ANS Control of BP Flashcards
What is systolic BP
pressure inside the arteries when the heart pumps
What is diastolic BP
pressure when the heart relaxes between beats
Normal BP
S: less than ___
AND
D: less than ___
120, 80
Elevated BP
S: ___ - ___
AND
D: less than ___
120-129
80
High BP Stage 1
S: ___ - ___
OR
D: ___ - ___
130-139
80-89
High BP Stage 2
S: ___ or higher
OR
D: ___ or higher
140
90
Hypertensive Crisis
S: higher than ___
and/or
D: higher than ___
180
120
HTN
S: > ___ mmHg
D: > ___ mmHg
Resting Pulse Pressure (SBP-DBP) > ___ mmHg
- a pulse pressure > ___ mmHg is unhealthy
- a pulse pressure > ___ is a risk factor for heart disease, especially for old people
- often asymptomatic (may experience ___ or ___ )
- 130
- 80
- 65
- 40
- 60
- dizziness, headaches
relationship between blood pressure and age
T or F: by age 60, the average systolic blood pressure of women exceeds that of men
True
as you get older
- ___ decreases
- ___ inreases
- cardiac output
- peripheral resistance
Classifications of HTN
Primary
- ___ - ___ % of all cases, no identifiable cause
Secondary
- has a cause
85-90%
Causes of Secondary HTN
- ___ disease, ___ artery constriction
- tumor
- ___ disease
- coarctation of the ___
- pregnancy
- medication adverse effects
kidney, renal
endocrine
aorta
Causes of Secondary HTN
acronym
ABCDE
- aldosteronism
- bad kidneys
- Cushing’s/Coarctation
- drugs
- endocrine disorders
PCOL Strategies for reducing Risk of HTN
BP = ___ x ___
- reduce ___
- reduce vascular ___ (vaso dilation, decrease blood volume)
- cardiac output (CO), peripheral vascular resistance (TPR)
- CO
- resistance
Which of the following will have the greatest impact on the management of HTN
A) addition of 2 glasses of wine with dinner
B) addition of whole milk to diet
C) reduction in red meat
D) replacement of table salt with kosher salt
E) weight reduction
E) weight reduction
T or F: HTN does not self resolve and must be treated for life
True
races most affected by HTN (highest % to lowest)
- black
- white
- asian
- hispanic
CO = ___ x ___
- stroke volume (SV)
- HR
SV is determined by:
- cardia ___
- venous return to the heart ( ___ )
- ___ to the left ventricle must overcome to eject blood into the aorta ( ___ )
- contractility
- preload
- resistance
- afterload
Parasympathetic = ___
- endogenous neurotransmitter: ___
- exogenous: ___ and ___
Sympathetic = ___
- endogenous neurotransmitters: ___ and __
cholinergic
- ACh
- muscarine, nicotine
adrenergic
- Norepinephrine, epinephrine
Adrenergic receptors
a1 = ___ coupled
B = ___ coupled
a2 = ___ coupled
alpha control ____
beta control ___ stimulation
Gq
Gs
Gi
- vasoconstriction
- cardiac
a1 is the most involved in vasocontriction, not really a2
epinephrine binds stronger to ___ than ___
norepinephrine has strong ___ , doesnt really affect heart
beta, alpha
vasocontriction
a1 is the most involved in vasocontriction, not really a2
T or F: the vasculature is controlled only by the PSNS
FALSE FALSE FALSE
- SNS
vascular smooth muscle
which two receptors are highly populated in vascular smooth muscle
a1 and B2
Adrenergic receptor involvement in blood pressure regulation
Baroreceptor Reflex
decrease in blood pressure
- activates ___ fibers that feed back and innervate the heart ( ___ receptor) - increases HR - reflex ___
- innervate blood vessels ( ___ receptors) resulting in ___
- inhibits vagus ( ___ )
- net result: ___ BP
- SNS, B1, tachycardia
- a1, vasoconstriction
- PSNS
- increased
Adrenergic receptor involvement in blood pressure regulation
Increase in blood pressure
- inhibits ___ fibers
- activates vagus ( ___ )
- decrease ___ (reflex ___ )
- no direct effect on ___
- net result: decrease ____
- SNS
- PSNS
- HR, bradycardia
- blood vessels
- blood presure
Adrenergic receptor involvement in blood pressure regulation
NE: raises ___ and lowers ___ (a1, B1)
E: raises ___ and lowers ___ (a1, B1, and B2)
Isoproterenol: raises ___ and lowers ___ (B1, B2)
E more elective for B
NE more selective for a
- peripheral resistance, HR
- HR, peripheral resistance
- HR, peripheral resisitance
B2 = vasodilation
B1 = heart stimulation
B1 = heart stimulatio
B2 - vasodialtion
a1 = vasoconstriction
Adrenergic receptor involvement in blood pressure regulation
phenylephrine: acting at a receptors
result: ___ in systolic BP, ___ in HR
- a1 effect ___
- activation of baroreceptor reflex which can ___ HR
- increase, decrease
- vasoconstriction
- decrease
Adrenergic receptor involvement in blood pressure regulation
epinephrine: acting at B and a receptors
result: ___ in systolic pressure, pulse pressure, and HR
- a1 effect: ___
- B2 effect: ___
- B1 effect: positive inotropic and chronotropic effects
- activation of baroreceptor reflex which mitigates the direct effects
increase
- vasoconstriction
- vasodilation
Adrenergic receptor involvement in blood pressure regulation
isoproterenol: acting at B receptors
result: ___ in diastolic pressure, ___ pulse pressure and HR
- B2 effect: ___
- B1 effect: positive inotropic and chronotropic effects
- activation of barorecptor reflex which could enhance the direct effects
decrease, increase
- vasodilation
Targets for anti-hypertensives
heart = reduce ___
- both ___ and ___
resistance of ___ and ___
Kidney
- reduce ___ and ___
- cardiac output
- SNS, PSNS
- fluids, blood volume
Meds indicated for heart failure
- diuretics
- B blockers
- ACE inhibitors
- angiotensisn II receptor blockers
- aldosterone antagonists
Meds indicated for post MI
- B blockers
- ACE inhibitors
- angiotension II receptor blockers
- aldosterone antagonists
Meds indicated for diabetes
- ACE inhibitors
- angiotensin II receptor blockers
- calcium channel blockers
Meds indicated for CKD
- ACE inhibitors
- angiotensin II receptor blockers
which receptor is most present in cardiac muscle?
B1
a1 antagonists (-osins)
- ___ produce peripheral ___ without reflex ___ or increased CO
- acyl moiety determines ___ activity
- indications: ___ , ___ disease, and ___
- side effects: first dose phenomenon, postural hypotension and syncope
Examples (3 - in order of increasing t1/2)
- undergo extensive metabolism, excreted in the bile
- quinazolines, vasodilation, tachycardia
- PK
- HTN, Reynaud’s, BPH
- prazosin (3hrs), terazosin (12 hrs), doxazosin (20 hrs)
T or F: non-selective a blockers cause reflex tachycardia
True
selective (a1 -osins) do not cause tachycardia
a2 agonists
reduce BP by reducing ___ output from the brain
Inhibition of ___ release
- decreased ___ tone in CNS
- decreased __
- decreased ___
- decreased ___ release
- decreased ___
sympathetic
NE
- sympathetic
- HR
- contractility
- renin
- vasoconstriction
Direct acting a2 receptor agonist - clonidine (Catapres)
- (phenylimino) imidazolidine
- ____ a2 receptor agonist
- the basicity of the guanidine group is 13.6 but it is decreased to 8 due to being attached to the ___ ring
- activation of a2 receptors in the CNS decreases ___ activity; good ___
- indication: HTN, opiate withdrawal, ADHD
- Side effects: hypotension, sedation, dry mouth
- must be ___
- selective
- dichlorophenyl
- SNS, lipophilicity
- tapered
Direct acting a2 receptor agonist - Guanabenz and Guanfacine
- ___ ring imidazolines
- __ atom bridge to the guanidine group decreases the pKa so the drug is mostly ___ at physiological pH
- t1/2 guanabenz < guanfacine = clonidine
- uses: HTN. ADHD (guanfacine)
- open
- 2
- non-ionized
Direct acting a2 receptor agonist - methyldopa (Aldomet)
- a ___ metabolized to active a2 receptor agonist, ___
- ___ - water soluble, ester hydrochloride salt is used for ___ solutions
- PO = ___ , inj = ___
- uses: HTN, especially in ___
- combine with ___ due to sodium/water retention
- prodrug, (1R, 2S) - a - methylnorepinephrine
- methyldopate, parenteral
- methyldopa, methyldopate
- pregnancy
- diuretic
Beta blockers
Hypertension
- decrease ___ output
- inhibition of ___ secretion
- cardiac
- renin
B-Blockers - structure
aryloxypropanolamines
B-Blocker - propranolol (Inderal)
- non-selective
- lipophilic
- extensive ___ metabolism
- decreased cardiac __ and ___
- reduced ___ release
- increase ___, decrease ___
- inhibit ___ and compensatory ___ and glucose release in response to ___
- increase ___ airway resistance
- hepatic
- output, HR
- renin
- VLDL, HDL
- lipolysis, gluconeogenesis, hypoglycemia
- bronchial
B-Blockers - Nadolol (Corgard)
- non-selective
- less lipophillic than ___
- ___ t1/2
- mostly excreted unchanged in ___
- administered PO
- use: hypertension, angina, migraine
- propanolol
- long
- urine
B-Blockers - Timolol (Timoptic, Blocadren)
- non-selective
- thiadiazole nucleus with morpholine ring
- administered PO, ophthalmic
- uses: glaucoma, HTN, angina, migraine
B-Blockers - pindolol (Visken)
- non-selective
- intrinsic sympathomimetic activity
- ___ agonist
- less likely to cause ___ and lipid adnormalities
- good for patients who have severe ___ or little cardiac reserve
- partial
- bradycardia
- bradycardia
B-blockers - carteolol (Cartrol, Ocupress)
- non-selective
- intrinsitc sypathomimetic activity
- partial ___
- less likely to cause ___ and lipid abnormalities
- administered: PO, ophthalmic
- uses: hypertension, glaucoma
- agonist
- bradycardia
B-blockers - metoprolol (Lopressor, Toprol) and bisoprolol (Zebeta)
- ___ selective
- ___ substituted phenyl derivatives
- “cardioselective”
- less ___
- moderate lipophilicity
- significant first pass metabolism
- uses: HTN, angina, anti-arrhythmic, CHF
- rebound HTN is discontinued abruptly - ___ dose
- B1
- para
- bronchoconstriction
- taper
B-blockers - atenolol (Tenormin)
- selective ___
- “cardioselective”
- less ___
- low lipophilicity “water soluble ___ “
- PO and inj
- uses: HTN, angina
- B1
- bronchoconstriction
- metoprolol
B-blocker - esmolol (Brevibloc)
- ___ selective
- very short acting
- half life: 9 min
- rapid hydrolysis by ___ found in red blood cells
- administered: ___ , incompatible with sodium bicarb
- uses: supravenricular tachycardia, atrial fibrillation/flutter, perioperative hypertension
B1
esterases
parenteral
B-blocker - nebivolol (Bystolic)
- 3rd generation
- ___ selective
- vasodilation due to ___ production
B1
nitric oxide
B-blockers
SE
- ___ cardia
- ___ block
- sedation
- mask symptoms of ___ , withdrawal syndrome
Containdications:
- ___ and ___
- congestive HF type ___
- bradycardia
- AV
- hypoglycemia
- asthma, COPD
- IV
effect of chronic B-receptor block
- more ___ will grow
B-receptors
Mixed adrenergic receptor antagonists - labetalol (Normodyne, Trandate)
- ___ B receptor antagonist
- ___ receptor antagonists
- B blocking activity prevent reflex ___ normally associated with ___ receptor antagonists
- administered: oral and parenteral
- uses: HTN, hypertensive crisis
- 1R, 1’R - isomer possesses ___ blocking activity
- 1S, 1’R isomer possesses greatest ___ receptor blocking activity
- non selective
- a1
- tachycardia, a1
- B
- a1
Mixed adrenergic receptor antagonists - carvedilol (Coreg)
- ___ B receptor antagonist
- ___ receptor antagonist
- both enantiomers antagonize ___ receptors
- only S enantiomer posses ___ blocking activity
- B blocking activity prevent reflex ___ normally associated with ___ receptor antagonists
- PO
- uses: HTN, CHF
- non-selective
- a1
- a1
- B
- a1
Beta blocker withdrawal
___ the dose when DC
taper
D1 receptor agonist - Fenoldopam
used in __ HTN
prolems: should not be used in patients with ___ due to increases in IOP
notes: maintains or ___ renal perfusion while lowering ___ ‘ paticularly useful in patients with ___ impairment
severe
glaucoma
increases, BP
renal
Catecholamine Synthetic Path
inhibiting with Metyrosine
action: inhibits ___ hydroxylase
Clinical Uses: perioperative management of ___
problem: depletes ___ everywhere
- tyrosine
- pheochromocytoma
- catecholamines
pheochromocytoma - tumor in adrenal gland that makes excess E and NE
VMAT Inhibitor Reserpine
Action:
- nonselective, ___ inhbitor of vesicular monoamine transporter (VMAT)
- depletes stored ___
Clinical Use
- HTN but rarely used due to AE
Problems:
- expected peripheral adverse effects (orthostatic, hypotension, increased GI activity)
- CNS effects such as sedation severe depression/suicide
- irreversibel
- NE
Catecholamine depleters - Reserpin (Serpasil)
- indole alkaloid obtained from root of Rauwolfia serpentina
- block vesicular monoamine transporters
- depletes vesicular pool of NE
- slow onset of action
- sustained effects (weeks)
