Learn: Coronary Artery Disease

Overview

Welcome! In this session, we’ll break down the essential concepts underlying coronary artery disease (CAD) and hypertension management, as tested in NCLEX-RN-style questions. You’ll learn how to recognize key symptoms, select appropriate interventions, understand medication choices, and anticipate complications. By the end, you’ll be equipped with not only the “what” but also the “why” behind the correct approaches, preparing you for both exams and real-world clinical scenarios.

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Concept-by-Concept Deep Dive

Hypertension: Management and Medication Classes

What it is:
Hypertension, or high blood pressure, is a chronic condition that increases the risk for heart disease, stroke, and organ damage. Managing hypertension involves both pharmacological and non-pharmacological strategies tailored to individual risk factors and comorbidities.

Medication Classes

• Diuretics: Lower blood pressure by promoting sodium and water excretion, reducing blood volume.
• Beta-blockers: Slow the heart rate and decrease cardiac output.
• Calcium channel blockers: Relax blood vessels by inhibiting calcium movement into muscle cells.
• ACE inhibitors and ARBs: Interrupt the renin-angiotensin-aldosterone system, resulting in vasodilation and decreased volume.
• Other agents: Such as alpha-blockers and centrally acting drugs, used for resistant cases.

Medication Interactions

• Some medications can interact to raise blood pressure or reduce the effectiveness of antihypertensives (e.g., NSAIDs, certain decongestants).
• Always assess the full medication regimen for potential interactions.

Step-by-Step Approach

1. Assess baseline BP and comorbid conditions.
2. Choose first-line agent based on guidelines (e.g., ACE inhibitors for diabetics).
3. Monitor effectiveness and side effects.
4. Adjust regimen as needed, considering interactions.

Common Misconceptions

• Not all antihypertensives are interchangeable; comorbidities and contraindications matter.
• Overlooking OTC or herbal medications that can interfere with BP control.

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Hypertensive Crisis: Recognition and Immediate Interventions

What it is:
A hypertensive crisis is an acute, severe elevation in blood pressure that may be life-threatening and requires prompt intervention.

Symptoms and Manifestations

• Severe headache, visual changes, chest pain, confusion, nausea/vomiting.
• Distinguish between hypertensive urgency (no organ damage) and emergency (evidence of organ dysfunction).

Immediate Management Steps

1. Rapid assessment: Evaluate symptoms and signs of end-organ damage (e.g., neuro, cardiac, renal).
2. Initiate IV antihypertensive therapy for emergencies.
3. Monitor BP and organ function closely.
4. Avoid rapid overcorrection to prevent ischemic complications.

Common Misconceptions

• Not every high BP reading constitutes a crisis—context and symptoms matter.
• Oral medications are not appropriate for emergencies requiring rapid BP reduction.

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Drug-Resistant Hypertension: Causes and Evaluation

What it is:
Drug-resistant hypertension persists despite adherence to three or more antihypertensive medications, including a diuretic.

Contributing Factors

• Non-adherence (intentional or unintentional).
• Secondary causes (renal disease, endocrine disorders).
• Lifestyle factors (obesity, high sodium intake, alcohol use).

Step-by-Step Evaluation

1. Review medication adherence and dosing accuracy.
2. Screen for secondary causes (labs, imaging).
3. Assess lifestyle and dietary contributors.
4. Collaborate with specialists if needed.

Common Misconceptions

• Assuming resistance is always due to inadequate medication, rather than lifestyle or secondary causes.
• Failing to reassess the full clinical picture.

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Coronary Artery Disease: Symptoms, Diagnosis, and Risk Factors

What it is:
CAD is the narrowing or blockage of coronary arteries due to atherosclerosis, leading to reduced oxygen delivery to the heart muscle.