ANS Control of BP Flashcards by Reagan Smith

What is systolic BP

pressure inside the arteries when the heart pumps

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What is diastolic BP

pressure when the heart relaxes between beats

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Normal BP

S: less than ___
AND
D: less than ___

120, 80

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Elevated BP

S: ___ - ___
AND
D: less than ___

120-129
80

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High BP Stage 1

S: ___ - ___
OR
D: ___ - ___

130-139
80-89

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High BP Stage 2

S: ___ or higher
OR
D: ___ or higher

140
90

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Hypertensive Crisis

S: higher than ___
and/or
D: higher than ___

180
120

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HTN

S: > ___ mmHg
D: > ___ mmHg
Resting Pulse Pressure (SBP-DBP) > ___ mmHg
- a pulse pressure > ___ mmHg is unhealthy
- a pulse pressure > ___ is a risk factor for heart disease, especially for old people
- often asymptomatic (may experience ___ or ___ )

130
80
65
40
60
dizziness, headaches

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relationship between blood pressure and age

T or F: by age 60, the average systolic blood pressure of women exceeds that of men

True

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as you get older
- ___ decreases
- ___ inreases

cardiac output
peripheral resistance

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Classifications of HTN

Primary
- ___ - ___ % of all cases, no identifiable cause

Secondary
- has a cause

85-90%

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Causes of Secondary HTN

___ disease, ___ artery constriction
tumor
___ disease
coarctation of the ___
pregnancy
medication adverse effects

kidney, renal
endocrine
aorta

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Causes of Secondary HTN

acronym
ABCDE

aldosteronism
bad kidneys
Cushing’s/Coarctation
drugs
endocrine disorders

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PCOL Strategies for reducing Risk of HTN

BP = ___ x ___
- reduce ___
- reduce vascular ___ (vaso dilation, decrease blood volume)

cardiac output (CO), peripheral vascular resistance (TPR)
CO
resistance

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Which of the following will have the greatest impact on the management of HTN
A) addition of 2 glasses of wine with dinner
B) addition of whole milk to diet
C) reduction in red meat
D) replacement of table salt with kosher salt
E) weight reduction

E) weight reduction

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T or F: HTN does not self resolve and must be treated for life

True

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races most affected by HTN (highest % to lowest)

black
white
asian
hispanic

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CO = ___ x ___

stroke volume (SV)
HR

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SV is determined by:
- cardia ___
- venous return to the heart ( ___ )
- ___ to the left ventricle must overcome to eject blood into the aorta ( ___ )

contractility
preload
resistance
afterload

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Parasympathetic = ___
- endogenous neurotransmitter: ___
- exogenous: ___ and ___

Sympathetic = ___
- endogenous neurotransmitters: ___ and __

cholinergic
- ACh
- muscarine, nicotine

adrenergic
- Norepinephrine, epinephrine

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Adrenergic receptors

a1 = ___ coupled
B = ___ coupled
a2 = ___ coupled

alpha control ____
beta control ___ stimulation

Gq
Gs
Gi
- vasoconstriction
- cardiac

a1 is the most involved in vasocontriction, not really a2

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epinephrine binds stronger to ___ than ___

norepinephrine has strong ___ , doesnt really affect heart

beta, alpha
vasocontriction

a1 is the most involved in vasocontriction, not really a2

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T or F: the vasculature is controlled only by the PSNS

FALSE FALSE FALSE
- SNS

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vascular smooth muscle

which two receptors are highly populated in vascular smooth muscle

a1 and B2

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# Adrenergic receptor involvement in blood pressure regulation Baroreceptor Reflex decrease in blood pressure - activates ___ fibers that feed back and innervate the heart ( ___ receptor) - increases HR - reflex ___ - innervate blood vessels ( ___ receptors) resulting in ___ - inhibits vagus ( ___ ) - net result: ___ BP

- SNS, B1, tachycardia - a1, vasoconstriction - PSNS - increased

# Adrenergic receptor involvement in blood pressure regulation Increase in blood pressure - inhibits ___ fibers - activates vagus ( ___ ) - decrease ___ (reflex ___ ) - no direct effect on ___ - net result: decrease ____

- SNS - PSNS - HR, bradycardia - blood vessels - blood presure

# Adrenergic receptor involvement in blood pressure regulation NE: raises ___ and lowers ___ (a1, B1) E: raises ___ and lowers ___ (a1, B1, and B2) Isoproterenol: raises ___ and lowers ___ (B1, B2) E more elective for B | NE more selective for a

- peripheral resistance, HR - HR, peripheral resistance - HR, peripheral resisitance B2 = vasodilation B1 = heart stimulation B1 = heart stimulatio B2 - vasodialtion | a1 = vasoconstriction

# Adrenergic receptor involvement in blood pressure regulation phenylephrine: acting at a receptors result: ___ in systolic BP, ___ in HR - a1 effect ___ - activation of baroreceptor reflex which can ___ HR

- increase, decrease - vasoconstriction - decrease

# Adrenergic receptor involvement in blood pressure regulation epinephrine: acting at B and a receptors result: ___ in systolic pressure, pulse pressure, and HR - a1 effect: ___ - B2 effect: ___ - B1 effect: positive inotropic and chronotropic effects - activation of baroreceptor reflex which mitigates the direct effects

increase - vasoconstriction - vasodilation

# Adrenergic receptor involvement in blood pressure regulation isoproterenol: acting at B receptors result: ___ in diastolic pressure, ___ pulse pressure and HR - B2 effect: ___ - B1 effect: positive inotropic and chronotropic effects - activation of barorecptor reflex which could enhance the direct effects

decrease, increase - vasodilation

# Targets for anti-hypertensives heart = reduce ___ - both ___ and ___ resistance of ___ and ___ Kidney - reduce ___ and ___

- cardiac output - SNS, PSNS - fluids, blood volume

Meds indicated for heart failure

- diuretics - B blockers - ACE inhibitors - angiotensisn II receptor blockers - aldosterone antagonists

Meds indicated for post MI

- B blockers - ACE inhibitors - angiotension II receptor blockers - aldosterone antagonists

Meds indicated for diabetes

- ACE inhibitors - angiotensin II receptor blockers - calcium channel blockers

Meds indicated for CKD

- ACE inhibitors - angiotensin II receptor blockers

which receptor is most present in cardiac muscle?

# a1 antagonists (-osins) - ___ produce peripheral ___ without reflex ___ or increased CO - acyl moiety determines ___ activity - indications: ___ , ___ disease, and ___ - side effects: first dose phenomenon, postural hypotension and syncope Examples (3 - in order of increasing t1/2) - undergo extensive metabolism, excreted in the bile

- quinazolines, vasodilation, tachycardia - PK - HTN, Reynaud's, BPH - prazosin (3hrs), terazosin (12 hrs), doxazosin (20 hrs)

T or F: non-selective a blockers cause reflex tachycardia

True selective (a1 -osins) do not cause tachycardia

# a2 agonists reduce BP by reducing ___ output from the brain Inhibition of ___ release - decreased ___ tone in CNS - decreased __ - decreased ___ - decreased ___ release - decreased ___

sympathetic NE - sympathetic - HR - contractility - renin - vasoconstriction

# Direct acting a2 receptor agonist - clonidine (Catapres) - (phenylimino) imidazolidine - ____ a2 receptor agonist - the basicity of the guanidine group is 13.6 but it is decreased to 8 due to being attached to the ___ ring - activation of a2 receptors in the CNS decreases ___ activity; good ___ - indication: HTN, opiate withdrawal, ADHD - Side effects: hypotension, sedation, dry mouth - must be ___

- selective - dichlorophenyl - SNS, lipophilicity - tapered

# Direct acting a2 receptor agonist - Guanabenz and Guanfacine - ___ ring imidazolines - __ atom bridge to the guanidine group decreases the pKa so the drug is mostly ___ at physiological pH - t1/2 guanabenz < guanfacine = clonidine - uses: HTN. ADHD (guanfacine)

- open - 2 - non-ionized

# Direct acting a2 receptor agonist - methyldopa (Aldomet) - a ___ metabolized to active a2 receptor agonist, ___ - ___ - water soluble, ester hydrochloride salt is used for ___ solutions - PO = ___ , inj = ___ - uses: HTN, especially in ___ - combine with ___ due to sodium/water retention

- prodrug, (1R, 2S) - a - methylnorepinephrine - methyldopate, parenteral - methyldopa, methyldopate - pregnancy - diuretic

# Beta blockers Hypertension - decrease ___ output - inhibition of ___ secretion

- cardiac - renin

# B-Blockers - structure aryloxypropanolamines

# B-Blocker - propranolol (Inderal) - non-selective - lipophilic - extensive ___ metabolism - decreased cardiac __ and ___ - reduced ___ release - increase ___, decrease ___ - inhibit ___ and compensatory ___ and glucose release in response to ___ - increase ___ airway resistance

- hepatic - output, HR - renin - VLDL, HDL - lipolysis, gluconeogenesis, hypoglycemia - bronchial

# B-Blockers - Nadolol (Corgard) - non-selective - less lipophillic than ___ - ___ t1/2 - mostly excreted unchanged in ___ - administered PO - use: hypertension, angina, migraine

- propanolol - long - urine

# B-Blockers - Timolol (Timoptic, Blocadren) - non-selective - thiadiazole nucleus with morpholine ring - administered PO, ophthalmic - uses: glaucoma, HTN, angina, migraine

# B-Blockers - pindolol (Visken) - non-selective - intrinsic sympathomimetic activity - ___ agonist - less likely to cause ___ and lipid adnormalities - good for patients who have severe ___ or little cardiac reserve

- partial - bradycardia - bradycardia

# B-blockers - carteolol (Cartrol, Ocupress) - non-selective - intrinsitc sypathomimetic activity - partial ___ - less likely to cause ___ and lipid abnormalities - administered: PO, ophthalmic - uses: hypertension, glaucoma

- agonist - bradycardia

# B-blockers - metoprolol (Lopressor, Toprol) and bisoprolol (Zebeta) - ___ selective - ___ substituted phenyl derivatives - "cardioselective" - less ___ - moderate lipophilicity - significant first pass metabolism - uses: HTN, angina, anti-arrhythmic, CHF - rebound HTN is discontinued abruptly - ___ dose

- B1 - para - bronchoconstriction - taper

# B-blockers - atenolol (Tenormin) - selective ___ - "cardioselective" - less ___ - low lipophilicity "water soluble ___ " - PO and inj - uses: HTN, angina

- B1 - bronchoconstriction - metoprolol

# B-blocker - esmolol (Brevibloc) - ___ selective - very short acting - half life: 9 min - rapid hydrolysis by ___ found in red blood cells - administered: ___ , incompatible with sodium bicarb - uses: supravenricular tachycardia, atrial fibrillation/flutter, perioperative hypertension

B1 esterases parenteral

# B-blocker - nebivolol (Bystolic) - 3rd generation - ___ selective - vasodilation due to ___ production

B1 nitric oxide

# B-blockers SE - ___ cardia - ___ block - sedation - mask symptoms of ___ , withdrawal syndrome Containdications: - ___ and ___ - congestive HF type ___

- bradycardia - AV - hypoglycemia - asthma, COPD - IV

effect of chronic B-receptor block - more ___ will grow

B-receptors

# Mixed adrenergic receptor antagonists - labetalol (Normodyne, Trandate) - ___ B receptor antagonist - ___ receptor antagonists - B blocking activity prevent reflex ___ normally associated with ___ receptor antagonists - administered: oral and parenteral - uses: HTN, hypertensive crisis - 1R, 1'R - isomer possesses ___ blocking activity - 1S, 1'R isomer possesses greatest ___ receptor blocking activity

- non selective - a1 - tachycardia, a1 - B - a1

# Mixed adrenergic receptor antagonists - carvedilol (Coreg) - ___ B receptor antagonist - ___ receptor antagonist - both enantiomers antagonize ___ receptors - only S enantiomer posses ___ blocking activity - B blocking activity prevent reflex ___ normally associated with ___ receptor antagonists - PO - uses: HTN, CHF

- non-selective - a1 - a1 - B - a1

Beta blocker withdrawal ___ the dose when DC

taper

# D1 receptor agonist - Fenoldopam used in __ HTN prolems: should not be used in patients with ___ due to increases in IOP notes: maintains or ___ renal perfusion while lowering ___ ' paticularly useful in patients with ___ impairment

severe glaucoma increases, BP renal

# Catecholamine Synthetic Path inhibiting with Metyrosine action: inhibits ___ hydroxylase Clinical Uses: perioperative management of ___ problem: depletes ___ everywhere

- tyrosine - pheochromocytoma - catecholamines | pheochromocytoma - tumor in adrenal gland that makes excess E and NE

# VMAT Inhibitor Reserpine Action: - nonselective, ___ inhbitor of vesicular monoamine transporter (VMAT) - depletes stored ___ Clinical Use - HTN but rarely used due to AE Problems: - expected peripheral adverse effects (orthostatic, hypotension, increased GI activity) - CNS effects such as sedation severe depression/suicide

- irreversibel - NE

# Catecholamine depleters - Reserpin (Serpasil) - indole alkaloid obtained from root of Rauwolfia serpentina - block vesicular monoamine transporters - depletes vesicular pool of NE - slow onset of action - sustained effects (weeks)