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Advanced Pharm, Exam 2 > Regulation of Blood Pressure > Flashcards

Regulation of Blood Pressure Flashcards

(67 cards)

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1
Q

Define Preload

A

End diastolic volume

Increased preload, increases contractility
Decreased preload, decreases contractility

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2
Q

Describe relationship between preload and contractility

A

Increased preload, increased contractility

Decreased preload, decreased contractility

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3
Q

What drugs/drug classes decrease preload? (4)

A

ACE
ARB
CCB
Nitro

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4
Q

What drugs/drug classes decrease preload? (4)

A

Fluids

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5
Q

Define Afterload

A

Pressure that must be overcome by the left ventricle or pulmonary artery pressures that must be overcome by the right ventricle

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6
Q

What ‘symptoms’ can develop with a decrease in perload? (2)

A

Reflex Tachycardia

Angina

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7
Q

What drugs/drug classes decrease afterload? (4)

A

ACE
ARB
CCB
Nitro

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8
Q

What drugs/drug classes increase afterload? (9)

A 
Dobutamine
Dopamine
Epi
Ketamine
Norepi
ADHD eds
TCAs
Vasopressin
Effexor (venlafaxine
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9
Q

Define baroreceptor reflex.

How does it work?

A

Homeostatic mechanism that helps to maintain nearly constant levels.

Baroreceptors stretch and respond to pressure changes in the arterial wall in vessel they are found in

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10
Q

Where are baroreceptors located? (2)

A

Carotid sinus

Aortic Arch

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11
Q

What condition can impairment of the baroreceptor reflex cause? (2)

A

Hypertension

Heart Failure

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12
Q

Baroreceptors in which location respond to INCREASE in arterial pressures?

A

Aortic arch

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13
Q

Baroreceptors in which location respond a DECREASE in arterial pressures?

A

Carotid Sinus

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14
Q

Which part of the baroreceptor reflex (carotid sinus or aortic arch) do most anti-hpertensives affect?

A

Carotid Sinus

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15
Q

What is the body’s response to activation of the baroreceptor reflex in carotid sinus?

A

Increased HR
Increased Contractility
Vasoconstriction of arterioles and veins (activation of sympathetic NS)

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16
Q

Name all 4 Nodal Cells

A

SA
AV
Purkingi Fibers
Bundle of His

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17
Q

Define Chronotrophy

A

Changes in heart rate via an increase or decrease in firing of the SA node

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18
Q

Define Dromotrophy

A

Speed of Contraction

The speed of movement from the atrium through the AV node (CCB effect) SLOWS pulse and prolongs the PR interval

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19
Q

Define Inotrophy

A

Force of Contraction

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20
Q

Lusitrophy

A

Relaxation of hearth (diastole)

How fast Ca++ is removed from the cell (no heart contraction)

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21
Q

What Drugs/drug classes decrease chronotrophy? (4)

A

BB
Verapamil
Diltiazem
Methyldopa

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22
Q

What drugs/drug classes increase chronotrophy? (4)

A

Epi
Nor-epi
CCB
A1 Blockers (doxaxosin, Prazosin, Terazosin

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23
Q

What phase of the action potential represents dromotrophy?

A

Phase 0

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24
Q

What drugs/class of drugs affect dromotrophy?

A 
Antiarrthymics (amioderone, sotalol), phase 4
CCB Class (IV (Diltiazem, verapamil), phase 0
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25
The influx of what ion into the cell strengthens inotrophy?
Ca++
26
Explain what happens in an Action Potential Phase 0, SA/AV Node Phase 0, Ventricular Myocyte Phase 3 of Both
Phase 0 in SA/AV node: influx of ca causing the inside of the cell to become and more (+) Phase 0 in ventricular myocyte: influx of Na making cell less more (+) Phase 3 of both: K+ out of the cell making the inside of the cell more (-)
27
Explain what happens in an Action Potential in SA/AV Node Phase 4 Phase 0 Phase 3
Phase 4: NA+ moves inside of the cell causing it to be more (+) (THRESHOLD) THEN FIRES resulting in Phase 0: influx of Ca++ causing the inside of the cell to be rapidly (+) then has to restart by becoming more (-) Phase 3: K+ moves outside of the cell causing the inside of the cell to become more (-)
28
Explain what happens in an Action Potential in the Ventricular Myocyte Phase 0 Phase 1 Phase 2
Phase 0: rapid influx of Na+ into cell causing it to be more (+) Phase 1: initial repolarization; K+ moves out of the cell (via Na/K pump) causing inside of cell more (-) Phase 2: Ca++ is moving in to cause contraction (systole) QT interval Phase 3: repolarization; K+ moves out (diastole) Phase 4: Inward/outward K+
29
Absolute Refractory Period
Period where ventricular myocyte cannot receive another action potential
30
Explain the role of Angiotensin II on Blood Pressure
Increases Altosterone release (increases Na+/H20 reabsorption and K+ excretion DRT This increases thirst and H20 consumption Angiotnesin II is a strong vasoconstrictor, participates in vascular remodeling
31
What phases of the ventricular myocyte action potential represent systole?
0 1 2
32
What phases of the ventricular myocyte action potential represent diastole?
3 | 4
33
If age 40-70 years with baseline BP of 75/115-115/185 and SBP raises 20mmHG and/or DBP increases by 10mmHG, what happens to the risk of CVD?
It doubles with each increase of 20 or 10, respectively.
34
What are the hemodynamic and pathophysiologic factors that contribute to blood pressure? (5)
``` Autonomic NS Heart Blood Vessel Anatomy Distribution and Movement of Blood Hormonal Influences and Plasma Volume ```
35
Define systolic Blood Pressure
HIGHEST arterial pressure during the cardiac cycle Pressure generated during systole/ventricular contraction where blood being ejected out of arterial system
36
Define Diastolic Blood Pressure
LOWEST arterial pressure during the cardiac cycle. Pressure generated during diastole/relaxation phase 'Resting Pressure"
37
Define Mean Arterial Pressure (MAP)
'Average Pressure' in vascular system with respect to time
38
What is the clinical application of understanding MAP?
Vasomotor center in brain usually maintains a MAP of 100mmHG Goal in sepsis, spinal cord injury less
39
Define Pulse Pressure
Difference between SBP & DBP
40
Formula for Cardiac Output?
SVxHR
41
Define Stroke Volume
Volume of blood ejected with each ventricular beat Influences pulse pressure Influenced by: preload, afterload & inotrophy
42
Define Ejection Fraction
Fraction of end diastolic volume (EDV) ejected out of heart with a ventricular bat and related to contractility
43
Formula for ejection fraction?
EF=SV/EDV
44
Normal percentage for Ejection Fraction?
60%
45
Formula for MAP?
CO x SVR
46
What happens to the aorta during systole and diastole?
expands during systole, recoils in diastole
47
What part of the Nodal Action Potential is a primary influence on chronotrophy?
Primarily influenced by rate of rice in Phase 4 (pacemaker cells & inward Ca++ current
48
What drug classes decrease chronotropy? (4)
a2 agonists Beta Blockers Digoxin Non-DHP CCB
49
What a2 Agonists decrease chronotrophy? (3)
Clonidine Guanfacine Methyldopa
50
What Beta Blockers decrease chronotrophy (3)
atenolol esmolol metoprolol
51
What non-DHP CCBs decrease chronotropy? @)
Diltiazem | Verapamil
52
Activation of what receptor increases Chronotropy?
Beta 2
53
What specific drugs increase chronotropy directly? (4)
Dobutamine Dopamine (high dose) Epi NorEpi
54
What classes of drugs increase chronotroy by affecting baroreceptor reflex? (7) (decrease TPR/preload)
``` a1 Blockers DHP CCB Diuretics Fenoldopam Hydralazine Nitroprusside Phentolamine ```
55
What classes of drugs decrease dromotropy? (3)
Beta Blockers Class 1 Antiarrthymics Non-DHP CCB
56
What Beta Blockers decrease dromotropy? (3)
Atenolol Esmolol Metoprolol
57
What Class I Antiarrthymics decrease dromotropy? (4)
Procanamide Lidocaine Flecainide Propafenone
58
What non-DHP CCB decrease dromotropy?(1)
Diltiazem
59
What drugs increase dromotropy?
NONE
60
What drug lasses decrease inotropy?(4)
a2 Agonists beta blockers Non-DHP ccB Class III Anti-arrhythmics
61
What a2 agonists are used to decrease inotropy? (3)
Clonidine Guanfacine Methyldopa
62
What Beta Blockers are used to decrease inotrophy? (3)
Atenolol Esmolol Metoprolol
63
What Non-DHP CCB are used to decrease inotropy? (2)
Diltiazem | Verapamil
64
What Class III Antiarrhymics are used to decrease inotropy? (2)
Amiodarone | Sotolol
65
What classes of drugs increase Lusitropy? (3)
Beta agonists Catecholamines Dobutamine
66
What classes of drugs decrease lusitropy? (4)
beta blockers Non-DHP CCB +/- Digoxin
67
What factors influence increase of MAP? (4)
Increase heart rate Increase contractility and SV Increase vasoconstriction of arterioles (Increases TPR) Increase Vasoconstriction of veins

Advanced Pharm, Exam 2 (8 decks)

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