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2060 Pharmacology > Module 13 Hypertension > Flashcards

Module 13 Hypertension Flashcards

(80 cards)

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1
Q

Blood Pressure

A
  • Force against artery walls
  • Heart pumps blood through body
  • Measured with sphygmomanometer
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1
Q

Hypertension

A
  • Elevated arterial blood pressure
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2
Q

Accurate BP Measurement

A
  • Seated for 5 minutes
  • No caffeine/nicotine 30 mins prior
  • Feet flat on floor
  • Arm elevated to heart level
  • Measure both arms 5 mins apart
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3
Q

Hypertension Diagnosis

A
  • 3 blood pressure measurements
  • Each 2 weeks apart
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4
Q

Systole

A
  • Contraction of heart
  • Top number
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5
Q

Diastole

A
  • Heart fills with blood
  • After contraction/ejection
  • Bottom number
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6
Q

Prehypertension Range

A
  • 120-139 systolic
  • 80-89 diastolic
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7
Q

Stage 1 Hypertension

A
  • 140-159 systolic
  • 90-99 diastolic
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8
Q

Stage 2 Hypertension

A
  • 160+ systolic
  • 100+ diastolic
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9
Q

Primary Hypertension

A
  • No known cause
  • Majority of cases
  • 90% of people over 55
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10
Q

Secondary Hypertension Causes

A
  • Kidney disease
  • Hyperthyroidism
  • Pregnancy
  • Erythropoietin
  • Pheochromocytoma (adrenal tumour)
  • Sleep apnea
  • Contraceptive use
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11
Q

Hypertension Consequences

A
  • Increased morbidity & mortality
  • Myocardial infraction
  • Kidney failure
  • Stroke
  • Retinal damage
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12
Q

BP Determinants

A
  • Cardiac output x peripheral resistance
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13
Q

CO Determinants

A
  • Heart rate, contractility
  • Blood volume
  • Venous return
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14
Q

Peripheral Resistance Determinants

A
  • Arteriolar constriction
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15
Q

Blood Pressure Regulation

A
  • Sympathetic NS
  • Renin-angiotensin-aldosterone system (RAAS)
  • Renal regulation
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16
Q

Sympathetic Nervous System (SYN)

A
  • Fight/flight response
  • Maintain homeostasis
  • Baroreceptor reflex for BP regulation
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17
Q

Baroreceptors

A
  • Aortic arch & carotid sinus
  • Sense blood pressure
  • Relay to brainstem
  • Rapid response
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18
Q

Baroreceptor Reflex Low BP

A
  • Brainstem sends impulses along SYN neurons
  • Stimulate heart
  • Increase CO
  • Vasoconstriction (smooth muscle)
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19
Q

Baroreceptor Reflex High BP

A
  • Decrease sympathetic activity
  • Decrease CO
  • Vasodilation
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20
Q

Renin-Angiotensin-Aldosterone System (RAAS)

A
  • Protein hormones
  • Blood pressure/volume regulation
  • Electrolyte balance
  • Long term response
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21
Q

RAAS Role

A
  • Affects kidney & vascular smooth muscle
  • Target of BP lowering drugs
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22
Q

RAAS Formation

A
  • Angiotensinogen
  • Renin
  • Ang I (inactive)
  • Ang converting enzyme (ACE)
  • Ang II (active)
  • Aldosterone/ADH
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23
Q

Renin

A
  • Formation of Ang I from angiotensinogen
  • Rate limiting step in Ang II formation
  • Juxtaglomerular cells of kidney
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24
Increase Renin Release
- Decrease blood volume - Low blood pressure - Beta 1 receptor stimulation (juxtaglomerular cells)
25
Angiotensin Converting Enzyme (ACE)
- Convert inactive Ang I to active Ang II
26
Angiotensin II Function
- Potent vasoconstrictor (bind to receptor) - Stimulates aldosterone release from adrenal cortex - ADH release from posterior pituitary
27
Aldosterone Function
- Acts on kidneys - Increase Na+ retention - Increase H2O retention
28
Antidiuretic Hormone (ADH) Function
- Also known as vasopressin - Acts on kidneys - Increase H2O retention
29
Renal Regulation of BP
- Decrease in BP causes increase in H2O retention - Increase in H20 retention causes increase blood volume - Increase blood volume causes increased CO - Increased CO causes increase BP
30
Non-Drug Hypertension Treatment
- Decrease body weight - Restriction of sodium intake - Physical exercise - Potassium supplementation - DASH diet - Smoking cessation - Alcohol restriction
31
Mechanisms of Obesity causing Hypertension
- Increased insulin secretion - Increased reabsorption of Na+ - Increased H20 absorption - Higher blood volume - Increase SYN activity
32
Sodium Intake Restriction
- Increased salt levels cause increase H2O reabsorption - Increase in blood volume & pressure - Kidney regulates salt, eliminating extra in urine
33
Physical Exercise
- Decrease fluid volume - Decrease levels of plasma catecholamines (epinephrine) - Pairs with sodium restriction & weight loss
34
Potassium Supplementation
- Inversely correlated with BP - Decrease BP - Increase Na+ excretion - Decrease renin release - Vasodilation - Don't mix with ACE inhibitors
35
DASH Diet
- 14 days for results - Rich in fruits, vegetables - Low fat dairy - Lean meats - Whole grains
36
Smoking Cessation
- Elevates BP - No direct link in causing hypertension - Risk for cardiovascular disease
37
Alcohol Restriction
- Excessive consumption increase BP - Decrease medication response (antihypertensive) - Less than 14 (men)/9 (women) drinks per week
38
Hypertension Medication SItes
- Vascular Smooth muscle - RAAS - Brainstem - Heart - Kidney
39
Vascular Smooth Muscle
- Ca+ channel blockers - Thiazide diuretics
40
RAAS
- Beta blocker - Renin inhibitors - ACE inhibitors - ARB - Aldosterone receptor antagonists
41
Brainstem
- Alpha 2 antagonists
42
Heart
- Beta blockers - Ca+ channel blockers
43
Kidney
- Thiazide diuretics - Loop diuretics - K+ sparing diuretics
44
Diuretics
- Blood Na+/Cl- reabsorption in nephron - Prevent H2O reabsorption - Promotes excretion of all
45
Loop Diuretics
- Largest BP decrease - Blood Na+/Cl- reabsorption - Ascending loop of henle - Situations of rapid fluid loss
46
Conditions for Loop Diuretics
- Edema - Severe hypertension - Severe renal failure
47
Adverse Effects of Loop Diuretics
- Hypokalemia (K+ into blood) - Hyponatremia - Dehydration - Hypotension
48
Thiazide Diuretics
- Most common treatment (work on own) - Less diuresis than loop diuretics
49
Mechanisms of Thiazide Diuretics
- Block Na+/Cl- reabsorption in distal tubule - Decrease vascular resistance
50
Adverse Effects of Thiazide Diuretics
- Hypokalemia - Dehydration - Hyponatremia
51
K+ Sparing & Aldosterone Antagonists
- Minimal BP lowering - Use with other diuretic - Don't combine with ACE/renin inhibitors - Inhibiting aldosterone receptors in collecting duct - Increase Na+ excretion - Increase K+ retention
52
Beta Blockers
- Blocking cardiac beta 1 receptors - Blocking juxtaglomerular cell beta 1 receptors - Suffix "olol"
53
Cardiac Beta Receptor 1 Block
- Catecholamines bind to cardiac beta receptors - Decrease CO - Decreases BP
54
Beta 1 Receptors on Juxtaglomerular Cells Block
- Decrease renin release - Decreasing RAAS vasoconstriction
55
1st Gen Beta Blockers
- Non-selective blockade - Inhibit beta 1 (heart & juxtaglomerular) - Inhibit beta 2 (lung)
56
2nd Gen Beta Blockers
- Selective blockade of beta 1 receptors
57
Adverse Effects of Beta 1 Blockers
- Bradycardia - Decrease CO - Heart failure - Hypertension/excitation (abrupt withdrawal)
58
Adverse Effects Non-Selective Beta Blockers
- Bronchoconstriction - Hepatic & muscle glycogenolysis inhibition
59
Angiotensin Converting Enzyme Inhibitors (ACEI)
- Decrease Ang II production - Inhibit bradykinin breakdown - Suffix "pril"
60
Ang II Decrease
- Causes vasodilation - Decease blood volume - Reduces CO & peripheral resistance
61
Bradykinin Breakdown Inhibition
- Causes vasodilation
62
Adverse Effects of Ang II Decrease
- Hypotension (1st dose emphasis) - Hyperkalemia
63
Adverse Effects of Bradykinin Increase
- Persistent cough - Angioedema
64
Angiotensin Receptor Blockers (ARB)
- Block Ang II binding to AT1 receptor - Cause vasodilation - Decrease aldosterone release - Increase Na+/H2O excretion - Suffix "sartan"
65
ARB Adverse Effects
- Angioedema (less risk than ACEI) - Hyperkalemia
66
Direct Renin Inhibitors (DRI)
- Bind to renin - Block angiotensinogen to Ang I conversion - Limit RAAS pathway - Decrease BP
67
DRI Adverse Effects
- Hyperkalemia - Persistent cough/angioedema (low) - Diarrhea
68
Calcium Channel Blockers
- Block movement of Ca++ into cell - Heart/smooth muscle cells - Decrease contraction
69
Dihydropyridine Calcium Channel Blockers
- Decrease Ca++ into smooth muscle/arteries - Vasodilation/relaxation - Suffix "dipine" - No action on heart
70
Adverse Effects of Dihydropyridine Blockers
- Flushing - Dizziness - Headache - Peripheral edema - Reflex tachycardia - Rash
71
Non-Dihydropyridine Calcium Channel Blockers
- Block Ca++ in smooth muscle & heart - Vasodilation of arteries - Decrease CO
72
Adverse Effects of Non-Dihydropyridine Blockers
- Constipation - Dizziness - Flushing - Headache - Edema - May compromise cardiac function
73
Centrally Acting Alpha 2 Agonists
- Bind & activate receptors in brainstem - Decrease sympathetic activity in heart & vessels - Decrease CO & peripheral resistance
74
Adverse Effects of Alpha 2 Agonists
- Drowsiness - Dry mouth - Hypertension (abrupt withdrawal)
75
Treatment Algorithms
- 140/90mmHg target BP - 130/80mmHg target Bp for diabetes/kidney disease - Slow disease progression by lowering BP
76
Prehypertension Algorithm
- Lifestyle modifications - Thiazide diuretic
77
Stage 1/2 Hypertension Algorithm
- Lifestyle modification - Thiazide diuretic - Add ACEI, ARB, BB, CCB
78
Moderate Renal Disease/Diabetes Algorithm
- Lifestyle modifications - Thiazide diuretic - ACE/ARB
79
Severe Renal Disease Algorithm
- Lifestyle modification - Loop diuretic - ACE/ARC

2060 Pharmacology (18 decks)

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