Exam (elaborations)
Hypertension & Hypertensive Emergency
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Hypertension & Hypertensive Emergency
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Hypertension & Hypertensive Emergency• Baroreceptors not working properly - ANS-- Carotid arteries
- Aortic Arch
• Supposed to respond to increased arterial pressure/fluid by slowing heart rate and
vasodilation
• But it doesn't always happen
• Calcium Channel Blockers - ANS-- Interfere with calcium influx
- Promotes vasodilation
- Slows conduction (AV and to some extent SA)
- Dilates coronary arteries
- First line for atrial fibrillation --- Diltiazem (Cardizem)
lowers HR and BP
• Education, education, education....
- Diet and Lifestyle Modification - ANS-• Restrict sodium intake
• Lose weight
• Control cholesterol
• Exercise
• Quit smoking
• Manage stress
• Pheochromocytoma (PCT) - ANS-Too much adrenaline (epi) released from adrenal
gland
- Excessive catecholamine production
• nor-epinephrine & epi
- Catecholamines stimulate alpha and beta receptors
• Alpha- vasoconstriction
• Beta- increased HR & force of contraction
• Primary HTN
- Risk Factors - ANS-• Older age
• Heredity
• Obesity
• Sedentary Lifestyle
• Tobacco Use
, • Stress
• Excessive dietary sodium intake
• Elevated serum lipids
• Secondary HTN - ANS-• Renal artery disease
• Hyperaldosteronism: What does aldosterone do? Retains sodium, water; BP will go
up.
• Pheochromocytoma: Adrenal medulla tumor
• PIH: Pregnancy Induced Hypertension
• Brain tumors
• Medications
- Steroids
- BCP: Birth Control Pills
- NSAIDs
• Stage 1- Diuretics proven most effective - ANS-- Inexpensive
- Decrease circulating blood volume
- Reduce systemic vascular resistance
- Increased urination may interfere with ADLs
Ace Inhibitors "pril" - ANS-- Interfere with Angiotensin I to Angiotensin II
• May cause persistent cough
- Dilates blood vessels
- Decrease afterload & SVR (systemic vascular resistance)
- Reduce LV workload
- Decrease HR
- Do not work well in African Americans or those with renal disease
Ace inhibitors EXAMPLES - ANS-1. Captopril (Capoten)
2. Enapril (Vasotec)
3. Lisinopril (Prinivil, Zestril)
• Monitor for renal impairment (ROUTINE BUN & CREATININE)
• Teach about postural hypotension
- rise slowly
Afterload - ANS-"Pressure" "Resistance"
The resistance to ejection of blood flow from the ventricle
-It is your systematic vascular resistance
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