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Flashcards in Hypertension Deck (72)
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31

What is the morphology of large/medium arteries?

accelerated atherogenesis
degenerative changes in vascular walls
increase risk of aortic dissection and cerebovascular hemorrhage

32

What is the hypertension morphology of small arteries/arterioles?

hyaline arteriolosclerosis
hyperplastic arteriolosclerosis

33

What is hyaline arteriolosclerosis pathology?

elderly pts
similar changes in diabetics
benign nephrosclerosis
homogenus pink thickening of vessels with narrow lumen
leakage of plasma across endothelium due to HTN
excess matrix production by smooth cells occurs secondarily

34

What are the histology of hyperplastic arteries?

characteristic of malignant htn
onion skinning laminated wall with luminal narrowing
-replication basement membrane and smooth muscle cells

35

What is necrotoizing arteriolitis?

malignant HTN; term used when these changes are associated with fibrinoid necrosis

36

What is the systemic HTN heart disease: morpoholgy?

cardiomegaly: concentric hypertrophhy without dilation
thickness of left ventricular wall impairs diastolic filling and causes left atrial enalrgment
myoccyte hypertrophy-- increased myocyte and nuclear enlargement

37

What are the direct arterial vasodilators?

hydralazine
minoxidil
diazoxide
nitroprusside
fenoldopam

38

What is the compensatory mechanism that reduces effectiveness of direct arterial vasodilators?

baroreceptor activation: compensatory increase in sympathetic outflow; tachyphylaxis can cause loss of antihyptertensive as well as reflex rellease ofrenin

39

What can be given with direct arterial vasodilators to counteract compensatory baroreceptor activation?

beta blocker

and diuretic for water retention

40

What is hypertensive urgency?

elevated Bp but no acute or progressing target organ injury

41

What is a hypertesnive emergency?

acute or progressing target organ damage from elevated BP

42

What are adverse effects of hydralazine?

lupus like syndrome

43

What are the general adverse effects of arterial vasodilators?

sodium/water retention
tachycardia/angina

44

what is an adverse effect of minoxidil?

hair growth

45

What are teh calcium channel blockers?

nifedipine
diltiazem
verapamil
amlodidpine

46

What are two alpha blockers?

phenoxybenzamine and phentolamine

47

What are teh effect of alpha blockers?

inhibit smooth muscle catecholamine uptake: vasodilation and BP lowering

48

What are the benefits of alpha1 selective blockers?

allow activation of alpha 2 and inhiiton of NE release; and don't stim renin release
and smaller increase in heart rate

49

What are the alpha 1 selective blockers?

prazozin
terazosin
doxazosin

50

What are the addverse effects of alpha1 blockers?

first dose effect
-orhtostatic hypotension
transient dizziness, faintness, palpitations, syncope
reflex tachy

51

Where are hte Beta 1 receptors located?

heart and kidney, stimulate incrased HR, contractility and renin release

52

Where are beta 2 receptors located and what do they do?

lung, liver, pancrease, arteriolar smooth muscle
stim bronchodilation and vasodilation
mediate insulin secretion and glycogenolysis

53

What are the potential beta blockers adverse effects?

glucose intolerance, masked hypoglycemia
bradycardia, dizziness
bronchospasm
up TG and decrease HDL
CNS depression, fatigue, sleep disturbance
reduce CO, exacerbattion of herat failure
impotence
exercise intolerance

54

What are the central alpha2 agaonists?

clonidine
guanabenz
alpha-methyldopa

55

What is tehmechansim of action of clonidine?

central alpha 2 agonist
-reduces sympathetic outflow from braint o vasomotor sensor
-increase vagal tone.

56

What are the adverse effects of cnetral alpha2 agaonists?

sodium retention
rebound HTN
depression
orthostatic hypotension
dizziness

57

What is an adverse effect of clonididne?

anticholinergic side effects

58

What is an adverse effect of methyldopa

hepitisi or rarely hemolytic anemia

59

What are neuronal and ganglionic blockers used to treat HTN??

guanethidine
guanadrel
resperine
trimethaphan--ganglionic

60

What are the adverse effects of reserpine and guanethidine?

sedation(reserpine)
depression (reserpine0
decreased CO
sodium/water
increased gastric acid secretion (reserpine)
diarrhea
bradycardia