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Therapeutics 2 Exam 5 > ANS Control of Blood Pressure > Flashcards

ANS Control of Blood Pressure Flashcards

1
Q

What is systolic blood pressure?

A

The pressure inside arteries when the heart pumps

(top number)

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2
Q

What is the diastolic blood pressure?

A

Pressure when the heart relaxes between beats

(bottom number)

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3
Q

What systolic and diastolic blood pressures indicate “elevated” blood pressure?

A

Systolic: 120-129
AND
Diastolic: Less than 80

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4
Q

What systolic and diastolic blood pressures indicate “High Blood Pressure Stage 1”?

A

Systolic: 130-139
OR
Diastolic: 80-89

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5
Q

What systolic and diastolic blood pressures indicate “High Blood Pressure Stage 2”?

A

Systolic: 140 or higher
OR
Diastolic: 90 or higher

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6
Q

What systolic and diastolic blood pressures indicate a “hypertensive Crisis”?

A

Systolic: Higher than 180
AND/OR
Diastolic: Higher than 120

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7
Q

What pulse pressure is considered unhealthy?

A

> 40 mm Hg

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8
Q

What pulse pressure is a risk factor for heart disease?

A

> 60

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9
Q

What two factors determine blood pressure?

A

-Cardiac Output (CO)

-Peripheral Resistance (TPR)

**impact of TPR increases with age

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10
Q

What diet factors are associated with development of hypertension?

A

High sodium intake

Low potassium intake

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11
Q

What are the possible causes of secondary hypertension?

A

-Kidney disease, Renal artery constriction
-Tumors
-Endocrine disease
-Coarctation of the aorta
-Pregnancy
-Medication advrse effects

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12
Q

What acronym can help you remember the secondary causes of HTN?

A

A- Aldosteronism
B- Bad kidneys
C- Cushing’s/Coarctation
D- Drugs
E- Endocrine disorders

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13
Q

If a patient has an elevated blood pressure and is not started on medication, when should they be reassessed?

A

3-6 months

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14
Q

If a patient is started on hypertension medication, when should they be reassessed?

A

1 month

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15
Q

What is the first treatment that should be used for hypertension?

A

Life-style modification

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16
Q

What fraction of the US population is affected by hypertension?

A

1/3

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17
Q

What is the goal of hypertension treatment?

A

Reduce pressure as quickly as possible

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18
Q

What is the main neurotransmitter of the parasympathetic pathway?

A

Acetylcholine

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19
Q

What is the receptor of the parasympathetic nervous system?

A

Cholinergic

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20
Q

What are the 2 main neurotransmitters of the sympathetic pathway?

A

Norepinephrine and Epinephrine

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21
Q

What is the main receptor of the sympathetic pathway?

A

Adrenergic

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22
Q

What are the 2 cholinergic receptors?

A

Nicotinic

Muscarinic

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23
Q

What are the 2 adrenoceptors?

A

Alpha

Beta

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24
Q

Which adrenergic receptor is Gq coupled?

A

a1

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25
Which adrenergic receptor is Gi coupled?
a2
26
which adrenergic receptor is Gs coupled?
B
27
Which receptor has the main control over the heart?
B1
28
Which receptor has the main control over the vasculature?
a1
29
What are the two receptors found in the vascular smooth muscle?
a1 (main) B2
30
What receptors does phenylephrine work on?
a receptors
31
What is the effect of phenylephrine?
Increases systolic blood pressure Decreases heart rate (activates baroreceptors) a1: vasoconstriction
32
What is the effect of epinephrine?
Acts at B and a receptors Increases systolic pressure, pulse pressure, and heart rate a1: vasoconstriction B2: vasodilation B1: positive inotropic and chronotropic effects *activation of baroreceptor mitigates direct effects
33
What is the effect of isoproterenol?
Acts at B receptors Decreases diastolic pressure, increases pulse pressure, increases heart rate B2: vasodilation B1: positive inotropic and chronotropic effects *activation of baroreceptors enhances direct effects
34
Where are the two locations that the beta blockers work on?
Heart: affect heart rate Kidneys: inhibit renin release
35
what is the job of a1 receptors?
Mediate vasoconstriction
36
What ending represents the a1 antagonists?
-osins
37
What is the function of alpha 1 antagonists?
Vasodilators Relax smooth muscle in enlarged prostate and in bladder base Decrease peripheral resistance
38
What affect do quinazoline rings found in the structure of alpha 1 antagonists have on reflex tachycardia and increased cardiac output?
-Quinazolines produce peripheral vasodilation without causing reflex tachycardia or increased cardiac output (because they are selective for a1)
39
What are the indications of a1 antagonists?
Hypertension *not first line Benign prostatic hyperplasia Raynaud's Disease
40
Do alpha 1 antagonists affect arterioles, venules, or both?
BOTH
41
Arrange the 3 a1 antagonists by their half lives (Prazosin, Doxazosin, Terazosin)
Prazosin: 3hr Terazosin: 12hr Doxazosin: 20hr
42
How do a2-adrenergic agonists work and what is their effect?
Reduce blood pressure by reducing sympathetic output from the brain -Decrease total peripheral resistance -decrease heart rate
43
Which a-2 adrenergic agonist is used in pregnancy?
Methyldopa
44
What are the 2 a-2 agonists?
Clonidine Methyldopa
45
What is the indications of clonidine?
-Hypertension (not first line) -ADHD -Pain -Restless leg syndrome
46
What are the side effects of methyldopa?
Sedation Water retention (use with diuretic)
47
What are the side effects of clonidine?
Sedation Hypertensive crisis with sudden withdrawal (taper dose)
48
What ending signifies that a drug is a beta blocker?
"lol"
49
What caution is associated with propanolol and timolol?
Use caution in patients with asthma because they are non-selective and can block beta 2 receptors
50
What are the B1 selective beta blockers?
Metoprolol, Atenolol, Esmolol, Nebivolol (3rd Generation)
51
What is a problem with metoprolol?
Rebound hypertension after stopping (need to taper dose)
52
What are the side effects of beta blockers?
-Bradycardia -AV block -Sedation -Mask symptoms of hypoglycemia -Withdrawal symptoms
53
What are the contraindications of beta blockers?
-Asthma -COPD -Congestive heart failure (Type IV)
54
What are the mixed adrenergic receptor antagonists?
Labetalol Carvedilol
55
What is the effect of the mixed beta adrenergic antagonists?
Decrease total peripheral resistance by decreasing a-mediated vasoconstriction which results in lower blood pressure -Prevent reflex tachycardia
56
What is labetolol used for?
Hypertensive emergencies Pheochromocytoma
57
What is carvedilol used for?
Heart failure
58
Which drug is the dopamine receptor agonist?
Fenoldopam
59
What is fenoldopam used for?
Severe hypertension
60
What is an important concern with fenoldopam?
Do not use in patients with glaucoma due to increases in intraocular pressure
61
What are the two indirect acting sympatholytics?
Metyrosine and Reserpine
62
How does metyrosine?
Inhibits tyrosine hydroxylase Depletes catecholamines everywhere *problem
63
What is metyrosine used for?
Perioperative management of pheochromocytoma
64
How does reserpine work?
Nonselective, irreversible inhibitor of vesicular monoamine transporter (VMAT) Depletes stored noerpinephrine
65
What is reserpine used for?
Hypertension **rarely because of adverse effects
66
What are the adverse effects of reserpine?
Peripheral adverse reactions (orthostatic hypertension, increased GI activity) CNS effects (sedation, depression, suicidal thoughts)

Therapeutics 2 Exam 5 (9 decks)

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