Hypertension Flashcards
(108 cards)
1
Q
Systolic blood pressure
A
Pressure in arteries when heart pumps
2
Q
Diastolic blood pressure
A
Pressure in arteries when heart relaxes between beats
3
Q
Which is more concerning–diastolic hypertension or systolic hypertension?
A
Systolic
4
Q
Hypertension = ____ measurements of blood pressure with diastolic > ___, systolic > _____, resting pulse pressure > _____
A
2 or more measurements
Diastolic > 90
Systolic > 140
Resting pulse pressure > 65
5
Q
What is resting pulse pressure?
A
Systolic - diastolic
6
Q
What is primary hypertension?
A
Hypertension with no identifiable cause
7
Q
What are the lifestyle risk factors for primary hypertension?
A
Excess body weight Smoking Alcohol Excess Sodium low K+ Sedentary lifestyle
8
Q
What are the risk factors for primary HTN?
A
Lifestyle Hyperlipidemia Depression Age Sex (<55 more common in men, >55 more common in women) Genes (FH) Race (african american) (low Vitamin D Stress smoking diet Alcohol)
9
Q
What is secondary hypertension also called?
A
Inessential HTN
10
Q
What are the causes of secondary hypertension?
A
Kidney disease/renal artery constriction Tumor of the adrenal gland Cushings/Conns Coarctation of the aorta Pregnancy (preeclampsia) Medication
11
Q
What medications can cause hypertension?
A
High estrogen oral contraceptives
Antidepressants (clozapine, venlafaxine)
12
Q
What is rebound hypertension?
A
Hypertension after d/c antihypertensive medication
13
Q
What kidney factors can cause hypertension?
A
Stenosis
Cysts
Glomerulonephritis
14
Q
What type of tumor can cause hypertension?
A
Pheochomocytoma–adrenal gland (increases adrenaline)
15
Q
People with diabetes are ____ more likely to get hypertension
A
2-4 x
16
Q
How does diabetic nephropathy cause hypertension?
A
Not fully understood--involves; Excess sodium retention Sympathetic nervous system RAAS Endothelial cell dysfunction Oxidative stress
17
Q
___ and ___ can lead to vascular damage (associated with diabetes)
A
Glucose and fat
18
Q
Autonomic neuropathy can lead to ________
A
Orthostatic hypotension
19
Q
What organs can be damaged from chronic HTN?
A
Heart (HF, CAD, angina)
Kidney
Brain (stroke)
Eyes
20
Q
What is the equation for BP?
A
BP = CO x peripheral vascular resistance
21
Q
What are the 3 possible mechanisms of antihypertensive meds?
A
- Reduce systolic BP
- Reduce CO
- Reduce vascular resistance (vasodilation or decreased BV)
22
Q
Diastolic blood pressure (is/ is not) predictive of mortality?
A
Is NOT
23
Q
Vascular resistance is controlled by _____
A
Sympathetic autonomic nervous system
24
Q
What is the equation for CO?
A
Stroke Volume x HR
25
SV and HR are controlled by ____
PANS and SANS
26
What does the baroreceptor reflex detect?
Change in blood pressure based on stretch of the blood vessels
27
How do baroreceptors respond to low blood pressure?
Activate the SANS --> vasoconstriction, increased HR, increased SV
28
What happens when baroreceptors detect low blood pressure?
The Sympathetic output is decreased (vasodilation, decreased force of contraction, decreased HR)
Parasympathetic output is increased (decreases heart rate)
29
What do chemoreceptors detect?
Changes in pH, CO2, O2
30
High O2 causes increase/decrease in HR?
Decrease
31
High pH causes increase/decrease in HR?
Decrease
32
High CO2 causes increase/decrease in HR?
Increase (also vasoconstriction and SNS stimulation)
33
What are the 4 targets of antihypertensive drugs?
Heart (from SNS and PSNS)
Resistance arterioles
Veins
Kidney
34
What are the 3 neurotransmitters in the PSNS?
Acetylcholine, muscarine, nicotine
35
What are the 3 sympathetic neurotransmitters?
Norepinephrine and epinephrine, acetylcholine
36
What receptor on the heart and blood vessels are stimulated by the parasympathetic nervous system?
Muscarinic
37
What receptors on the heart and blood vessels are stimulated by the sympathetic nervous system?
Beta and alpha
38
What receptors are found on sweat glands?
Muscarinic (but still part of PSNS!)
39
What receptors are found on renal vessels?
Dopamine (cause vasodilation)
40
What is released from the adrenal gland?
Norepinephrine and epinephrine
41
Where does norepinephrine and epinephrine released by the adrenal gland act?
Alpha and Beta receptors of the heart and blood vessels
42
What G-protein are alpha-1 receptors activating?
Gq
43
What g-protein do alpha-2 receptors activate?
Gi
44
What g-protein do Beta receptors activate?
Gs
45
Which receptors cause vasoconstriction?
A1
46
Which receptors cause vasodilation?
B2
47
What does NO do?
Vasodilation!
48
What receptor causes the production of NO?
M3
49
What two receptors are found in the heart?
M2 and B1
50
B1 activation increases/decreases ____ found in the cell
increases cAMP
51
M2 activation increases/decreases ____ found in the cell
decreases cAMP
52
What is chronotropic?
Rate of contraction
53
What is inotropic?
Force of contraction
54
What do B1 receptors in the kidney control?
Renin release
55
Renin increases or decrease BP?
Increase blood pressure
56
Where are dopamine receptors found?
Along the kidney tubules
57
Where is dopamine produced?
proximal tubules
58
When dopamine is <3 ug/kg/min, what is the effect?
Vasodilation
59
When dopamine is 3-7.5 ug/kg/min, what is the effect?
Increased cardiac output
60
When dopamine is >7.5 ug/kg/min, what is the effect?
Vasoconstriction
61
At what concentration does dopamine only activate dopamine receptors?
<3
62
At what concentration does dopamine also activate B1 receptors?
3-7.5
63
How does dopamine decrease blood pressure?
Decrease sodium reabsorption in the proximal tubule (by generating cAMP, which decreases NaH exchange needed for re-entry of sodium)
64
When are sympatholytic drugs used for hypertension?
Rescue hypertensives in inpatient
65
Why are sympatholytic drugs not used as monotherapy?
Baroreceptor reflex will create homeostasis--small effect on blood pressure
66
Can sympatholytics be used in pregnant patients?
No
67
When do sympatholytic drugs need close monitoring?
In patients with angina, Parkinson's
68
Alpha blockers reduce ____
vasoconstriction
69
A1-antagonists are used primarily for ____
BPH
70
When are a1 antagonists used for hypertension?
Phaeochromocytoma (adrenal gland tumor)
| 3rd or 4th line
71
How do a1 antagonists reduce BP?
Dilate arteries and veins (decrease PVR and CO)
72
What are some side effects of a1 antagonists?
Tachycardia, Na and water retention, Orthostatic hypotension
73
What are non-selective alpha blockers used for?
Hypertensive emergency
| Cocaine-induced CV complications
74
How does blocking a2 affect BP?
Prevents negative feedback of NE release, causing more NE release
Causes reflex tachycardia, arrhythmias
75
What are the 2 non-selective alpha-blockers?
Phentolamine
| Phenoxybenzamine (irrevesible)
76
What are the a-1 antagonists?
-osins
77
What are the a2 agonists?
Methyldopa
Clonidine
Guanabenz
Guanfacine
78
How do alpha agonists works?
Inhibit release of NE in CNS (negative feedback)
79
Can methyldopa be used in pregnant women?
Yes
80
Is methyldopa a prodrug?
Yes
81
What is clonidine used for?
Drug withdrawal
| ADHD
82
What are side effects of alpha agonists?
Dry mouth, sedation, depression, rebound hypertension
83
What drug does clonidine interat with?
TCAs (block alpha-receptors)
84
Clonidine acts at ___ receptors to reduce blood pressure
imidazoline
85
What is reserpine?
Catecholamine depleter
86
Reserpine irreversibly blocks ____ to deplete ____ of ___ and ____
VMAT (vesicular monoamine transporter), neurtransmitter vesicles, Dopamine and norepinephrine
87
What are side effects of catecholamine depleters?
GI: Diarrhea, cramps, acid secretion
CNS: Sedation, nightmares, depression
88
What is the first generation beta blocker?
Propranolol
89
How does propranolol decrease blood pressure?
Reduces HR and SV
| Reduces renin release
90
What are the Beta blocker partial agonists?
Pindolol
| Acetbutalol
91
What are 1st gen beta-blockers used for?
Angina, cardiac arrhthmia, reduce tremors
92
1st gen beta blockers increase the risk for _____ by blocking _____ release and ___ release
diabetes
Insulin
Glucose
93
What populations are 1st gen beta blockers contraindicated in?
COPD, asthma, CHF
94
What are side effects of beta blockers?
bradycardia, AV block, hypotension, sedation, rebound tachycardia
95
What side effect is from Beta-1 blockage?
bronchospasm
96
Which drugs are 2nd gen beta blockers?
Metoprolol tartrate
Metoprolol succinate (XR, for CHF)
Atenolol
97
What do 2nd gen beta bockers do?
selectively block B1 receptors for less bronchoconstriction
98
What are the 3rd gen beta blockers?
Nebivolol
| Betaxolol
99
What does nebivolol do?
Block B1 selectively
| Induce vasodilation via NO
100
What does betaxolol do?
Induce vasodilation by Calcium channel blocking
| Block B1 selectively
101
What is carvedilol?
Beta and a-1 blocker
102
What is labetalol
Beta and a-1 blocker
103
What antihypertensive meds are safe for pregnant women?
Methyldopa
| Labetalol
104
Are alpha1/Beta blockers used in HF?
Yes
105
What is the benefit of combining Beta-block with A1-block?
B-block prevents reflexive tachycardia normally associated with a1 receptor antagonists
106
Drugs that _____ BP produce reflex bradycardia
Increase
107
Drugs that ___ BP produce reflex tachycardia
Decrease
108
What two things can blunt baroreceptor response (and cause orthostatic hypotension?)
Hypertension (able to respond to increases in BP, not falls)
| Autonomic neuropathy
