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Pharm > Chapter 13 > Flashcards

Chapter 13 Flashcards

1
Q

How do you accurately test for blood pressure?

A
  1. seated for 5 minutes
  2. no nicotine or caffeine within 30 min
  3. feet touching floor
  4. arm elevated to heart level
  5. two measurements in each arm, at least 5 minutes apart
  6. before diagnosis of hypertension, the patient should be tested 3 times at least 2 weeks apart
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2
Q

Primary hypertension (cause)

A

No known cause in 92% of all cases

90% of people over 55 have high BP

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3
Q

Secondary hypertension

A 
Kidney disease
Hyperthyroidism
Pregnancy
Erythropoietin
Pheochromocytoma
Sleep apnea
Contraceptive use
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4
Q

Decreasing BP by 5 mmHg can reduce risk of stroke and heart attack by - %

A

20-35%

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5
Q

What are the three systems that regulate BP in our bodies?

A
  1. sympathetic NS
  2. RAAS
  3. renal regulation
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6
Q

What increases renin release in the RAAS system?

A
  1. Decreased blood volume
  2. Low BP
  3. Stimulation of beta 1 receptors on juxtaglomerular cells
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7
Q

What does angiotensin 2 do?

A
  • potent vasoconstrictor
  • stimulates release of aldosterone from cortex
  • stimulates ADH release from post. pituitary
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8
Q

What does aldosterone do?

A

increase sodium absorption, increase water retention

secrete potassium and hydrogen

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9
Q

Equation for BP

A

BP = CO x PR

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10
Q

What are the non-drug treatments for hypertension?

A 
Decreasing body weight
Restricting sodium intake
Physical exercise
Potassium supplementation
DASH diet
Smoking cessation
Alcohol restriction
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11
Q

How is obesity related to hypertension?

A

Obese people have increased insulin secretion which increases sodium reabsorption = increased water retention = increased cardiac output

AND

obese people have increased parasympathetic NS

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12
Q

Limiting salt intake to 5 g/day decreases systolic BP by __ mmHg and diastolic BP by __ mmHg

A 
systolic = 12 mmHg
diastolic = 6 mmHg
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13
Q

Regular physical exercise decreased BP by __ mmHg

A

10

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14
Q

Increased potassium levels = __ BP

A

decreased

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15
Q

How does potassium decrease BP?

A

increasing sodium excretion, decreasing renin release and vasodilation

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16
Q

Why does drinking alcohol raise BP?

A

decrease response to antihypertensive medications

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17
Q

What are the 3 types of diuretics?

A
  1. loop
  2. thiazide
  3. potassium sparing/aldosterone antagonists
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18
Q

Loop diuretics are reserved for situations like:

A
  1. edema
  2. severe hypertension that does not respond to milder directics
  3. in severe renal failure
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19
Q

Adverse effects of loop diuretics

A

Hypokalemia
Hyponatremia
Dehydration
Hypotensions

20
Q

Thiazide diuretics are the most common class of drugs for hypertension. They act by what two mechanisms:

A
  1. Blocking sodium and chloride ion reabsorption

2. Decreasing vascular resistance

21
Q

Adverse effects of thiazide diuretics

A

Hypokalemia
Dehydration
Hyponatremia

22
Q

What do potassium sparing diuretics do?

A

Act by inhibiting aldosterone receptors in the collecting duct
This causes increased sodium excretion and potassium retention
The main use is with thiazide or loop to counteract the hypokalemia side effects

should NOT be used with ACE inhibitors or renin inhibitors

23
Q

Adverse effects of potassium sparing diuretics

A

hyperkalemia - causing fatal dysrhythmias

24
Q

Beta blockers are effective at treating hypertension by which two mechanisms:

A

1) Blocking cardiac beta 1 receptors (less epinephrine binds)
2) Blocking beta 1 receptors on juxtaglomerular cells (decrease renin release)

25
Q

What is the suffix for beta blockers?

A

-olol

26
Q

Difference between first generation and second generation beta blockers

A

1st gen - non-selective blockade of beta receptors - inhibit beta 1 (heart and juxtaglomerular) and beta 2 (in lung)

2nd gen - these drugs produce selective blockade of beta 1 receptors

27
Q

Adverse effects of beta 1 receptor blockers:

A

Bradycardiac
Decreased CO
Heart failure
Rebound hypertension if withdrawn abruptly

28
Q

Adverse effects of non-selective beta blockers:

A

Same as beta 1 receptor blockers +
Bronchoconstriction - avoid in patients with asthma
Inhibition of hepatic and muscle glycogenolysis

29
Q

Angiotension converting enzyme inhibitors (ACEI) work decrease BP by which two mechanisms:

A

Decreasing the production of angiotensin 2 (a potent vasoconstrictor and) which also decreases blood volume

and

Inhibiting the breakdown of bradykinin (causes vasodilation)

30
Q

ACEI all have the suffix:

A

-pril

31
Q

Adverse effects of ACEI:

A

Generally well tolerated

1) Decreased angiotensin 2 - 1st dose hypotension and hyperkalemia
2) Increased bradykinin - persistent cough and angioedema

32
Q

____ may decrease the effect of ACE inhibitors

A

NSAIDs

33
Q

Angiotensin receptor blockers (ARBs) do what?

A

Similar action to ACEI
Decrease actions of angiotensin 2
Act by blocking the binding of angiotensin 2 to its receptor (AT1)
Block the action not the synthesis
Causes vasodilation and decrease aldosterone release

34
Q

ARBs have the suffix:

A

-sartan

35
Q

Adverse effects of ARBs:

A

Do not cause cough

Do not cause hyperkalemia

36
Q

What do Direct Renin Inhibitors (DRIs) do?

A

Bind to renin and block the conversion of angiotensinogen to angiotensin 1
Since that is the rate-limiting step in the RAAS pathway - they influence the entire pathway

37
Q

Adverse effects of DRIs:

A

Hyperkalemia
Low incidence of cough and angioedema
Diarrhea

38
Q

What do calcium channel blockers do?

A

Block the entry of calcium into heart cells and smooth muscle cells, therefore decreasing contraction

39
Q

What are the two categories of calcium channel blockers?

A

1) Dihydropyridine CCB
- work in smooth muscle of arteries
- suffix: -dipine
2) Non-dihydropyridine CCB
- work in heart and smooth muscle of arteries

40
Q

Adverse effects of dihydropyridine:

A

flushing, dizziness, headache, peripheral edema, reflex tachycardia, rash

41
Q

Adverse effects of non-dihydropyridine:

A

Constipation, dizziness, flushing, headache, edema, possible compromise of cardiac function

42
Q

What do centrally acting alpha 2 agonists do?

A

Bind and activate alpha 2 receptors in the brainstem

Decreases sympathetic outflow to heart and vessels

43
Q

Adverse effects of centrally acting alpha 2 agonists:

A

Drowsiness, dry mouth, rebound hypertension if withdrawn abruptly

44
Q

The target BP that most people should achieve is less than:

A

140/90

45
Q

Patients with diabetes or chronic kidney disease should achieve BP of less than:

A

130/80

Pharm (8 decks)

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