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1

pre htn. values

120-130/80-90

2

stage 1 htn. values

140-160/90-100

3

stage 2 htn. values

>160/100

4

essential htn. is

idiopathic and is 90% of all htn.

5

secondary htn. is caused by a specific

etiology. 10% of all htn.

6

specific htn. etiologies.

coarctation of the aorta, pregnancy (primary htn.) kidney disease, hyperthyroidism, cushing syndrome (hyper adrenal)

7

cushings disease

hyper secretion of ACTH

8

natural bp control

arterioles, venules, heart, renin/angiotensin

9

external bp control

the pump , anesthetic depth, drugs

10

anti hypertensive work to alter bp by

decreasing CO or decreasing SVR

11

CO SVR are generally controlled by

SNS and baroreceptor feedback, or renin/angiotensin system

12

first line Rx for HTN.

DIURETICS (INEXPENSIVE/SAFE)

13

110% OF NORMAL BV can cause

profound htn. in patients with stiff arteries. while 95% can mean normotensive

14

diuretics are superior for treatment in

the elderly

15

b blocker decrease bp by

decreasing CO, SNS TONE, RENAL RENIN RELEASE

16

ARBS

angiotensin receptor blockers

17

beta 1 selective are being

used more and more because of less side effects

18

bystolic

nebivolol b1 selective and potent vasodilator.

19

results of ace inhibitors

decrease sym. activity, aldosterone secretion, tubular nacl/water reabsrorption, k excretion, vasocontriction, adh secretion

20

rate limiting factor of ace inhibitors

the inhibition of bradykinin degradation. vasodilator but causes problems

21

commonly used as a first line drug post-MI for HTN

ace inhibitors

22

ace inhibitors cannot be used

in pregnant women

23

problems from bradykinin from ace inhibitors

dry heaving because they get caught in lungs

24

ARBs advantage over ACE inhibitors

don't cause bradykinin release. fewer respiratory problems

25

why ARBs more effective then ACE

ore effective than ACE-Inhibitors in blocking Angiotensin since there are other chemicals that also convert Angiotensin-I into Angiotensin-II (understand?)

26

A2 AGONIST WORK BY

decrease sympathetic firing from CNS, decrease vascular tone, used with other drugs because of sedative side effect

27

clonidine

(catapres,duraclon) dilates peripheral vessels but not renal arteries. useful in HTN. complicated with renal disease

28

a-methyldopa (aldomet)

like clonidine but less tranplacental passage

29

#1 to control bp on bypass

flow

30

more anesthetized the

lower the bp

31

when giving drugs on bypass its different because

there is no cardiac reflex, urgent, reversal agents

32

hydralazine

apresoline. arterial and arteriole effect > venous effect. causes endothelial cell to releases NO (vasodilator muscle relaxant) can be used in pregnant girls

33

nitroglycerin

• Used for treatment of angina for > 100 years! • At lower doses venous dilation>arterial • At higher doses arterial dilation>venous

34

forms of NTG

NTG tablets, Nitro Bid ointment, translucent NITREK patch,

35

NTG in body

• Converted to nitric oxide by mitochondrial enzymes.
• Commonly used as a bolus (what’s this?) or IV drip on CPB to treat “HTN”.
• Decreases B.P., pulmonary capillary wedge pressure, and SVR.
• decreases myocardial O2 demand during ischemia while leaving contractility unaffected.

36

two ways to blow air out of coronaries

changes in EKG indicates injury or MI. half of surgeons will want to increase BP. some will give NTG to dilate

37

NITROPRUSSIDE

NIPRIDE OR NITROPRESS. *Potent arterial & capacitance dilator.
...so it decreases both preload and afterload (explain) which helps increase C.O. in patients with heart failure.

38

nitroprusside must be

iven parenterally
*Very commonly used to control BP on CPB (both bolus and IV drip) Breaks down in the blood stream into nitric oxide...
• and cyanide

39

nitroprusside half life

• Although nitroprusside has a half-life of 1-2 minutes...
• It’s toxic metabolite thiocyanate has a half- life of many days. babies susceptible

40

nitroprusside dose

***Normal adult dosage is 0.5-10.0 μg/kg/min (peds receive the low end of this dose
BUT
DO NOT give at higher dosages for more than ten minutes or toxicity can result!!!

41

*Cyanide “shuts down” cellular metabolism. Why would this be problematic on bypass??

you can poison a patient because you are flying blind on bypass. because if you keep giving it and no decrease in BP

42

NITROPRUSSIDE AND NTG USED ON TERMINATION BUT..

you can transfuse a vast majority of volume this way??