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Pharm (Marcus) > Exam 3 Chapter 11 (CV antihypertensives) > Flashcards

Exam 3 Chapter 11 (CV antihypertensives) Flashcards

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1
Q

The ____ processes the signal of low or high BP & the ____ sends the signal to make the appropriate change.

A

Hypothalamus & brainstem

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2
Q

Capacitance venules best respond to?

A

Nitric oxide

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3
Q

Alpha blockers affect the resistance arterioles & capacitance venules?

A

False only Resistance arterioles

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4
Q

What two effect does Angiotensin 2 have?

A

Directly constrict arterioles & get adrenal cortex to release Aldosterone

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5
Q

What are the 3 centrally acting Sympathoplegics?

A

Methyldopa, Clonidine, & Dexmedetomidine

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6
Q

What two things stimulate Renin release?

A

Low BP & Beta-1 agonism

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7
Q

Diuretics specifically target what structure?

A

Renal tubules

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8
Q

Delineate the pathway of the RAA system.

A

Angiotensinogen -> Renin released by kidneys -> Renin cleaves Angiotensinogen to Angiotensin 1 -> ACE converts Angiotensin 1 to Angiotensin 2

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9
Q

Where is Angiotensin-converting enzyme located?

A

Cell membranes that line the lungs

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10
Q

What is the negative feedback loop for Angiotensin 2?

A

The increase in volume inhibits further release of renin

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11
Q

What are the 4 anatomic control sites for antihypertensives?

A

Heart, arteries, veins, & kidneys

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12
Q

What is the MOA for Methyldopa & Clonidine?

A

Alpha-2 agonist activity in the brainstem

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13
Q

Explain the pathway how Methyldopa & Clonidine achieve their desired effect.

A

Both agonize the Nucleus of the Tractus Solitarius, which stimulates the Vagus nerve & sends a stimulus to the Rostral Ventrolateral Medulla, which sends an inhibitory signal to decrease sympathetic outflow resulting in decreased vasoconstriction, heart rate, & contractility

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14
Q

Methyldopa is useful for what two types of patient poluations?

A

Pregnancy induce HTN (does not affect fetus) & ppl unresponsive to other medications.

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15
Q

What is the major side effect of Clonidine & methyldopa?

A

Sedation

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16
Q

What kind of drug is Clonidine & what will we see initially?

A

A partial agonist. A brief rise in BP followed by hpotension

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17
Q

What are the off label uses for Clonidine?

A

ADHD, Tourette’s, EtOH withdrawal, Anxiety, PTSD

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18
Q

What are all the effects of Propranolol?

A

Lower BP, prevents reflex tachycardia, decreased CO, inhibits renin production

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19
Q

What is the IV dose for Metoprolol?

A

1mg q10min

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20
Q

What is the IV dose for atenolol?

A

5mg q10min

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21
Q

What is the IV dose for Esmolol?

A

20-30mg

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22
Q

What is MAP?

A

The pressure, which is consistently getting to the tissue

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23
Q

What happens to the blood fractions when an individual is hypotensive?

A

More blood is pumped into the venous system

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24
Q

_____% of blood is in the arterial system & _____% of blood is in the venous system.

A

25% & 75%

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25
What 2 items contribute to loss of vessel elasticity?
Age & plaque
26
True or false, higher blood viscosity means lower Hematocrit?
False, higher viscosity= higher Hct
27
If you double a blood vessel’s radius, what happens to flow?
Flow is 16x higher
28
What happens peripheral resistance in obese people?
More vessels= more resistance
29
What is the difference between primary & secondary hypertension?
Primary= can point out why. Secondary= don’t know why
30
What are some of the most common causes for Primary HTN?
Diet, obesity, Age >40, DM, heredity, stress, smoking, renal failure, cardiac disease, stroke
31
List the 3 initial nonpharmacologic steps to treat HTN.
Decrease Na+ intake, exercise, reduce weight
32
What is the goal of a first line low dose diuretic?
Reduce BP by 10 – 15mmHg
33
What is the difference between a Hypertensive urgency vs. emergency & the goal?
Urgency= no acute organ damage present & lower BP in hours to days. Emergency= acute end organ damage signs present & need for immediate lowering of BP.
34
What percentage of all cases are Hypertensive emergencies?
1%
35
How should a hypertensive emergency blood pressure be addressed?
Parenteral antihypertensive, not too rapidly to avoid hypotensive emergency. Once in range switch to oral.
36
What are 2 the most common antihypertensive emergency medications?
Nitroprusside & Fenoldopam
37
What is the MOA of CCB’s and their effects?
MOA: inhibit Ca++ influx in arterial smooth muscle. They dilate peripheral arterioles & additionally they are antianginal & anti-arrhythmic
38
What is the basic function of diuretics?
They deplete sodium
39
What is the basic function of Sympathoplegics?
Decrease PVR & CO
40
What is the basic function of vasodilators?
Relax vascular smooth muscle
41
What kind of drug is usually the fist & safest option for HTN?
Diuretics
42
What are the 6 sub classifications of Diuretics?
Carbonic anhydrase inhibitors, Loop diuretics, Thiazides, K+ sparing diuretics, Osmotic diuretics, ADH antagonists
43
What is the most common toxicity with diuretics?
Potassium depletion
44
The ____ processes the signal of low or high BP & the ____ sends the signal to make the appropriate change.
Hypothalamus & brainstem
45
Capacitance venules best respond to?
Nitric oxide
46
Alpha blockers affect the resistance arterioles & capacitance venules?
False, only Resistance arterioles
47
What two effect does Angiotensin 2 have?
Directly constrict arterioles & get adrenal cortex to release Aldosterone
48
What are the 3 centrally acting Sympathoplegics?
Methyldopa, Clonidine, & Dexmedetomidine
49
What two things stimulate Renin release?
Low BP & Beta-1 agonism
50
Diuretics specifically target what structure?
Renal tubules
51
Delineate the pathway of the RAA system.
Angiotensinogen -> Renin released by kidneys -> Renin cleaves Angiotensinogen to Angiotensin 1 -> ACE converts Angiotensin 1 to Angiotensin 2
52
Where is Angiotensin-converting enzyme located?
Cell membranes that line the lungs
53
What is the negative feedback loop for Angiotensin 2?
The increase in volume inhibits further release of renin
54
What are the 4 anatomic control sites for antihypertensives?
Heart, arteries, veins, & kidneys
55
What is the MOA for Methyldopa & Clonidine?
Alpha-2 agonist activity in the brainstem
56
Explain the pathway how Methyldopa & Clonidine achieve their desired effect.
Both agonize the Nucleus of the Tractus Solitarius, which stimulates the Vagus nerve & sends a stimulus to the Rostral Ventrolateral Medulla, which sends an inhibitory signal to decrease sympathetic outflow resulting in decreased vasoconstriction, heart rate, & contractility
57
Methyldopa is useful for what two types of patients?
Pregnancy induce HTN (does not affect fetus) & ppl unresponsive to other medications.
58
What is the major side effect of Clonidine & methyldopa?
Sedation
59
What kind of drug is Clonidine & what will we see initially?
A partial agonist. A brief rise in BP followed by hpotension
60
What are the off label uses for Clonidine?
ADHD, Tourette’s, EtOH withdrawal, Anxiety, PTSD
61
What are all the effects of Propranolol?
Lower BP, prevents reflex tachycardia, decreased CO, inhibits renin production
62
What is the IV dose for Metoprolol?
1mg q10min
63
What is the IV dose for atenolol?
5mg q10min
64
What is the IV dose for Esmolol?
20-30mg

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