ANS and Sympatholytics - van Rijn

Question 1

Systolic BP

Answer 1

pressure inside arteries when heart is pumping

Question 2

Diastolic BP

Answer 2

pressure when the heart relaxes between beats

Question 3

Isolated diastolic hypertension

Answer 3

When only the diastolic BP (bottom number) is elevated (90 or over)

Question 4

Isolated systolic hypertension

Answer 4

When only the systolic BP (top number) is elevated (140 or over)

Question 5

HTN

Answer 5

two or more measurements of diastolic BP >90 or systolic pressure >140

Question 6

Resting pulse pressure

Answer 6

Systolic BP minus Diastolic BP

Question 7

Resting pulse pressure indicative of HTN

Answer 7

> 65mmHg

Question 8

2 classifications of HTN

Answer 8

Primary (essential) and Secondary (inessential)

Question 9

Causes of primary HTN

Answer 9

• Lifestyle
• Hyperlipidemia
• Depression
• Age (increases with age)
• Sex
• Genes (family history)
• Race (African american most common)

Question 10

What are lifestyle causes of HTN

Answer 10

• Obesity
• Smoking
• Alcohol
• Excess sodium
• Too little potassium
• Lack of exercise

Question 11

Causes of secondary HTN

Answer 11

• Kidney disease, renal artery constriction
• Tumors
• Endocrine disease
• Coarctation of the aorta
• Pregnancy
• Medication side effects

Question 12

What is pheochromocytoma

Answer 12

• Tumor of the adrenal gland - increases adrenaline

- Cause of secondary HTN

Question 13

What are the ABCDE causes of secondary HTN?

Answer 13

A - Aldosteronism
B - Bad kidneys
C - Cushing's/Coarctation
D - Drugs
E - Endocrine disroders

Question 14

What complication of diabetes can cause HTN?

Answer 14

Nephropathy

Question 15

What complication of diabetes can cause orthostatic hypotension

Answer 15

Autonomic neuropathy

Question 16

What end organs are commonly damaged by HTN?

Answer 16

Heart, kidney, brain, eyes

Question 17

What is the primary goal of pharmacotherapy of HTN?

Answer 17

Reduce systolic BP (diastolic BP not predicative of mortality)

Question 18

What is the BP equation?

Answer 18

BP = cardiac output x peripheral vascular resistance

Question 19

What are secondary goals of pharmacotherapy of HTN?

Answer 19

• Reduce cardiac output

- Reduce vascular resistance (Vasodilation, Decrease blood volume)

Question 20

What controls vascular resistance (VR)?

Answer 20

Sympathetic Autonomic Nervous System (SANS)

Question 21

What controls Stroke Volume (SV)?

Answer 21

Parasympathetic and Sympathetic Autonomic Nervous System (PANS and SANS)

Question 22

What controls Heart Rate (HR)?

Answer 22

Parasympathetic and Sympathetic Autonomic Nervous System (PANS and SANS)

Question 23

What 2 factors control blood pressure?

Answer 23

Blood flow (Q) and Resistance (R)

Question 24

How does the ANS control resistance (R)?

Answer 24

Vasodilation and Vasoconstriction

Question 25

How does the ANS control Stroke volume (SV)?

Answer 25

Increasing/decreasing force of contraction and HR by increasing/decreasing frequency

Question 26

Where are baroreceptors located?

Answer 26

Carotid sinus and aortic arch

Question 27

What do baroreceptors sense?

Answer 27

Pressure

Question 28

What organs are targets for antihypertensive drugs?

Answer 28

- Heart - Kidney - Resistance arterioles - Veins

Question 29

What drugs dilate resistance arterioles?

Answer 29

- ACEI - ARBs - CCBs

Question 30

What does ACEI stand for?

Answer 30

Angiotensin converting enzyme inhibitor

Question 31

What does ARB stand for?

Answer 31

Angiotenisn Receptor Blocker

Question 32

What does CCB stand for?

Answer 32

Calcium channel blocker

Question 33

What kind of actions does the ANS control?

Answer 33

Involuntary actions (BP, urination, RR, salivation, body temp, digestion, pupillary response, sexual arousal)

Question 34

What does SNS stand for?

Answer 34

Somatic nervous system

Question 35

What does SANS stand for?

Answer 35

Sympathetic autonomic nervous system

Question 36

What does PNS stand for?

Answer 36

Peripheral Nervous System

Question 37

What does PANS stand for?

Answer 37

Parasympathetic autonomic nervous system

Question 38

What neurotransmitters do PANS neurons respond to?

Answer 38

- Acetylcholine - Muscarine - Nicotine

Question 39

What neurotransmitters do SANS neurons respond to?

Answer 39

- Norepinephrine | - Epinephrine

Question 40

What kind of receptors are found in the PANS?

Answer 40

Cholinergic

Question 41

What kind of receptors are found in the SANS?

Answer 41

Adrenergic

Question 42

All preganglionic nerves release ____ onto post-ganglionic nerves expressing ____ receptors

Answer 42

ACh; Nicotinic

Question 43

Parasympathetic postganglionic nerves release ____ onto organs expressing _____ receptors

Answer 43

ACh; Muscarinic

Question 44

Sympathetic postganglionic nerves primarily release ___ that can bind to ____ receptors

Answer 44

NE; Adrenergic

Question 45

Postganglionic nerves innervating the kidney release ____ to bind to ____ receptors causing ____

Answer 45

Dopamine; Dopamine D1; vasodilation

Question 46

Postganglionic nerves that terminate in teh adrenals cause the release of ____ into the bloodstream

Answer 46

Epi (mostly) and a little NE

Question 47

What are alpha 1 adrenergic receptors primarily responsible for?

Answer 47

SANS responses

Question 48

What are beta adrenergic receptors primarily responsible for?

Answer 48

SANS responses

Question 49

Where are alpha 2 receptors primarily found?

Answer 49

- Primarily in the CNS | - Also in the GI-tract and pancreas

Question 50

Activation of sympathetic nerves causes release of ____ from ____

Answer 50

E and NE; Adrenals

Question 51

In vascular smooth muscle and increase in cAMP leads to what?

Answer 51

smooth muscle relaxation

Question 52

What does Nitric Oxide do to the veins?

Answer 52

Vasodilation

Question 53

ANS responses in the heart are mediated primarily by what receptors?

Answer 53

M2 and Beta 1

Question 54

ANS responses in most tissues are mediated primarily by what receptors?

Answer 54

M3, beta 1, alpha 1

Question 55

What kind of receptors do juxtaglomerular cells express?

Answer 55

Beta 1 adrenergic receptors

Question 56

What are sympatholytic drugs primarily used as?

Answer 56

Rescue antihypertensives in "in patient" settings

Question 57

Why are sympatholytics not too effective as monotherapy?

Answer 57

due to the homeostatic nature of the autonomic nervous system on blood pressure via the baroreceptor reflex

Question 58

Alpha blockers ____ vasoconstriction

Answer 58

reduce

Question 59

What are alpha 1 antagonists primarily used for?

Answer 59

Benign Prostatic Hyperplasia (BPH)

Question 60

What is pheochromocytoma and what is used to treat it?

Answer 60

rare tumor of adrenal gland; alpha 1 antagonist

Question 61

What do central acting alpha 2 agonists act on?

Answer 61

- The Nucleus Tractus Solitarius (NTS) | - Rostral Ventrolateral Medulla (RLVM)

Question 62

What is methyldopa and what does it get metabolized to?

Answer 62

Prodrug; alpha-methylnorepinephrine

Question 63

What anti-hypertensives can be used in pregnant women?

Answer 63

Methyldopa, Labetalol

Question 64

What drug does clonidine interact with?

Answer 64

Tricyclic antidepressants (TCAs)

Question 65

What does reserpine irreversibly block?

Answer 65

VMAT (Vesicular Monoamine Transporter)

Question 66

What is the primary use of 1st generation beta blockers?

Answer 66

Angina, cardiac arrhythmia, reduced tremors

Question 67

What were 1st generation beta blockers replaced by for treatment of HTN?

Answer 67

- Diuretics - RAS inhibitors - Ca channel blockers

Question 68

What medication was the first beta blocker?

Answer 68

Propranolol

Question 69

When are 1st generation beta blockers contraindicated?

Answer 69

- Asthma - COPD - CHF

Question 70

What are the advantages of 2nd generation beta blockers over 1st generation beta blockers?

Answer 70

Less bronchoconstriction with 2nd generation beta blockers

Question 71

How do third generation beta blockers work?

Answer 71

Induce vasodilation