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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
Q

Which adrenergic receptor is Gi coupled?

A

a2

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26
Q

which adrenergic receptor is Gs coupled?

A

B

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27
Q

Which receptor has the main control over the heart?

A

B1

28
Q

Which receptor has the main control over the vasculature?

A

a1

29
Q

What are the two receptors found in the vascular smooth muscle?

A

a1 (main)

B2

30
Q

What receptors does phenylephrine work on?

A

a receptors

31
Q

What is the effect of phenylephrine?

A

Increases systolic blood pressure

Decreases heart rate (activates baroreceptors)

a1: vasoconstriction

32
Q

What is the effect of epinephrine?

A

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
Q

What is the effect of isoproterenol?

A

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
Q

Where are the two locations that the beta blockers work on?

A

Heart: affect heart rate

Kidneys: inhibit renin release

35
Q

what is the job of a1 receptors?

A

Mediate vasoconstriction

36
Q

What ending represents the a1 antagonists?

A

-osins

37
Q

What is the function of alpha 1 antagonists?

A

Vasodilators

Relax smooth muscle in enlarged prostate and in bladder base

Decrease peripheral resistance

38
Q

What affect do quinazoline rings found in the structure of alpha 1 antagonists have on reflex tachycardia and increased cardiac output?

A

-Quinazolines produce peripheral vasodilation without causing reflex tachycardia or increased cardiac output

(because they are selective for a1)

39
Q

What are the indications of a1 antagonists?

A

Hypertension *not first line

Benign prostatic hyperplasia

Raynaud’s Disease

40
Q

Do alpha 1 antagonists affect arterioles, venules, or both?

A

BOTH

41
Q

Arrange the 3 a1 antagonists by their half lives (Prazosin, Doxazosin, Terazosin)

A

Prazosin: 3hr
Terazosin: 12hr
Doxazosin: 20hr

42
Q

How do a2-adrenergic agonists work and what is their effect?

A

Reduce blood pressure by reducing sympathetic output from the brain

-Decrease total peripheral resistance
-decrease heart rate

43
Q

Which a-2 adrenergic agonist is used in pregnancy?

A

Methyldopa

44
Q

What are the 2 a-2 agonists?

A

Clonidine

Methyldopa

45
Q

What is the indications of clonidine?

A

-Hypertension (not first line)
-ADHD
-Pain
-Restless leg syndrome

46
Q

What are the side effects of methyldopa?

A

Sedation

Water retention (use with diuretic)

47
Q

What are the side effects of clonidine?

A

Sedation

Hypertensive crisis with sudden withdrawal (taper dose)

48
Q

What ending signifies that a drug is a beta blocker?

A

“lol”

49
Q

What caution is associated with propanolol and timolol?

A

Use caution in patients with asthma because they are non-selective and can block beta 2 receptors

50
Q

What are the B1 selective beta blockers?

A

Metoprolol, Atenolol, Esmolol, Nebivolol (3rd Generation)

51
Q

What is a problem with metoprolol?

A

Rebound hypertension after stopping

(need to taper dose)

52
Q

What are the side effects of beta blockers?

A

-Bradycardia
-AV block
-Sedation
-Mask symptoms of hypoglycemia
-Withdrawal symptoms

53
Q

What are the contraindications of beta blockers?

A

-Asthma
-COPD
-Congestive heart failure (Type IV)

54
Q

What are the mixed adrenergic receptor antagonists?

A

Labetalol

Carvedilol

55
Q

What is the effect of the mixed beta adrenergic antagonists?

A

Decrease total peripheral resistance by decreasing a-mediated vasoconstriction which results in lower blood pressure

-Prevent reflex tachycardia

56
Q

What is labetolol used for?

A

Hypertensive emergencies

Pheochromocytoma

57
Q

What is carvedilol used for?

A

Heart failure

58
Q

Which drug is the dopamine receptor agonist?

A

Fenoldopam

59
Q

What is fenoldopam used for?

A

Severe hypertension

60
Q

What is an important concern with fenoldopam?

A

Do not use in patients with glaucoma due to increases in intraocular pressure

61
Q

What are the two indirect acting sympatholytics?

A

Metyrosine and Reserpine

62
Q

How does metyrosine?

A

Inhibits tyrosine hydroxylase

Depletes catecholamines everywhere *problem

63
Q

What is metyrosine used for?

A

Perioperative management of pheochromocytoma

64
Q

How does reserpine work?

A

Nonselective, irreversible inhibitor of vesicular monoamine transporter (VMAT)

Depletes stored noerpinephrine

65
Q

What is reserpine used for?

A

Hypertension

**rarely because of adverse effects

66
Q

What are the adverse effects of reserpine?

A

Peripheral adverse reactions (orthostatic hypertension, increased GI activity)

CNS effects (sedation, depression, suicidal thoughts)

Therapeutics 2 Exam 5 (9 decks)

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