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PHRM 844 > ANS and Sympatholytics - van Rijn > Flashcards

ANS and Sympatholytics - van Rijn Flashcards

1
Q

Systolic BP

A

pressure inside arteries when heart is pumping

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2
Q

Diastolic BP

A

pressure when the heart relaxes between beats

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3
Q

Isolated diastolic hypertension

A

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

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4
Q

Isolated systolic hypertension

A

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

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5
Q

HTN

A

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

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6
Q

Resting pulse pressure

A

Systolic BP minus Diastolic BP

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7
Q

Resting pulse pressure indicative of HTN

A

> 65mmHg

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8
Q

2 classifications of HTN

A

Primary (essential) and Secondary (inessential)

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9
Q

Causes of primary HTN

A
  • Lifestyle
  • Hyperlipidemia
  • Depression
  • Age (increases with age)
  • Sex
  • Genes (family history)
  • Race (African american most common)
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10
Q

What are lifestyle causes of HTN

A
  • Obesity
  • Smoking
  • Alcohol
  • Excess sodium
  • Too little potassium
  • Lack of exercise
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11
Q

Causes of secondary HTN

A
  • Kidney disease, renal artery constriction
  • Tumors
  • Endocrine disease
  • Coarctation of the aorta
  • Pregnancy
  • Medication side effects
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12
Q

What is pheochromocytoma

A
  • Tumor of the adrenal gland - increases adrenaline

- Cause of secondary HTN

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13
Q

What are the ABCDE causes of secondary HTN?

A 
A - Aldosteronism
B - Bad kidneys
C - Cushing's/Coarctation
D - Drugs
E - Endocrine disroders
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14
Q

What complication of diabetes can cause HTN?

A

Nephropathy

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15
Q

What complication of diabetes can cause orthostatic hypotension

A

Autonomic neuropathy

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16
Q

What end organs are commonly damaged by HTN?

A

Heart, kidney, brain, eyes

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17
Q

What is the primary goal of pharmacotherapy of HTN?

A

Reduce systolic BP (diastolic BP not predicative of mortality)

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18
Q

What is the BP equation?

A

BP = cardiac output x peripheral vascular resistance

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19
Q

What are secondary goals of pharmacotherapy of HTN?

A
  • Reduce cardiac output

- Reduce vascular resistance (Vasodilation, Decrease blood volume)

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20
Q

What controls vascular resistance (VR)?

A

Sympathetic Autonomic Nervous System (SANS)

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21
Q

What controls Stroke Volume (SV)?

A

Parasympathetic and Sympathetic Autonomic Nervous System (PANS and SANS)

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22
Q

What controls Heart Rate (HR)?

A

Parasympathetic and Sympathetic Autonomic Nervous System (PANS and SANS)

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23
Q

What 2 factors control blood pressure?

A

Blood flow (Q) and Resistance (R)

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24
Q

How does the ANS control resistance (R)?

A

Vasodilation and Vasoconstriction

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25
Q

How does the ANS control Stroke volume (SV)?

A

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

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26
Q

Where are baroreceptors located?

A

Carotid sinus and aortic arch

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27
Q

What do baroreceptors sense?

A

Pressure

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28
Q

What organs are targets for antihypertensive drugs?

A
  • Heart
  • Kidney
  • Resistance arterioles
  • Veins
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29
Q

What drugs dilate resistance arterioles?

A
  • ACEI
  • ARBs
  • CCBs
30
Q

What does ACEI stand for?

A

Angiotensin converting enzyme inhibitor

31
Q

What does ARB stand for?

A

Angiotenisn Receptor Blocker

32
Q

What does CCB stand for?

A

Calcium channel blocker

33
Q

What kind of actions does the ANS control?

A

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

34
Q

What does SNS stand for?

A

Somatic nervous system

35
Q

What does SANS stand for?

A

Sympathetic autonomic nervous system

36
Q

What does PNS stand for?

A

Peripheral Nervous System

37
Q

What does PANS stand for?

A

Parasympathetic autonomic nervous system

38
Q

What neurotransmitters do PANS neurons respond to?

A
  • Acetylcholine
  • Muscarine
  • Nicotine
39
Q

What neurotransmitters do SANS neurons respond to?

A
  • Norepinephrine

- Epinephrine

40
Q

What kind of receptors are found in the PANS?

A

Cholinergic

41
Q

What kind of receptors are found in the SANS?

A

Adrenergic

42
Q

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

A

ACh; Nicotinic

43
Q

Parasympathetic postganglionic nerves release ____ onto organs expressing _____ receptors

A

ACh; Muscarinic

44
Q

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

A

NE; Adrenergic

45
Q

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

A

Dopamine; Dopamine D1; vasodilation

46
Q

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

A

Epi (mostly) and a little NE

47
Q

What are alpha 1 adrenergic receptors primarily responsible for?

A

SANS responses

48
Q

What are beta adrenergic receptors primarily responsible for?

A

SANS responses

49
Q

Where are alpha 2 receptors primarily found?

A
  • Primarily in the CNS

- Also in the GI-tract and pancreas

50
Q

Activation of sympathetic nerves causes release of ____ from ____

A

E and NE; Adrenals

51
Q

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

A

smooth muscle relaxation

52
Q

What does Nitric Oxide do to the veins?

A

Vasodilation

53
Q

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

A

M2 and Beta 1

54
Q

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

A

M3, beta 1, alpha 1

55
Q

What kind of receptors do juxtaglomerular cells express?

A

Beta 1 adrenergic receptors

56
Q

What are sympatholytic drugs primarily used as?

A

Rescue antihypertensives in “in patient” settings

57
Q

Why are sympatholytics not too effective as monotherapy?

A

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

58
Q

Alpha blockers ____ vasoconstriction

A

reduce

59
Q

What are alpha 1 antagonists primarily used for?

A

Benign Prostatic Hyperplasia (BPH)

60
Q

What is pheochromocytoma and what is used to treat it?

A

rare tumor of adrenal gland; alpha 1 antagonist

61
Q

What do central acting alpha 2 agonists act on?

A
  • The Nucleus Tractus Solitarius (NTS)

- Rostral Ventrolateral Medulla (RLVM)

62
Q

What is methyldopa and what does it get metabolized to?

A

Prodrug; alpha-methylnorepinephrine

63
Q

What anti-hypertensives can be used in pregnant women?

A

Methyldopa, Labetalol

64
Q

What drug does clonidine interact with?

A

Tricyclic antidepressants (TCAs)

65
Q

What does reserpine irreversibly block?

A

VMAT (Vesicular Monoamine Transporter)

66
Q

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

A

Angina, cardiac arrhythmia, reduced tremors

67
Q

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

A
  • Diuretics
  • RAS inhibitors
  • Ca channel blockers
68
Q

What medication was the first beta blocker?

A

Propranolol

69
Q

When are 1st generation beta blockers contraindicated?

A
  • Asthma
  • COPD
  • CHF
70
Q

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

A

Less bronchoconstriction with 2nd generation beta blockers

71
Q

How do third generation beta blockers work?

A

Induce vasodilation

PHRM 844 (9 decks)

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