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Flashcards in Exam 4 Deck (72)
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1

What is blood pressure?

Arterial pressure.

(cardiac output) x (peripheral resistance)

Cardiac output is determined by: HR, contractility, blood volume, and venous return.

Peripheral resistance is determined by: Arteriolar constriction.

2

How is BP controlled?

Autonomic Nervous System (sympathetic ns?)

Renin-Angiotensin-Aldosterone-System (RAAS): pronounced "raz".

Renal Regulation: Renin is released from the kidneys...

3

What BP measure is considered hypertensive?

> 140/90 mm Hg

4

Explain Primary vs Secondary hypertension:

Primary: No specific cause of HTN can be identified. AKA "idiopathic" or "essential".
- Accounts for 90% of all cases.
- May not be curable, but the disease can be managed such that the long-term consequences can be reduced.

Secondary: A specific cause is identified.
- Accounts for 10% of all patients with HTN.
- Correcting the comorbid condition will cure the associated HTN.

5

What certain diseases are associated with elevated blood pressure?

- Cushing's Syndrome

- Hyperthyroidism

- Chronic renal impairment

- Pheochromocytoma

- Arteriosclerosis

6

The consistent elevation of systemic arterial blood pressure:

Hypertension (HTN)

They start getting concerned about HTN when BP systolic is at 135

7

What are some risk factors for HTN?

- Obesity

- Smoking

- Caffeine

- Family history

- Diabetes

- Excessive salt/fat intake

- Lack of exercise

- Stress

- Age

8

CCBs:

Calcium-Channel Blockers.

One of the most widely prescribed classes...

9

What 2 chronic diseases do CCBs treat?

1. Hypertension. Often asymptomatic.

2. CAD: Coronary Artery Disease

Other therapeutic uses:
Angina and Dysrhythmias

10

1 in 3 people have this:

High BP

11

Which systems are effected by high BP?

All.

The heart is the primary organ damaged by chronic HTN. It's subjected to chronic pressure overload = LT ventricular hypertrophy. Left untreated = HF heart failure.

HTN accelerates the deposition of atherosclerotic plaque, creating or worsening CAD.

HF and MI are the most common causes of death in patients with HTN.

Creates major stress on kidneys; small arteries become injured, inflamed, and atherosclerotic=renal decline.

12

What is the mechanism of action for CCBs?

CCBs inhibit calcium from moving into the cell membrane thereby decreasing muscle contraction.

In normal physiology, calcium is needed in the automatic and conducting cells of the heart to help create an action potential & muscle contraction.

13

What are the effects seen on arteries of the heart from the CCB inhibition drugs?

- Decreased force of contraction- reduced HR

- Decreased velocity and conduction through the SA/AV nodes

- Dilation of the blood vessels

14

This drug name is sometimes called the proprietary name, product name, or brand name:

Trade name.

Intentionally selected to be short and easy to remember.

15

Stroke, heart disease, and kidney disease are all possible effects of what condition?

Hypertension

Also asymptomatic

16

How do we treat HTN?

Treat the cause!

If no cause known, lifestyle changes.

Last resort: drug therapy.

17

Where is the effect of the CCBs seen?

Seen on arteries of the heart and blood vessels...

- Decreased force of contraction- reduced HR
- Decreased velocity and conduction through the SA/AV nodes
- Dilation of the blood vessels = decrease BP

18

Name a prototype CCB:

nifedipine (Adalat CC, Procardia)

Use: to treat hypertension and angina

19

How does nifedipine work?

Works by blocking calcium channels in the vascular smooth muscle, including the coronary arteries which then decreases the amount of calcium available for muscle contraction

20

What other names is nifedipine known by?

Adalat CC
and
Procardia

21

What patient would you not give nifedipine to?

Those on digoxin because a side effect is a possible increase in digoxin.

Or alcoholic since alcohol perpetuates adverse effects!

22

Adverse effects of Adalat CC?

AKA nifedipine AKA Procardia

- Hypotension
- Headache
- Dizziness
- Flushing
- Increased digoxin levels

Alcohol perpetuates effects!

23

Name a CCB prototype other than nifedipine:

verapamil (Calan)

24

How does verapamil work?

- Works by blocking calcium channels in the vascular smooth muscle and cardiac muscle (myocardium)

- Causes vasodilation of peripheral blood vessels

- Reduces contractility of heart

Use:
To treat hypertension, angina & dysrhythmias - particularly the fast HR dysrhthmias.

25

What are some adverse effects of Calan?

AKA verapamil

Same as nifedipine, plus edema...

- Headache
- Fushed skin
- Dizziness
- Lightheadedness
- Peripheral edema.

26

What does ACE stand for?

Angiotensin-Converting Enzyme

27

What class does Lisinopril belong to?

ACE inhibitor.

AKA Prinivil

28

What is the mechanism of action for ACE inhibitors?

Prevent the formation of angiotensin II from angiotensin I = Inhibits the action of ACE

29

All the drugs that end in "pril" belong to which class?

Angiotensin-Converting Enzyme Inhibitor.

30

What is another name for Lisinopril?

Prinivil