PC707-module 4-Cardiac Exam with 100% Verified and Updated Solutions

PC707-module 4-Cardiac Exam with 100% Verified and Updated Solutions What is BP? - answer-Peripheral vascular resistance X Cardiac Output What is Cardiac output? - answer-Stroke volume X Heart rate What is something important to screen for in the elderly in relation to blood pressure? - answer-screen for orthostatic hypotension Blood pressure stages: - answer-Normal *<120/<80* -Elevated *120-129/80-89* -Stage 1 *130-139/80-89* -Stage 2 *>140/>90* When do we treat high blood pressure? Are medications the only treatment option? - answer-Depends on a variety of risk factors. -Initiate medications sooner if high cardiovascular risk -Lifestyle modifications are extremely important to remember first* (DASH diet, exercise, limiting alcohol, weight loss if appropriate, stress management) What are the available drugs for treating HTN after lifestyle modifications? - answer- Diuretics (Thiazides or Loops) -ACE inhibitors -ARBs -Calcium channel blockers (CCBs) -Aldosterone receptor antagonists (Potassium sparing diuretic) -Alpha-1 Blockers/Antagonists -Beta Adrenergic Blockers -Vasodilators How do thiazide diuretics work? - answer-promotes sodium & water excretion by inhibiting sodium reabsorption -potassium loss* -*weak* diuretic effect -mostly used as an "add on" drug -used for HTN & volume overload -Ex: Chlorthalidone is preferred in this class due to long half-life & proven to decreased CVD risk* --thiazides work very well in African Americans* Side effects & contraindications for thiazides? - answerS/E--> hyperglycemia (careful with DM), hyperuricemia (careful with gout), hypertriglyceridemia & hypercholesteremia (monitor lipid levels), HYPOkalemia (increased risk for cardiac arrhythmias), hyponatremia, erectile dysfunction Contraindications-->sulfa allergies (contains sulfa), significant renal impairement (anuria), and pre-existing hypokalemia* What are potential benefit to women using thiazide diuretics other than intended use? - answer-may help protect women against post-menopausal osteoporosis because it can be calcium sparing* How do ACE inhibitors work? - answer-ACE is an enzyme needed to convert angiotensin 1 to angiotensin 2 -ACE inhibitors block this conversion -Angiotensin 2 is a POTENT vasoconstrictor--so blocking this helps with vasodilation -Angiotensin 2 also stimulates the release of Aldosterone (which causes sodium & water reabsorption and potassium loss) -Blocking Aldosterone--causes sodium and water excretion and potassium absorption* What is bradykinin? What is its role in causing a particular side effect in ACE inhibitors? - answer-Bradykinin is an inflammatory mediator that causes vasodilation, cough, and potential angioedema -ACE decreases bradykinin levels -So when ACE is inhibited--bradykinin levels can RISE--therefore causing the unwanted side effects of dry, hacky cough & the risk for angioedema Side effects of ACE inhibitors? - answer-dry hacky non productive NEW cough* -HYPERkalemia* -potential for kidney deterioration -angioedema* (increased risk in women and African Americans) -->monitor renal function, blood pressure, & potassium levels Drug of choice for people with HTN & Diabetes mellitus? - answer-ACE inhibitors -ARBs as an alternative option* Indications for ACE inhibitors? - answer-HTN -Post-MI -Heart failure Can those with chronic kidney disease take ACE inhibitors? - answer-can be protective for mild chronic kidney disease -start low and titrate doses SLOWLY -monitor renal function tests -monitor potassium levels -However, if renal function starts to decline--stop & consult with nephrologist* -Weak kidneys need angiotensin II to maintain vascular tone--if absent--can cause complete kidney failure Brief review of the RAAS system? - answer-decreased blood pressure or blood volume-- causes kidneys to release RENIN -the liver releases angiotensinogen which combines with RENIN to create angiotensin I (inactive) -lungs release ACE enzyme which combines w