Med Surg - Cardiovascular (CH32)

172 flashcards · Other · by Carole Sneed

1. the tension/pressure exerted by blood against the arterial walls in called blood pressure

2. excess pressure in the arterial portion of systemic circulation is called hypertension

3. because of the pressure created by the ejection of blood frmo the heart during systole ans the tension created by the arterial walls, the supply side of circulation, or arterial circulation, has relatively high pressures

4. the pressure waves created by the contractions of the heart to eject blood during systole is called systolic blood pressure

5. systolic blood pressure is heard as Korotkoff sounds during measurement

6. during cardiac relaxation and filling, elastic arterial walls maintain a minimum pressure called diastolic blood pressure

7. the difference between the systolic and diastolic BP, normally 40mmHg, is called pulse pressure

8. the mean arterial pressure is the average pressure in the arterial circulation throughout the cardiac cycle

9. due to the increased heart rate and cardiac output that follows a drop in MAP and triggers SNS, one's BP will increase

10. due to the decreased cardiac output and heart rate that triggers arterial vasodilation and triggers the SNS, one's BP will decrease

11. triggered by the fight-or-flight response, epinephrine and norepinephrine, affect SNS stimulation

12. in response to stretching, the body will release atrial natriuretic peptide which promotes vasodilation of the blood vessels and sodium/water excretion, lowering BP

13. adrenomedullin is a potent peptide synthesized and released by the endothelial and smooth muscle

14. vasopressin, or antidiuretic hormone, promotes water retention and vasoconstriction of the blood vessels, raising BP

15. local factors such as inflammatory mediators and various metabolites can affect BP

16. the two primary factors affecting vessel compliance are arteriosclerosis and atherosclerosis, as these act directly on the arteries

17. known as essential hypertension, primary hypertension is a persistently elevated BP

18. systolic BP of 130-139 or diastolic BP of 80-89 taken over at least 3 readings is called stage 1 hypertension

19. BP that is 120/80 or less is considered to be normal BP

20. systolic BP from 120-129 and diastolic BP less than 80 is considered to be elevated BP

21. systolic BP that is at least 140 or diastolic BP that is at least 90 is considered to be stage 2 hypertension

22. systolic BP over 180 and/or diastolic BP over 120 is considered hypertensive crisis

23. low plasma renin levels are more commonly seen in African Americans

24. low renin levels make one more sensitive to the effects of sodium and puts them at risk for elevated BP

25. high levels of renin makes people less sensitive to the effects of sodium

26. excess SNS with overstimulation of a-and b-adrenergic receptors can result in vasoconstriction and increased cardiac output

27. chemical mediators such as atrial natriuretic peptide endothelin-1(vasoconstrictor) produce hormones that affect BP

28. excess insulin can contribute to hypertension through sodium retention in the kidneys, increased SNS activity, hypertrophy of vascular smooth muscle and changes in ion transport across cell membranes

29. systolic blood pressure continues to rise with age

30. in Whites and Hispanics, more males than females experience hypertension

31. in Blacks, more women than men experience hypertension

32. Genes involved in the RAAS and others that affect vascular tone, salt and water transportation in the kidney, obesity, and insulin resistance are likely involved in the development of hypertension

33. potassium promotes vasodilation by reducing responses to catecholamines and angiotensin II

34. the electrolyte calcium has a vasodilator effect, lowering BP

35. abdominal obesity has a stronger correlation with hypertension than BMI or skinfold thickness

36. insulin resistance with resulting hyperinsulinemia is linked with hypertension

37. regular consumption of three or more alcoholic drinks a day increases hypertension risk

38. the early stages of hypertension are typically asymptomatic and therefore difficult to notice

39. with persistent hypertension, the workload of the left ventricle increases, leading to ventricular hypertrophy

40. the diastolic blood pressure is a significant cardiovascular risk factor until age 50; the systolic BP then become more important

41. sustained hypertension leads to accelerated atherosclerosis

42. accelerated atherosclerosis associated with hypertension increases the risk of stroke

43. swelling of the optic nerve is called papilledema and is often seen alongside primary and sustained hypertension

44. Other symptoms of primary hypertension result from target organ damage and may include nocturia, confusion, nausea and vomiting, and visual disturbances.

45. hypertensive encephalopathy is a syndrome characterized by high BP, altered level of consciousness, increased intracranial pressure, papilledema, and seizure

46. the risk of cardiovascular complications decreases when the average BP is less than 120/80 mmHg, especially if the patient has diabetes or renal disease

47. most people with hypertension will require two or more drug along with lifestyle changes.

48. the diagnostic tests taken to treat hypertension include ECG, urinalysis, blood glucose, hematocrit, serum potassium, creatinine and calcium, and cholesterol and lipoprotein profile

49. previously sedentary patients are encouraged to engage in aerobic exercise for 30-45 minutes a day for 5 to 6 days a week

50. isometric exercise may not be appropriate to manage high BP because it can raise systolic BP

51. diuretics are the preferred treatment for systolic hypertension in adults

52. Diuretics control hypertension primarily by preventing tubular reabsorption of sodium, thus promoting sodium and water excretion and reducing blood vo-ume.

53. Thiazide diuretics reduce systemic vascular resistance through an unknown mechanism

54. Diuretics are particularly effective in Blacks and in patients who are obese, older, or who have increased plasma volume or low renin activity

55. In addition to hypokalemia, diuretics may affect serum levels of glucose, triglycerides, uric acid, LDLs, and insulin

56. Patients with heart failure, coronary heart disease, or diabetes may initially be treated with a beta-blocker

57. Beta-blockers lower blood pressure, apparently by reducing peripheral vascular resistance.

58. Beta-blockers may reduce the amount of renin released by the kidneys by blocking beta1 receptors in the kidney.

59. Beta-blockers are relatively contraindicated for patients with asthma or chronic obstructive pulmonary disease because they promote bronchial constriction.

60. ACE inhibitors and ARBs are commonly used in initial treatment of hypertension, particularly for patients who are diabetic or who have heart failure, a history of MI, or chronic kidney disease.

61. ACE inhibitors block formation of angiotensin II by inhibiting the action of angiotensin-converting enzyme on angiotnsin I. This prevents vasoconstriction and sodium/water retention.

62. ARBs have a very similar effect to ACE inhibitors, although their action is to block angiotensin II receptors, thus preventing their vasoconstrictive and volume expansion effects.

63. Alpha-blockers such as prazosin and terazosin block stimulation of alpha1-receptors on arterioles and veins, preventing vasoconstriction

64. Because of their ability to dilate both arterioles and veins, alpha-blockers can cause significant orthostatic hypotension, particularly following the initial dose.

65. Calcium channel blockers promote dilation of arterioles, the primary regulators of peripheral vascular resistance, and can cause reflex tachycardia

66. In general, diuretics and calcium channel blockers are more effective for treating hypertension in Blacks than beta-blockers or ACE inhibitors.

67. Beta-blockers are preferred to treat hypertension with concurrent coronary heart disease and angina

68. Beta-blockers are contraindicated for patients who have asthma or depression

69. Beta-blockers reduce exercise tolerance and may adversely affect lifestyle for some patients.

70. ACE inhibitors and ARBs are contraindicated in pregnancy

71. The primary adverse effects of ACE inhibitors and ARBs are persistent cough, first-dose hypotension, and hyperkalemia

72. ACE inhibitor medications end in -pril

73. ARB medications end in -tan

74. Do not take a potassium supplement or use a potassium-based salt substitute while taking ACE inhibitors and ARBs unless prescribed by your healthcare provider

75. Calcium channel blockers inhibit the flow of calcium ions across the cell membrane of vascular tissue and cardiac cells. In doing so, they relax arterial smooth muscle, lowering peripheral resistance through vasodilation.

76. The calcium channel blockers of dihydropyridines all end in -ipine

77. the two main medications of non-hydropyridine calcium channel blockers include diltiazem (Cardizem) and verapamil (Isoptin)

78. Calcium channel blockers may cause constipation

79. Alpha-adrenergic blocking agents block alpha-receptors in vascular smooth muscle, decreasing vasomotor tone and vasoconstriction.

80. There is a risk of fainting after taking the first dose (first-dose syncope) of alpha-adrenergic blockers

81. Alpha-adrenergic blockers each end in -osin

82. Beta-adrenergic blockers reduce blood pressure by preventing beta-receptor stimulation in the heart, thereby decreasing heart rate and cardiac output.

83. Beta-adrenergic blockers also interfere with renin release by the kidneys, decreasing the effects of angiotensin and aldosterone

84. Potential adverse effects of beta-blockers include bronchospasm, bradycardia, heart block, worsening of heart failure, and impotence.

85. The centrally acting sympatholytics stimulate the alpha2-receptors in the CNS to suppress sympathetic outflow to the heart and blood vessels. A fall in cardiac output and vasodilation results, reducing blood pressure.

86. Dry mouth and sedation are common adverse of centrally acting sympatolytics. Severe reflex hypertension may occur if abruptly discontinued.

87. Except for methyldopa, three common centrally acting sympatholytic medications end in -ine.

88. Vasodilators reduce blood pressure by relaxing vascular smooth muscle (especially in the arterioles) and decreasing peripheral vascular resistance.

89. Vasodilators are often prescribed in combination with a diuretic or beta-blocker because they can cause reflex tachycardia and fluid retention.

90. The common vasodilator medication is callled hydralazine (Apresoline).

91. Because vasodilators can have significant toxic effects, they are not routinely used to manage chronic hypertension.

92. Beta-blockers are contraindicated for patients who have asthma or depression.

93. Unless other-wise indicated, a diuretic is recommended as the initial drug of choice to treat hypertension.

94. After a year of effective hypertension control, an effort may be made to reduce the dosage and number of drugs. This is known as step-down therapy.

95. FVE often contributes to hypertension by increasing cardiac output.

96. Changes in BUN and creatinine indicate impaired renal function, while changes in hematocrit and hemoglobin reflect changes in fluid volume

97. Secondary hypertension is elevated blood pressure result-ing from an identifiable underlying process.

98. Kidney disease is the most common identifiable cause of high blood pressure in both adults and children.

99. Altered kidney function affects the elimination of water and electrolytes, leading to hypertension.

100. Coarctation of the aorta is narrowing of the aorta, usually just distal to the sub-clavian arteries. Reduced renal and peripheral blood flow stimulates the RAAS and local vasoconstrictive responses, raising the blood pressure.