Antihypertensives

Question 1

Hydraulic equation

Answer 1

BP=CO (HRxSV) x PVR

Question 2

Regulates parasympathetic activity

Answer 2

Vagus nerve

Question 3

Preload is the result of what vessel characteristic

Answer 3

Venous capacitance

Question 4

If Peripheral resistance increases

Answer 4

More pressure needed to keep blood moving

Question 5

Autonomic feedback loop involves (components)

Answer 5

Baroreceptors, sympathetic and parasympathetic nervous systems

Question 6

Sympathetic response to low BP

Answer 6

Vasoconstriction, increased heart rate, increased PVR and increased contractility

Question 7

Parasympathetic response to high BP

Answer 7

Decreased heart rate.

*BP= CO (HRxSV) x PVR

Lowering one factor in the equation lowers BP.

Question 8

Hormonal loop involves what organ? What specific area of said organ?

Answer 8

The hormonal loop involves the kidneys. The juxtaglomerular apparatus of the kidneys detects changes in renal blood flow and oxygen delivery.

Question 9

Centrally acting sympathoplegics

Answer 9

Methyldopa, clonidine, dexmedetomidine

Question 10

Adrenoceptor Antagonists

Answer 10

Propranolol, metoprolol, Prozasin, terasozin, doxazosin

Question 11

Clonidine and methyldopa antihypertensive activity

Answer 11

Primarily due to alpha agonist activity in brain stem which leads to decreased sympathetic stimulation. Bind more tightly with Alpha 2 than Alpha 1.

Question 12

Centrally acting alpha 2 agonist

Answer 12

Dexmedetomidine

Question 13

Primary use of methyldopa

Answer 13

Pregnancy induced HTN

Question 14

Explain why clonidine causes brief rise in BP before exhibiting anti-HTN effects

Answer 14

Binds to alpha 1 in periphery prior to getting to CNS and binding to alpha 2

Question 15

Limitations of propranolol as treatment for HTN

Answer 15

Not cardioselective

Question 16

Alternative beta blocker that is a used for HTN rather than propranolol

Answer 16

Metoprolol. Beta 1 selective, decreased HR and Contractility.

Question 17

Short acting Beta 1 uses for transient elevations in heart rate

Answer 17

Esmolol

Question 18

Action of Alpha 1 blockers and their role in anti HTN

Answer 18

Block alpha 1 at arterioles and venules. Dilates resistance (arteries) and capacitance vessels (veins).

Increased capacitance volume results in decreased circulating blood volume (lower BP)

Question 19

Oral vasodilators

Answer 19

Hydralazine and minoxidil

Question 20

Parenteral vasodilators

Answer 20

Nitroprusside and fenoldopam

Question 21

Combination vasodilators

Answer 21

Calcium ch blockers

Question 22

Why vasodilators are best used in combination with other drugs

Answer 22

The reduction of PVR and MAP leads elicits compensatory responses. Alternative drugs that combat these mechanisms improve outcome.

Question 23

Vasodilator drugs MOA (from compensatory diagram)

Answer 23

Decreased SVR, Decreased MAP.

Question 24

Hormonal loop response to vasodilators

Answer 24

Decreased MAP sensed, increased Renin which increases angiotensin II, increased Aldosterone. Increased sodium retention and thereby increased water and volume. Which all leads to increased MAP

Question 25

Sympathetic Response to low MAP associated with vasodilator use.

Answer 25

Increased venous tone, increased contractility, increased heart rate, decreased capacitance, increased SVR, increased CO. All leads to increased MAP.

Question 26

Often first drug choice for HTN. Blocks portion of compensatory mechanism seen with vasodilator use

Answer 26

Diuretics. Block action of hormonal loop.

Question 27

PO vasodilator that induces NO release in endothelium

Answer 27

Hyrdalazine.

Question 28

PO vasodilator that opens K+ channels in smooth muscles

Answer 28

Minoxidil

Question 29

Vasodilator that releases NO directly into bloodstream

Answer 29

Nitroprusside. Used for HTN emergencies and heart failure

Question 30

Vasodilator that metabolizes into cyanide

Answer 30

Nitroprusside

Question 31

Vasodilator that targets Dopamine 1

Answer 31

Fenoldopam

Question 32

Target for calcium channel blockers

Answer 32

L type calcium channel

Question 33

Calcium Ch Blocker Drugs

Answer 33

Verapamil Diltiazem Dihydropyridine “-pine”

Question 34

Calcium Channel Blockers target different areas to lower blood pressure. Which one effects the heart, peripheral vasculature and which is mixed.

Answer 34

Verapamil- heart Diltiazem- both Dihydropyridines- peripheral vasculature. (Less cardiac effects)

Question 35

List the two classes of Angiotensin inhibitors

Answer 35

ACE inhibitors and ARBs

Question 36

What stimulates release of Renin in the kidney

Answer 36

Decreased arterial pressure Reduced sodium delivery Sympathetic stimulation

Question 37

Only Renin blocker

Answer 37

Aliskiren

Question 38

How is angiotensin II unique from angiotensin I?

Answer 38

Angiotensin II can cause vasoconstriction by itself. Whereas angiotensin cannot.

Question 39

Explain the relationship between ACE and Bradykinin

Answer 39

ACE breaks down Bradykinin into inactive metabolites.

Question 40

Explain why ACE inhibitors blocking breakdown of bradykinin is significant

Answer 40

Bradykinin will increase prostaglandin synthesis. Bradykinin is a vasodilator as are prostaglandins. This will help with lowering blood pressure. However, 10% of patients on ACEI will develop chronic cough. This cough can be debilitating and require change in medication.

Question 41

What suffix is associated with ACEI

Answer 41

-pril

Question 42

Contraindications for ACEI

Answer 42

Hypovolemic pts and first trimester pregnancy (teratogenesis)

Question 43

Suffix associated with ARBs

Answer 43

-sartan

Question 44

How are ARBs more beneficial than ACEI

Answer 44

ARBs have no effect on bradykinin therefore no cough is seen with ARBs.

Question 45

Pulmonary Hypertension treatments

Answer 45

Prostaglandins (prostacyclin) and endothelin receptor antagonists Bosentan (Tracleer), Tezosentan Also help (sildenafil, milrinone)

Question 46

Endothelin is produced in response to

Answer 46

Low shear stress

Question 47

Endothelin function

Answer 47

Vasoconstriction in the lung.

Question 48

Why are ET (endothelin) blockers more effective for pulmonary HTN?

Answer 48

Endothelin causes vasoconstriction on the lungs. Therefore blocking this will help decrease pressure in the lungs.

Question 49

Outpatient therapy for HTN initial, non pharmacological

Answer 49

Decrease sodium intake. Increase exercise. Lose weight.

Question 50

First line antihypertensives outpatient.

Answer 50

Low dose diuretic Beta blocker Calcium channel Dual therapy

Question 51

Hypertensive Crisis divided into what two categories

Answer 51

Hypertensive urgency Hypertensive emergency

Question 52

How does Hypertensive Urgency differ from hypertensive emergency

Answer 52

Urgency is same parameters for blood pressure as emergency (>180/110). The difference is there is no end organ damage with urgency. BP can be lowered in hours or days

Question 53

Hypertensive emergency

Answer 53

BP >180/110 Acute end organ damage. BP must be lowered immediately

Question 54

Most common drugs utilized during hypertensive emergencies

Answer 54

Nitroprusside and Fenoldopam

Question 55

Most common drugs utilized during hypertensive emergencies

Answer 55

Nitroprusside and Fenoldopam (increases renal perfusion)

Question 56

What two areas in the brain stem control sympathetic and parasympathetic outflow

Answer 56

(RLVM) Rostral Ventrolateral Medulla (NTS) Nucleus of the Tract Solitarius