pp 2

how do ace inhib work for hf

Lowers peripheral resistance (decrease blood pressure) and inhibits aldosterone secretion (reduce blood volume).

. Which of the following clinical manifestations may indicate that the patient taking metolazone (Zaroxolyn) is experiencing hypokalemia? 1. Hypertension 2. Polydipsia 3. Cardiac dysrhythmias 4. Skin rash

3. dysrhythmias

what is serum potassium

3.5-5.3 meq/L - this value must be within normal range or patient will have heart conduction problems. It will go down when patient has loop diuretic or thiazide diureti

how do cardio glycosides work for hf

By increasing myocardial contractility, it directly increases cardiac output, thus alleviating symptoms of HF

what is secretion like

Certain ions and molecules that are too large to pass through Bowman's capsule may still enter the urine by crossing from the blood to the filtrate in a process called tubular secretion. Potassium, phosphate, hydrogen, and ammonium ions enter the filtrate through active secretion.

The nurse is preparing the education for a client prescribed chlorothiazide (Diuril). Which information should the nurse include in the teaching? a. Daily weights with a report of a gain of more than 1 pound in 24 hours b. Report change in hearing c. Consumption of foods high in potassium d. Assessment of blood glucose daily

Consumption of foods high in potassium

Identify the major diseases that accelerate the progression of heart failure.

Coronary artery disease (CAD) Mitral stenosis Myocardial infarction (MI) Chronic hypertension (HTN) Diabetes mellitus Hyperthyroidism hypothyroidism.

what does calcitrol do

Sends message to parathryoid gland to move calcium from bone into bloodstream

what does renin do

Sends message to vessel barareceptors to constrict and to get some aldosterone into bloodstream

What is the difference between stable and unstable anigina?

When angina occurrences are fairly predictable as to frequency, intensity, and duration, the condition is described as stable angina. The pain associated with stable angina is typically relieved by rest. When episodes of angina arise more frequently, become more intense, or occur during periods of rest, the condition is called unstable angina.

what is the order of kidney process

filtration, reabsorption, and excretion

t or f Lisinopril acts by inhibiting angiotensin converting enzyme. This in turn decreases aldosterone secretion. Blood pressure is decreased and the heart does not have to work as hard.

true

What is the nurse's role in diuretic therapy?

watch for dehydration and monitor electrolyte levels

when does a pt have hyperkalemia

A patient has hyperkalemia when the serum potassium is above 5 meq/L

A patient with renal failure would have which of the following problems? a. fatigue b. hypercalcemia c. hypokalemia d. fluid overload e. anemia f. hypertension

hypertension, anemia, fluid overload, fatigue

Describe the general adverse effects of diuretic pharmacotherapy.

orthostatic hypotension, dehydration, electrolyte imbalance

Which of the following actions by the nurse is most important when caring for a patient with renal disease who has an order for furosemide (Lasix)? 1. Assess urine output and renal laboratory values for signs of nephrotoxicity. 2. Check the specific gravity of the urine daily. 3. Eliminate potassium-rich foods from the diet. 4. Encourage the patient to void every 4 hours.

1. Assess urine output and renal laboratory values for signs of nephrotoxicity.

how do beta blockers work

By decreasing the heart rate and contractility, they reduce cardiac output and lower end in olol, prototype doxazosin used angina, dysrythmias, hf, mi, and migraines

what is serum creatine

0.5-1.5mg/dL - this value will always be high when kidneys are failing

what is serum sodium

135-145meq/L - this value will go up when patient dehydrated and will go down when patient has had too much water. It gets lost when patient has diuretic

Which treatments below would decrease cardiac preload? Select all that apply: a. IV fluid bolus b. Norepinephrine c. furosemide (Lasix) d. Nitroglycerin

The answers are C and D. Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys. This will decrease venous return to the heart and decrease preload. An IV fluid bolus and Norepinephrine (a vasoconstrictor) will increase venous return to the heart and increase preload.

Select factors that lead to high blood pressure (HTN). Select one or more: a. oxygen saturation b. body temperature c. respiratory rate d. cardiac output (stroke volume x heart rate) e. peripheral vascular resistance

The correct answers are: cardiac output (stroke volume x heart rate), peripheral vascular resistance

t or f For every 180 L of water entering the filtrate each day, approximately 178.5 L is reabsorbed, leaving only 1.5 L to be excreted in the urine.

true

what is hf

- Heart failure (HF) is the inability of the ventricles to pump enough blood to meet the body's metabolic demands. HF can be caused by any disorder that affects the heart's ability to receive or eject blood. In HF, the myocardium becomes weakened, and the heart cannot eject all the blood it receives. - on the left side, excess blood accumulates in the left ventricle. Because the left ventricle has limits to its ability to compensate for the increased preload, blood "backs up" into the lungs, resulting in the classic symptoms of cough and shortness of breath. Left HF is sometimes called congestive heart failure (CHF). Although left HF is more common, the right side of the heart can also weaken, either simultaneously with the left side or independently. In right HF, the blood backs up into veins, resulting in peripheral edema and engorgement of organs such as the liver.

how do ace inhibitors work

-used for hf, MI, HTN lisinopril, end in pril ower peripheral resistance (decrease blood pressure) and inhibit aldosterone secretion (reduce blood volume) An additional effect of ACE inhibitors is dilation of veins. This action decreases pulmonary congestion and reduces peripheral edema. The combined reductions in preload, afterload, and blood volume caused by the ACE inhibitors substantially decrease the workload on the heart and allow it to work more efficiently. Adverse effects of ACE inhibitors are usually minor and include persistent cough and postural hypotension

A patient with a history of heart failure will be started on spironolactone (Aldactone). Which of the following drug groups should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? 1. Nonsteroidal anti-inflammatory drugs 2. Corticosteroids 3. Loop diuretics 4. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

4. ace inhibitors

how do loop diuretics work

Act by preventing the reabsorption of Na in the loop of Henle. Leads to a large amount of urine output. Watch for hypokalemia!

What are the indications for diuretic use?

Diuretics are drugs that are frequently used in the pharmacotherapy of renal and cardiovascular disorders. They are indicated for the treatment of hypertension, heart failure, and disorders characterized by accumulation of edema fluid.

Which of the following represents clinical manifestations of heart failure? a. fever b. dyspnea c. anxiety d. edema e. orthopnea (trouble breathing when lying down)

dyspnea, edema, orthopnea (trouble breathing when lying down), anxiety

what drugs treat hf

1. Reduction of preload 2. Reduction of blood pressure (afterload reduction) 3. Inhibition of both the renin-angiotensin-aldosterone-system (RAAS) and vasoconstrictor mechanisms of the sympathetic nervous system. ace inhibs, arbs, diuretics, beta adrenergic blockers, direct vasodilator, cardiac glycosides

what is urine specific gravity

1.005-1.030 - this value measures the kidney's ability to regulate fluid balance. It will be high when patient is dehydrated and low when patient has had a lot to drink.

how do direct vasodilators work

2nd line htn, lower blood pressure through indirect means by affecting enzymes (ACE inhibitors), autonomic nerves (alpha and beta blockers), or fluid volume (diuretics). highly effective but many adverse effects like reflex tachycardia, na/water retention body activates the RAAS mechanism stimulate the release of aldosterone, causing the kidneys to reabsorb sodium and thus water. side effect As the kidney retains more sodium and water, blood volume increases, thus raising blood pressure and canceling the antihypertensive action of the vasodilator.

what is blood urea nitrogen

5-25mg/dl - this value will go up when patient is dehydrated or when kidneys are failing (creatinine elevation indicates failing kidneys)

when does a pt have hypokalemia

A patient has hypokalemia when serum potassium level is below 3 meq/L

how do arbs work

A second mechanism for modifying the RAAS is to block the action of angiotensin II after it is formed. The angiotensin II receptor blockers (ARBs) block receptors for angiotensin II in arteriolar smooth muscle and in the adrenal gland, thus causing blood pressure to fall. Their effects of arteriolar dilation and increased sodium excretion by the kidneys are similar to those of the ACE inhibitors. ARBs have relatively few side effects, most of which are related to hypotension.

how do thiazide diuretics work

Acts by blocking Na in the distal tubule. Because most Na has already been reabsorbed from the filtrate by the time it reaches the distal tubule, there is less diuresis

how do beta blockers work for hf

Acts by reducing sympathetic stimulation of the heart, thus decreasing cardiac workload

how do vasodilators work for hf

Acts directly to relax blood vessels and lower blood pressure. Hydralazine acts on arterioles. It is an effective anti-hypertensive drug.

how do potassium sparing diuretics work

Acts on late distal tubule. Blocks aldosterone. Watch for hyperkalemia!

how do diuretics work for hf

Acts quickly to get rid of extra circulating fluid, especially IV formulations, to bring symptomatic relief to patients within minutes.

Select the statement below that best describes cardiac afterload: a. It's the volume amount that fills the ventricles at the end of diastole. b. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart. c. It's the amount of blood the left ventricle pumps per beat. d. It's the volume the ventricles must work against to pump blood out of the body.

Afterload = resistance that heart must work against. Valves can contribute to this resistance. The correct answer is: It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

Describe the diagnosis of acute coronary syndrome.

An acute coronary syndrome is a collection of symptoms that occur when a coronary artery is suddenly blocked, usually by a piece of plaque that has broken off and occluded a portion of the coronary artery. Exposed plaque activates the coagulation cascade, resulting in platelet aggregation and adherence. A new clot quickly builds on the existing plaque, making obstruction of the vessel imminent. unstable angina and MI

what's the difference between mi and angina

Angina, although painful and distressing, rarely leads to a fatal outcome, and the chest pain is usually immediately relieved by administering sublingual nitroglycerin. Myocardial infarction, however, carries a high mortality rate if appropriate treatment is delayed. Pharmacologic intervention must be initiated immediately and close patient follow-up must be maintained in the event of MI. Angina pain closely resembles that of an MI.

what is retention like

As filtrate travels through the nephron, its composition changes dramatically. Some substances in the filtrate cross the walls of the nephron to reenter the blood, a process known as tubular reabsorption. Water is the most important molecule reabsorbed in the tubule. For every 180 L of water entering the filtrate each day, approximately 178.5 L is reabsorbed, leaving only 1.5 L to be excreted in the urine. Glucose, amino acids, and essential ions such as sodium, chloride, calcium, and bicarbonate are also reabsorbed.

What adjustments in pharmacotherapy must be considered in patients with renal failure?

Before pharmacotherapy is initiated in a patient with renal failure, an assessment of the degree of kidney impairment is necessary. use urinalysis, gfr, and renal biopsy no nephrotoxic meds lower doses monitor status

what drugs treat htn

Drug Classes for Hypertension First-line drugs Angiotensin converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Calcium channel blockers (CCBs) Thiazide diuretics Second-line drugs Alpha -adrenergic agonists Alpha - adrenergic blockers Beta-adrenergic blockers Centrally acting alpha and beta blockers Direct-acting vasodilators Direct renin inhibitors Peripherally acting adrenergic neuron blockers

how do misc diuretics work

Drugs such as Mannitol. Also includes drugs for glaucoma. Acts early on in the proximal tubule leading to large amount of fluid and electrolyte loss.

t or f Drugs that increase contractility are called negative inotropic agents. Examples include epinephrine, norepinephrine, thyroid hormone, and dopamine.

FALSE: Drugs that increase contractility are called positive inotropic agents. Examples include digoxin, epinephrine, norepinephrine, thyroid hormone, and dopamine. These drugs make the heart beat harder.

t or f The pulmonary artery carries oxygen-rich blood from the right ventricle to the lungs.

False. Blood from the right ventricle has low oxygen. The pulmonary artery is the last stop on the route. The correct answer is 'False'.

t or f Parasympathetic nerves from the vasomotor center stimulate alpha -adrenergic receptors on peripheral arterioles, causing vasoconstriction.

False. Sympathetic nerves from the vasomotor center stimulate alpha -adrenergic receptors on peripheral arterioles, causing vasoconstriction. The correct answer is 'False'.

Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output.

Heart failure (HF) is the inability of the ventricles to pump enough blood to meet the body's metabolic demands. HF can be caused by any disorder that affects the heart's ability to receive or eject blood. Although weakening of cardiac muscle is a natural consequence of aging, the process can be caused or accelerated The heart is unable to pump the volume of blood required to meet the metabolic needs of the body In HF, the myocardium becomes weakened, and the heart cannot eject all the blood it receives.

How is hypertension defined and classified?

Hypertension (HTN), or high blood pressure, is defined as the consistent elevation of systemic arterial blood pressure elevated 120-129/<80 htn stage 130-139/80-89 htn stage 2 140+/90+ htn crisis 180+/120+

How can lifestyle changes help to treat hypertension?

Limit intake of alcohol Restrict sodium consumption Reduce intake of saturated fat and cholesterol Increase consumption of fresh fruits and vegetables Increase aerobic physical activity Discontinue use of tobacco products Reduce sources of stress and learn to implement coping strategies Maintain optimal weight. lower bp, done with meds usually

what drugs are used for acute coronary syndrome

MONA: morphine, oxygen, nitroglycerin, and high dose aspirin.

what is filtration like

Once in the nephron, the fluid is called filtrate. Many drugs are small enough to pass through the pores of the glomerulus and enter the filtrate. If the drug is bound to plasma proteins, however, it will be too large and will continue circulating in the blood. small goes through and big does not

What are the long-term consequences of untreated hypertension.

One of the most serious consequences of chronic HTN is that the heart must work harder to pump blood to the organs and tissues. The excessive cardiac workload can cause the heart to fail and the lungs to fill with fluid, a condition known as heart failure (HF). High blood pressure over a prolonged period adversely affects the vascular system. Damage to the blood vessels supplying blood and oxygen to the brain can result in transient ischemic attacks and strokes or cerebral vascular accidents. Chronic HTN damages arteries in the kidneys, leading to a progressive loss of renal function. Vessels in the retina can rupture or become occluded, resulting in visual impairment and even blindness.

Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume: a. Heart rate b. Afterload c. Blood pressure d. Contractility e. Preload

Preload, afterload, and contractility all have a role with influencing stroke volume.

In what way can drugs relieve the consequences of heart failure? a. Reduction of preload b. Stimulating the kidneys to secrete renin c. Reduction of afterload d. Inhibition of the renin-angiotensin-aldosterone-system (RAAS) e. Stimulating the central nervous system

Reduction of preload, Reduction of afterload, Inhibition of the renin-angiotensin-aldosterone-system (RAAS)

how do ccbs work

Relaxes arteriolar smooth muscle, thus lowering blood pressure. This reduction in afterload decreases myocardial oxygen demand. used to treat angina pectoris, dysrhythmias, and HTN CCBs block these channels and inhibit Ca from entering the cell, limiting muscular contraction. useful in treating certain populations such as the elderly and African Americans, who are sometimes less responsive to drugs in other antihypertensive classes. clevidipine (Cleviprex) and nicardipine (Cardene), are used to treat patients who present with serious, life-threatening HTN. end in ipine

what does erythropoietin do

Sends message to bone marrow to make more red blood cells

The primary means by which antianginal drugs work is to reduce the myocardial demand for oxygen. This may be accomplished by the following mechanisms:

Slowing the heart rate, Dilating veins, Lowering blood pressure

. ___________ is the amount of blood pumped by the left ventricle with each beat. a. Stroke volume b. Preload c. Cardiac output d. Afterload

Stroke volume is the amount of blood pumped by the left ventricle with each beat. The correct answer is: Stroke volume

Select non-pharmacological methods to prevent or reduce high blood pressure. Select one or more: a. maintaining weight between 18-25% body mass index b. drinking a 6-pack of beer daily c. smoking cessation d. refraining from coffee consumption a little coffee is perfectly fine e. adding a 2nd major to the nursing major f. exercising at least 150 minutes per week g. increasing fruits and vegetables in the diet

The American Heart Association recommends exercising 5x per week for 30 minutes or some variation of that. It's important to quit smoking and maintain optimal weight, which is 18-25 body mass index. Moderate alcohol and coffee intake is OK. Minimize saturated fats and triglycerides. The correct answers are: smoking cessation, maintaining weight between 18-25% body mass index, increasing fruits and vegetables in the diet, exercising at least 150 minutes per week

A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: a. decrease, increasing contractility b. increase, decreasing afterload c. decrease; decreasing preload d. increase, increasing preload

The answer is B. IV fluids will increase venous return to the heart. This will increase the amount of fluid that will fill the ventricles at the end of diastole...hence increasing preload and increasing cardiac output. The correct answer is: increase, increasing preload

A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will? a. Decrease the patient's blood pressure and increase cardiac preload b. Decrease the patient's blood pressure and decrease cardiac afterload c. Decrease the patient's blood pressure and increase cardiac afterload d. Increase the patient's blood pressure but decrease cardiac output.

The answer is B. The patient has a high systemic vascular resistance...as evidence by the patient's blood blood....there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now, the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will go down (hence the systemic vascular resistance).

True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload.

The answer is True. If pulmonary vascular resistance or systemic vascular resistance is high, it will create an increased cardiac afterload. If pulmonary vascular resistance or systemic vascular resistance is low, it will create a decreased cardiac afterload.

What two factors are used to calculate cardiac output? Select all that apply: a. Mean arterial pressure b. Blood pressure c. Heart rate d. Stoke volume

The answers are A and C. Cardiac output is calculated by taking the heart rate and multiplying it by stroke volume. CO = HR x SV

What conditions below can result in an increased cardiac afterload? Select all that apply: a. Pulmonary Hypertension b. Vasoconstriction c. Aortic stenosis d. Dehydration e. Vasodilation

The answers are A, B, and E. Vasoconstriction increases systemic vascular resistance which will increase cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve to get blood out of the heart....all of this increase cardiac afterload.

Which of the following organs/systems are affected by hypertension? Select one or more: a. the brain b. kidneys c. retina in the eye d. colon e. lungs f. the heart itself

The correct answers are: retina in the eye, the heart itself, the brain, kidneys

The nurse has completed the dietary teaching for a client prescribed spironolactone (Aldactone). Which statement made by the client indicates further teaching is required? a. "I love to eat eggs and toast in the morning." b. "I can still have orange juice, bananas, and apricots for breakfast." c. "I usually eat an apple a day to stay regular." d. "I am really happy that I can have cranberry juice."

The patient taking a potassium sparing diuretic must watch potassium intake. Tropical fruits and green vegetables contain a lot of potassium. The correct answer is: "I can still have orange juice, bananas, and apricots for breakfast."

What is the effects of cardiac output, peripheral resistance, and blood volume on blood pressure?

The volume of blood pumped per minute is the cardiac output. The higher the cardiac output, the higher the blood pressure. Cardiac output is determined by heart rate and stroke volume, the amount of blood pumped by a ventricle in one contraction. higher peripheral resistance higher bp, force of high speed blood against vessels, causes vessels to narrow total amount of blood in the vascular system, or blood volume, higher bv=higher bp

what is myocardial remodeling in hf

The wall of the left ventricle thickens and enlarges (hypertrophy) in an attempt to compensate for the increased workload. Over time, changes in the size, shape, and structure of the myocardial cells (myocytes) occur, a process called cardiac remodeling. Myocytes are injured by the excessive workload and continually die; inflexible fibrotic tissue fills the spaces between the dead cells.

t or f Although many different diuretics are available for HTN, all produce a similar outcome: the reduction of blood volume through the urinary excretion of water and electrolytes. Electrolytes are ions such as sodium (Na ), calcium (Ca ), chloride (Cl ), and potassium (K ) and multivitamins

This statement is almost correct. Multivitamins are not electrolytes. The main electrolytes to always watch with your patients are: sodium, potassium, calcium, magnesium, and phosphate. The correct answer is 'False'.

t or f CCBs relax arteriolar smooth muscle, thus lowering blood pressure. This reduction in afterload decreases myocardial oxygen demand.

True. Calcium channel blockers reduce the heart workload by dilating arteries.

t or f The heart feeds itself through coronary circulation during diastole.

True. Coronary circulation occurs while the heart is not contracting (during heart relaxation). The correct answer is 'True'.

What is the nurse's role in the pharmacologic management of renal failure?

all nephrotoxic medications should be either discontinued or used with extreme caution. Because the kidneys excrete most drugs or their metabolites, medications will require a significant dosage reduction in patients with moderate to severe renal failure. The importance of this cannot be overemphasized: Administering the "average" dose to a patient in severe renal failure can have fatal consequences.

How are drugs used to manage angina.

antianginal medications may be placed into two basic categories: those that terminate an acute angina episode in progress, and those that decrease the frequency of angina episodes. mostly done by reducing myocardial demand for o2 by: Slowing the heart rate Dilating veins so the heart receives less blood (reduced preload) Causing the heart to contract with less force (reduced contractility) Lowering blood pressure, thus offering the heart less resistance when ejecting blood from its chambers (reduced afterload).

what is the order of the kidney

blood enters kidneys goes through nephrons through renal arteries, glomerulus, bowman's capsule, proximal tubule, loop of henle, and distal tubule ends in collecting ducts, then ureters, bladder, urethra

Select the clinical manifestations of cardiac ischemia. a. pain in left arm b. bradycardia c. dyspnea d. chest pain e. confusion f. confusion

chest pain, pain in left arm, confusion, dyspnea, confusion

Although weakening of cardiac muscle is a natural consequence of aging, the process can be caused or accelerated by which of the following: a. mitral valve stenosis b. hypertension c. diabetes d. diuresis e. coronary artery disease

coronary artery disease, mitral valve stenosis, hypertension, diabetes

Which statement below best describes the term cardiac preload? Select one: a. The pressure the ventricles stretch at the end of systole. b. The pressure the ventricles must work against to pump blood out of the heart. c. The strength of the myocardial cells to shorten with each beat d. The amount the ventricles stretch at the end of diastole

d The amount the ventricles stretch at the end of diastole

Diuretics are useful for lowering blood pressure, decreasing the workload of the heart, and relieving pulmonary edema. However, there are several adverse effects. Which of the following would be adverse effects from diuretic use? a. hypokalemia (exception=spironalactone) b. nausea c. confusion d. orthostatic hypotension e. sodium loss f. dehydration

dehydration, hypokalemia (exception=spironalactone), sodium loss, orthostatic hypotension

how do cardiac glycosides work

digoxin used for hf, tackles symptoms not mortality The primary actions of digoxin are to cause the heart to beat more forcefully (positive inotropic effect) and more slowly, thus improving cardiac output. The reduced heart rate, combined with more forceful contractions, allows for much greater efficiency of the heart.

t or f The pain associated with unstable angina is typically relieved by rest.

f The pain associated with stable angina is typically relieved by rest. Unstable angina will occur at any unpredictable time and is not relieved by rest.

Describe the three processes of urine formation.

filtration, retention, and excretion

What is the primary functions of the kidney?

filtration, retention, excretion, produces hormones: renin, calcitriol, and erythropoietin also regulating fluid balance, electrolyte composition, and acid-base balance of body fluids maintains homeostasis

A diuretic is a drug that increases the rate of urine flow. The goal of most diuretic therapy is to reverse abnormal fluid retention by the body. Excretion of excess fluid from the body is particularly desirable in which of the following conditions: a. heart failure b. kidney failure c. pulmonary edema d. hypertension e. dementia f. dehydration

heart failure, pulmonary edema, hypertension, kidney failure

Hypoperfusion is the number one reason for acute renal failure. To correct this type of renal failure, the cause of the hypoperfusion must be quickly identified and corrected. Which of the following problems can lead to acute renal failure? a. diabetes with consistent blood sugars above 140mg/dL b. renal artery thrombus c. dehydration d. heart failure e. hemorrhage f. hypertension with blood pressures over 140 systolic and 90 diastolic

hemorrhage, dehydration, heart failure, renal artery thrombus

how do nitrates work

increases perfusion to the heart by dilating coronary arteries and veins. Can take effect immediately.

Compare and contrast the loop, thiazide, and potassium-sparing diuretics.

loop: largest fluid loss, works in loop of henle (Lasix) thiazide: works in distal tubule, by having more na be excreted, first line (Microzide), moderate diuresis potassium: works in distal tubule: has more na excreted, does not affect potassium levels (Aldactone), mild diuresis

how do alpha adrenergic blockers work

lower blood pressure directly by blocking sympathetic receptors in arterioles, causing the vessels to dilate. not first-line drugs for HTN because long-term clinical trials have shown them to be less effective at reducing the incidence of serious cardiovascular events than diuretics. used concurrently with other classes of antihypertensives doxazosin prototype, end is zosin

what is mi

n MI occurs when a coronary artery becomes completely occluded. Deprived of its oxygen supply, the affected area of myocardium becomes ischemic, and myocytes begin to die in about 20 minutes unless the blood supply is quickly restored. Ischemia to the myocardial tissue, which may cause irreversible myocardial tissue necrosis, releases certain enzyme markers, which can be measured in the blood to confirm that the patient has experienced an MI versus unstable angina.

what is cad

narrowing or occlusion of a coronary artery. The narrowing deprives cells of needed oxygen and nutrients, a condition known as myocardial ischemia. If the ischemia develops over a long period, the heart may compensate for its inadequate blood supply, and the patient may experience no symptoms. Indeed, coronary arteries may be occluded 50% or more and cause no symptoms. As CAD progresses, however, the myocardium does not receive enough oxygen to meet the metabolic demands of the heart, and symptoms of angina begin to appear. Persistent myocardial ischemia may lead to myocardial infarction (heart attack).

what drugs treat angina

need to Slowing the heart rate Dilating veins so the heart receives less blood (reduced preload) Causing the heart to contract with less force (reduced contractility) Lowering blood pressure, thus offering the heart less resistance when ejecting blood from its chambers (reduced afterload). organic nitrates, ccbs, and beta blockers

what drugs treat mi

pharmacologic goals for treating a patient with an acute MI are as follows: Restore blood supply (reperfusion) to the damaged myocardium as quickly as possible through the use of thrombolytics or PCI. Reduce myocardial oxygen demand with organic nitrates, beta blockers, or angiotensinconverting enzyme (ACE) inhibitors to prevent additional infarctions. Control or prevent MI-associated dysrhythmias with beta blockers or other antidysrhythmics. Reduce post-MI mortality with aspirin, beta blockers, and ACE inhibitors. Manage severe MI pain and associated anxiety with narcotic analgesics. Prevent enlargement of the thrombus with anticoagulants and antiplatelet drugs.

how does raas work

renin-angiotensin-aldosterone system (RAAS) is one of the primary homeostatic mechanisms controlling blood pressure and fluid balance in the body. Drugs that affect the RAAS decrease blood pressure and increase urine volume. They are widely used in the pharmacotherapy of HTN, HF, and myocardial infarction (MI).

What are the signs and symptoms of angina pectoris?

steady, intense pain in the anterior chest, sometimes accompanied by a crushing or constricting sensation. The discomfort may radiate to the left shoulder and proceed down the left arm and it may extend posterior to the thoracic spine or move upward to the jaw. In some patients, the pain is experienced in the mid-epigastric or abdominal area. In women, gastric distress, nausea and vomiting, a burning sensation in the chest or chest wall, overwhelming fatigue, and sweating may be more common symptoms. There is usually pallor, dyspnea with cyanosis, diaphoresis, tachycardia, panic, and elevated blood pressure.

The most common etiology of CAD in adults is atherosclerosis, the presence of plaque —a fatty, fibrous material within the walls of the coronary arteries.

t Coronary artery disease results from plaque in the arteries that feed the heart muscle (coronary arteries). When the plaque becomes inflamed, heart attack can result.

t or f When given sublingually, nitroglycerin reaches peak plasma levels in 2 to 4 minutes, thus terminating angina pain rapidly.

t If no response from nitroglycerin within 15 minutes, the patient needs to go to the emergency room.

how do organic nitrates work

terminating acute angina episode drug of choice, relax both arterial and venous smooth muscle. Dilation of veins reduces the amount of blood returning to the heart (preload), so the chambers contain a smaller volume. With less blood for the ventricles to pump, cardiac output is reduced and the workload on the heart is decreased, thereby lowering myocardial oxygen demand. The therapeutic outcome is that chest pain is alleviated and episodes of angina become less frequent. prototype: isosorbide, nitroglycerin

t or f ACE inhibitors and potassium sparing diuretics both work by blocking aldosterone. Aldosterone causes sodium and water retention. By blocking aldosterone, the patient will lose sodium and water but retain potassium. Therefore, the 2 drugs should not be given together or the patient could have hyperkalemia.

true

t or f If the patient is having a heart attack (muscle cell death) immediate re-perfusion is necessary. This might include percutaneous coronary intervention, coronary artery bypass surgery, or thrombolytic infusion.

true

t or f The best marker for estimating kidney function is the glomerular filtration rate (GFR), which is the volume of filtrate passing through the Bowman capsules per minute.

true

t or f In coronary artery disease (CAD) the myocardium does not receive enough oxygen to meet the metabolic demands of the heart, and symptoms of angina begin to appear. Persistent myocardial ischemia may lead to myocardial infarction (heart attack).

true Myocardial ischemia = temporary lack of oxygen while myocardial infarction = permanent lack of oxygen and death of heart cells.

t or f When the ST segment is elevated (STEMI), the MI must be treated aggressively because mortality is very high in this group of patients.

true The first thing that medical services will do for a patient with chest pain is to get an electrocardiogram (EKG). If ST segment elevation is seen on the EKG, the patient needs emergency treatment as this is evidence of cell death.

t or f Patients over age 60 who do not have chronic kidney disease or diabetes do not need pharmacotherapy until their blood pressure reaches 150/90 mmHg or higher.

true; According to the Eighth Joint National Committee (JNC-8). Blood pressure goes up with age so more acceptable for older adults to have high blood pressure without associated problems

How do phosphodiesterase inhibitors work?

used for hf positive inotropic block the enzyme phosphodiesterase in cardiac and smooth muscle. Blocking phosphodiesterase has the effect of increasing the amount of calcium available for myocardial contraction. The inhibition results in two main actions that benefit patients with HF: a positive inotropic action and vasodilation. prototype: milrinone