Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD3002 Week 6 > 6. The long-term control of blood pressure. Oedema, dehydration. > Flashcards

6. The long-term control of blood pressure. Oedema, dehydration. Flashcards

1
Q

Define stage 2 hypertension?

A

Stage 2 hypertension:
• Clinic BP 160/100 mmHg is or higher and
• ABPM or HBPM daytime average is 150/95 mmHg
or highe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define severe hypertension?

A
  • Clinic BP is 180 mmHg or higher or

* Clinic diastolic BP is 110 mmHg or higher.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is hypertensive drug treatment initiated?

A

Offer antihypertensive drug treatment to people:
• who have stage 1 hypertension, are aged under 80 and meet identified criteria
• who have stage 2 hypertension at any age.

If aged under 40 with stage 1 hypertension and without evidence of target organ damage, cardiovascular disease, renal disease or diabetes, consider:
• specialist evaluation of secondary causes of hypertension • further assessment of potential target organ damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Targets for bp for people under and over 80yrs?

A
  • 140/90 mmHg in people aged under 80

* 150/90 mmHg in people aged 80 and over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Targets for bp for people under and over 80yrs for people who don’t have “white-coat effects”?

A
  • 140/90 mmHg in people aged under 80

* 150/90 mmHg in people aged 80 and over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Targets for bp for people under and over 80yrs for people who do have “white-coat effects”?

A

Aim for ABPM/HBPM target average of:
• below 135/85 mmHg in people aged under 80
• below 145/85 mmHg in people aged 80 and over.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What defines having a “white-coat effect”?

A

A discrepancy of more than 20/10 mmHg between clinic and average daytime ABPM or average HBPM blood pressure measurements at the time of diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antihypertensive drug treatment for those under 55yrs?

A
  1. A (ACE inhibitor or ARB)
  2. A +C (calcium channel blocker)
  3. A+ C + D (thiazide-like diuretic)
  4. RESISTANT HYPERTENSION A + C + D + (Consider further diuretic) or alpha/beta-blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Antihypensive drug for treatment of those about 55 yrs or black person of African/Caribbean origin

A
  1. C (calcium channel blocker)
  2. A +C (ACE inhibitor or ARB)
  3. A+ C + D (thiazide-like diuretic)
  4. RESISTANT HYPERTENSION A + C + D + (Consider further diuretic) or alpha/beta-blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lifestyle interventions of hypertensive patients?

A

– diet (including sodium and caffeine intake) and exercise
– alcohol consumption
– smoking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

2 factors that control bp?

A
  1. Blood volume

2. Wall tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does blood volume control bp?

A

-Osmolality: Monitored by osmoreceptors in the hypothalamus and mediated by solutes, mainly NaCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does wall tension control bp?

A

-Baroreceptors: Low stretch detectors in atria and pulmonary vessels, high stretch detector in aortic arch, coronary sinus and juxtaglomerular apparatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does wall tension control bp:
Receptors?
Mechanism of control?
Role of ANP

A

Baroreceptors: Low stretch detectors in atria and pulmonary vessels, high stretch detector in aortic arch, coronary sinus and juxtaglomerular apparatus

Mechanism:
Information to medulla, alters ADH secretion from pituitary and sympathetic activity

Atrial natriuretic peptide (ANP) are found in atrial myocytes. Result in excretion of Na and H2O by dilating afferent arteriole of glomerulus and suppress ADH and renin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Juxtaglomerular apparatus, consists of:

A

Juxtaglomerular apparatus, consists of:

  1. Macula densa cells of the distal convoluted tubule (DCT) which monitors sodium.
  2. Granular cells of the afferent arteriole which monitors stretch
  3. Sympathetic activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Role of renin.

A

Converts angiotensinogen to angiotensin I.

This is then converted to angiotensin II which is a hormone which raises BP

17
Q

How does angiotensin II refuse bp?

A
  • Vasoconstricting arterioles ( mediated by inhibiting reuptake of noradrenaline/norepinehrine nerve endings)
  • Stimulating aldosterone production from adrenal cortex
  • Stimulating thirst centre
  • Stimulating ADH release
18
Q

ACE inhibitors:

  • How does it decrease bp?
  • Elimination?
  • Adverse effects?
A

Prevents the formation of Angiotension II leading to vasodilatation and ↓BP

Binds to tissues and plasma proteins so slow elimination by glomerular filtration

Adverse effects:
• First dose hypotension rare in essential hypertension
• Dry irritating cough (15% patients) due to accumulation of bradykinin (not dose related)
• Hyperkalaemia mediated by reduction of aldosterone

19
Q

Thiazide diuretics:

  • Action to reduce bp?
  • Major effect?
  • Adverse effects?
A

Acts on the proximal part of the distal convoluted tubule-↑sodium excretion and urine volume - > reduction in blood volume BUT transient

Major effect : ↓ peripheral resistance due to “subtle alterations in the contractile responses of vascular smooth muscle”

Adverse effects:
• Hypokalaemia
• Hyperuricaemia - risk of acute gout
• Hyperglycaemia - risk of new onset diabetes
• Hypercalcaemia
• Erectile dysfunction
• Thrombocytopaenia and skin rashes - rare

20
Q

Calcium channel blockers:

  • Action to reduce bp?
  • Adverse effects?
A

Action:

  • Acts by reducing calcium influx into vascular smooth muscle cells and promoting vasodilatation
  • Direct action on cardiac and gastrointestinal muscle cells

Adverse effects
• Headache and flushing due to dilatation
• Tachycardia due to reflex activation of sympathetic system
• Ankle swelling due to preferential pre-capillary arteriolar vasodilatation
• Gum hypertrophy

21
Q

Beta-blockers:
Action?
Adverse effects?

A

Action:
•Antagonise the effects of sympathetic system or circulating catecholamines at beta-1-receptors in heart, kidney; beta-2-lung, peripheral blood vessels and skeletal muscles.
(Inhibits the release of renin)
•Mode of action in lowering BP still controversial

Adverse effects
• Bronchospasm - contraindicated in asthma
• Bradycardia
• Peripheral vascontriction - cold hands and feet
• TATT reduced cardiac ouput
• Masking hypoglycaemia in IDDM – blunting of sympathetic response
• Hyperglycaemia – risk of new onset diabetes

TATT= Tiredness All The Time

22
Q

Factors that favour UTIs

A 
Adhesion to uroepithelium (e.g. P. fimbriae in E. coli)
Introital colonisation 
Catheterisation
Short urethra in women
Neurological problems: Incomplete bladder emptying, large volume of residual urine, loss of sphincter control
Pregnancy
Bladder stones
Tumour in or adjacent to urinary tract
Ureteric reflux
23
Q

Define cystitis?

A

Inflammation confined to the bladder

MD3002 Week 6 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions