Pharm Cardiac 1

What is the minimum sustained diastolic blood pressure threshold for a diagnosis of hypertension?

80 mm Hg.

How is primary hypertension distinguished from secondary hypertension in terms of etiology?

Primary is idiopathic (unknown cause), while secondary results from a specific systemic disease process.

Which two physiological factors does a systemic disease process typically raise to cause secondary hypertension?

Peripheral vascular resistance or cardiac output.

Which dietary factors are identified as genetic and lifestyle contributors to primary hypertension?

Calorie excess, high saturated fat, and high simple sugar intake.

What specific form of hypertension is associated with advanced age?

Isolated systolic hypertension.

In the pathophysiology of hypertension, what is the 'pressure-natriuresis relationship'?

The mechanism by which the kidneys regulate sodium excretion in response to changes in arterial pressure.

Why is primary hypertension often referred to as the 'silent disease'?

It frequently presents with no clinical manifestations until target organ damage occurs.

What are the four primary systems or organs affected by 'complicated hypertension'?

Eyes, kidneys, heart, and brain (cerebrovascular).

What is the clinical term for a hypertensive crisis?

Malignant hypertension.

What is the mandatory first-line treatment for hypertension before pharmacological intervention?

Lifestyle modifications.

What is the proper patient positioning for an accurate blood pressure reading?

Sitting with feet flat on the floor and legs uncrossed.

How long should a patient rest before a nurse takes a diagnostic blood pressure reading?

Five minutes.

According to the regulators of blood pressure chart, blood pressure is the product of cardiac output multiplied by _.

Total peripheral resistance.

Which two sensors located in the aorta and carotid sinus help regulate blood pressure?

Baroreceptors and chemoreceptors.

What is the effect of alcohol consumption on the renin-angiotensin system?

It increases renin secretions.

How does obesity contribute to increased cardiac output in hypertensive patients?

By increasing stroke volume and left ventricular filling.

Why do African American patients generally show higher mortality rates from hypertension?

They often develop the condition at an earlier age and have low-renin hypertension.

Which two classes of antihypertensives are typically less effective as monotherapy in African American patients?

Beta blockers and ACE inhibitors.

What pharmacological consideration is unique to Asian American patients regarding beta blockers?

They have an increased sensitivity and may require lower doses.

What is a common safety risk for older adults taking antihypertensive agents?

Orthostatic hypotension.

In the RAAS pathway, which enzyme is responsible for converting Angiotensin I to Angiotensin II?

Angiotensin-converting enzyme (ACE).

Which hormone is released by the adrenal cortex to hold onto sodium and water to boost blood volume?

Aldosterone.

Which cells in the kidney are responsible for the release of renin?

Juxtaglomerular (JG) cells.

What is the primary action of Angiotensin II on blood vessels?

Vasoconstriction (tightening blood vessels).

Which drug class is considered the first line of pharmacological treatment for hypertension?

Diuretics.

What is the mechanism of action for centrally acting α2 agonists like Methyldopa?

They stimulate α2 receptors to decrease cardiac output and reduce epinephrine, norepinephrine, and renin release.

What is a major contraindication for the use of Methyldopa?

Impaired liver function.

Why must centrally acting α2 agonists never be stopped abruptly?

It can result in rebound hypertension.

What is the mechanism of action for α-adrenergic blockers such as Prazosin?

They block α-adrenergic receptors, resulting in vasodilation and decreased blood pressure.

Which side effect of α-adrenergic blockers can lead to nasal stuffiness?

Nasal congestion.

What is the mechanism of action for adrenergic neuron blockers like Reserpine?

They block norepinephrine release from sympathetic nerve endings.

Which severe psychiatric side effects are associated with the use of Reserpine?

Depression, nightmares, and suicidal ideation.

Which side effect is specific to the direct-acting vasodilator Minoxidil and is utilized for other purposes?

Excess hair growth (hypertrichosis).

What reflex mechanism often occurs when direct-acting vasodilators cause a rapid drop in blood pressure?

Reflex tachycardia.

By what mechanism do ACE inhibitors lower blood pressure?

They inhibit the formation of Angiotensin II and block the release of aldosterone.

What is a common, benign, but bothersome side effect of ACE inhibitors that often leads to drug discontinuation?

A nonproductive dry cough.

Which electrolyte imbalance is a risk when taking ACE inhibitors or ARBs?

Hyperkalemia (high potassium).

Which life-threatening allergic-like reaction is a known side effect of ACE inhibitors?

Angioedema.

Why should patients on ACE inhibitors avoid salt substitutes?

Salt substitutes often contain potassium, increasing the risk of hyperkalemia.

Which category of antihypertensives is strictly contraindicated during pregnancy?

ACE inhibitors (and ARBs).

How do Angiotensin II Receptor Blockers (ARBs) differ from ACE inhibitors in their mechanism?

ARBs block Angiotensin II from binding to Angiotensin I receptors rather than preventing its formation.

What is the mechanism of action for Aliskiren?

It is a direct renin inhibitor that binds with renin to reduce levels of Angiotensin I, II, and aldosterone.

What metabolic side effect is associated with Aliskiren that may affect patients with joint pain?

Hyperuricemia or gout.

How do Calcium Channel Blockers (CCBs) promote vasodilation?

They block calcium channels in vascular smooth muscle cells.

What gastrointestinal side effect is common with the use of Calcium Channel Blockers like Verapamil?

Constipation.

What is the difference between a true aneurysm and a false aneurysm?

A true aneurysm involves weakening of all three layers of the vessel wall; a false aneurysm is an extravascular hematoma.

Which part of the vascular system is most susceptible to aneurysm formation?

The aorta, especially the abdominal portion.

What are the two most common clinical signs of an aneurysm rupture?

Pain and hypotension.

What is the definition of a thrombus?

A blood clot that remains attached to the vessel wall.

What constitutes an embolism?

A bolus of matter (thrombus, air, fat, etc.) circulating in the bloodstream.

What is the hallmark symptom of Peripheral Vascular Disease (PVD) involving the legs?

Claudication (pain with walking).

Which condition is characterized by episodic vasospasm in the arteries of the fingers and toes?

Raynaud phenomenon.

What is the difference between primary and secondary Raynaud phenomenon?

Primary is of unknown origin; secondary is caused by systemic diseases like pulmonary hypertension or cold exposure.

What is the definition of atherosclerosis?

A form of arteriosclerosis involving thickening and hardening caused by lipid-laden macrophages (foam cells).

Identify the correct progression of atherosclerosis starting from endothelial inflammation.

Inflammation → macrophage migration → LDL oxidation (foam cells) → fatty streak → fibrous plaque → complicated plaque.

What are the three non-modifiable risk factors for Coronary Artery Disease (CAD)?

Advanced age, male sex (or postmenopausal female), and family history.

Which lipoprotein is known as 'good' cholesterol because it removes cholesterol from the blood?

High-density lipoprotein (HDL).

Which lipoprotein is known as 'bad' cholesterol because it contains a high percentage of cholesterol and deposits it in tissues?

Low-density lipoprotein (LDL).

Which lipoprotein contains mostly triglycerides and transports them to the liver?

Chylomicrons.

Which specific apolipoprotein is the major component of LDL and is a better indicator of CAD risk than LDL alone?

Apolipoprotein B-100 (apoB-100).

How do Bile-acid sequestrants like Cholestyramine lower LDL levels?

By binding with bile acids in the intestine for excretion.

What is a significant gastrointestinal side effect risk for patients on Cholestyramine?

GI bleeding, peptic ulcers, or severe constipation.

What is the primary action of Nicotinic acid (Niacin)?

It reduces VLDL and LDL levels.

Which common side effect of Niacin can be mitigated by taking aspirin beforehand?

Flushing.

What is the mechanism of action for 'statins' (HMG-CoA reductase inhibitors)?

They inhibit the enzyme HMG-CoA reductase in cholesterol biosynthesis in the liver.

What is the most serious skeletal muscle adverse effect associated with statin therapy?

Rhabdomyolysis.

What occurs if a patient abruptly discontinues statin therapy?

A rebound effect (rapid rise in lipid levels).

Which amino acid, when found in high levels (>17 mmol/L), is linked to cardiovascular disease and blood clotting?

Homocysteine.

Which three vitamins can be taken to lower serum homocysteine levels?

Vitamin B6, Vitamin B12, and Folic acid.

What does a 'high risk' high-sensitivity C-reactive protein (hs-CRP) level (>3 mg/L) indicate?

An active inflammatory process due to atherosclerotic plaque buildup.

What is the target cholesterol level for a patient according to the clinical judgment slides?

Less than 200 mg/dL.

Which laboratory values should a nurse monitor to assess for adverse effects of statins on the liver?

Liver function tests (ALT/AST).

Why are annual eye examinations recommended for patients on long-term statin therapy?

To monitor for the development of cataracts.

What is the primary use of the drug Cilostazol (Pletal)?

Treatment of intermittent claudication.

How does Cilostazol improve peripheral blood flow?

It causes peripheral vasodilation and inhibits platelet aggregation.

What is the therapeutic goal for a patient taking Cilostazol regarding physical assessment?

Extremities should be warm and pink (indicating improved perfusion).

How long might it take for a patient to see a desired therapeutic response from Cilostazol?

1.5 to 3 months.

What is the mechanism of action for Pentoxifylline (Trental)?

It decreases blood viscosity and improves the flexibility of erythrocytes.

What are the signs of an overdose (excess dosing) of Pentoxifylline?

Blurred vision, hypotension, and tachycardia.

What are the modifiable risk factors for CAD included in the 'Atherogenic diet' category?

High intake of saturated fats and cholesterol.

Under the Cardiovascular-kidney-metabolic (CKM) syndrome, what is recognized as a modern risk factor for CAD?

Air pollution and ionizing radiation.

Which natriuretic peptide is often measured to assess for heart failure in hypertensive patients?

Brain natriuretic peptide (BNP).

According to the pathophysiology flowchart, which hormone system dysfunction leads to renal salt and water retention?

Renin-angiotensin-aldosterone system (RAAS).

What is the result of vascular remodeling (hyaline sclerosis) in the kidneys?

Nephrosclerosis (renal disease).