress and BP

Increased emotional strain can temporarily raise blood pressure.

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Healthcare Impact of Hypertension

Hypertension can affect job insurance and security, potentially leading to discrimination.

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Calcium-Channel Blocker Prototype

Diltiazem is a primary example used for treating essential hypertension.

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Teaching Points for Hypertension

Essential information that should be provided to patients about managing and understanding their condition.

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Impact of Medication on Lifestyle

The effect that starting antihypertensive drugs can have on daily activities and quality of life.

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Study Notes

Drugs Affecting Blood Pressure

  • Blood pressure (BP) is maintained by a closed system of blood vessels that deliver oxygenated blood to tissues and remove waste. Pressure is highest in the left ventricle during systole and lowest in the right atrium.
  • Blood pressure is regulated by areas in the brain, and various hormones. High blood pressure is hypertension, and low blood pressure is hypotension. Severe hypotension is shock.

Blood Pressure Control Mechanisms

  • Mean arterial pressure (MAP) is determined by:
    • Cardiac output (CO - heart rate x stroke volume)
    • Total peripheral resistance (PVR - resistance of muscular arteries to blood flow)
  • Arterioles, the smallest arteries, are most important in determining PVR. Their constriction increases PVR and MAP.
  • The autonomic nervous system strongly regulates BP:
    • Parasympathetic system lowers BP by decreasing heart rate and contractility.
    • Sympathetic system increases heart rate, contractility, and vasoconstriction (narrowing of arteries and veins).
    • The vasomotor / cardiovascular center in the medulla and pons controls these sympathetic and parasympathetic nerve fibers.
  • Baroreceptors (pressure sensors) in the arch of the aorta and carotid arteries monitor BP. Higher pressure stimulates vasodilation and decreased heart rate; lower pressure triggers vasoconstriction and increased heart rate. This reflex continually regulates BP.
  • Chemoreceptors respond to low oxygen or high carbon dioxide/hydrogen ion levels, also influencing the vasomotor center to regulate pressure.
  • The renin-angiotensin-aldosterone system (RAAS) is activated when kidney perfusion is low or oxygenation is poor. Low BP triggers renin release from juxtaglomerular cells, leading to angiotensin II formation and vasoconstriction, and aldosterone release which promotes sodium and water retention to increase blood volume and pressure. This process helps maintain kidney perfusion.

Hypertension (High Blood Pressure)

  • Essential (primary) hypertension accounts for 90% of cases, with no discernible cause; often elevated PVR is the underlying issue.
  • Secondary hypertension has an identifiable cause (e.g., pheochromocytoma - adrenal tumor).
  • Chronic hypertension can damage the heart, kidneys, brain, eyes, blood vessels, and other organs, increasing the risk of atherosclerosis. Damage can lead to heart failure, visual problems, or kidney failure, among other issues.

Antihypertensive Agents

  • Drugs affecting the renin-angiotensin-aldosterone system (RAAS):
    • ACE inhibitors (e.g., captopril) block the conversion of angiotensin I to angiotensin II.
    • Angiotensin II receptor blockers (ARBs - e.g., losartan) block angiotensin II from binding to receptor sites.
    • Renin inhibitors (e.g., aliskiren) block renin release at the beginning of the RAAS.
    • Aldosterone antagonists affect RAAS.
  • Calcium-channel blockers (e.g., diltiazem) prevent calcium entry in muscle cells, reducing heart muscle contraction and relaxing blood vessels leading to lower blood pressure. Can also be used for angina treatment.
  • Vasodilators (e.g., nitroprusside) directly relax blood vessel smooth muscles, causing vasodilation. Used for severe/emergency hypertension.
  • Diuretics (e.g., hydrochlorothiazide) increase urine output by affecting sodium levels and blood volume. Used for mild hypertension.
  • Sympathetic nervous system blockers (e.g., beta-blockers, alpha- and beta-blockers, alpha-blockers).
    • Beta-blockers decrease heart rate and contractility.
    • Alpha- and beta-blockers are more potent.
    • Alpha-blockers reduce sympathetic tone in blood vessels.
    • Alpha2-agonists inhibit the cardiovascular centers of the brain, reducing sympathetic output.
  • Fixed-combination drugs for easier patient adherence.
  • Special treatments for pulmonary hypertension exist, targeting substances like endothelin.

Antihypotensive Agents

  • Sympathomimetic drugs (e.g., droxidopa, midodrine) increase BP by stimulating the sympathetic system.

Additional Notes

  • Treatment for hypertension focuses on maintaining BP within a normal range to prevent damage.
  • Multiple drug therapies are often necessary.
  • Medication dosages typically start low and are titrated up.
  • Lifestyle changes such as a healthier diet, exercise, and stress reduction can help.
  • Specific dosages, side effects, and important drug-drug interactions are relevant to individual drugs within each class.
  • Patient teaching on proper drug use, avoiding interactions (like grapefruit juice with calcium-channel blockers), and recognizing potential side effects is crucial.
  • Safety measures and frequent monitoring are paramount.

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