ANS control of BP Flashcards
pressure inside arteries when the heart pumps
systolic
pressure when the heart relaxes between beats
diastolic
normal BP S/D
less than 120 and less than 80
elevated BP S/D
120-129 and less than 80
stage 1 htn S/D
130-139 or 80-89
stage 2 htn S/D
140 or higher or 90 or higher
htn crisis S/D
higher than 180 and/or higher than 120
what pulse pressure value is a risk factor for heart disease
> 60mmHg
what are some causes of secondary htn
kidney disease
tumors
endocrine disease
pregnancy
medication adverse effects
Fill in the acronym for causes of secondary htn
A
B
C
D
E
Aldosteronism
Bad kidneys
Cushings/coarctation
Drugs
Endocrine disorders
If a pt has elevated bp, what is the first thing you should try
nonpharm therapy, monitor in 3-6 months
if a pt is in stage 1 htn AND has a clinical ASCVD or estimated 10 year CVD risk >10% what do you do?
nonpharm therapy + BP-lowering medication, reaccess in 1 month
if a pt in stage 1 htn has attempted a BP lowering med and the goal is not met after 1 month, what is the next step?
assess and optimize adherence to therapy
if a pt is in stage 2 htn what is the first step of therapy?
BP lowering med with nonpharm changes
BP is the product of what and what
cardiac output (CO) and total peripheral resistance (TPR)
BP equation
CO x TPR
CO is the product of what and what?
cardiac stroke volume (SV) and heart rate (HR)
what is the equation for CO?
CO=SV x HR
SV is determined by what 3 things?
cardiac contractility
venous return to the heart
resistance the left ventricle must overcome to eject blood into the aorta
Parasymp or symp?
acetylcholine
p
Parasymp or symp?
norepinephrine
s
Parasymp or symp?
muscarine
p
Parasymp or symp?
nicotine
p
Parasymp or symp?
epinephrine
s
what are the two cholinoceptors (acetylcholine receptors)?
nicotine and muscarine
what are the two nicotinic receptors
Nm and Nn
what are the 3 muscarinic receptors
M1, M2, M3
What are the two adrenoceptors (norepinephrine and epinephrine receptors)
alpha and beta
what are the two alpha receptors
a1 and a2
what are the 3 beta receptors
B1, B2, B3
which receptor is Gq coupled
a. a1
b. a2
c. beta
d. M2
a. a1
which receptor is Gi coupled?
a. a1
b. a2
c. beta
d. M2
b. a2
which receptor is Gs coupled?
a. a1
b. a2
c. beta
d. M2
c. Beta
what 3 locations (broad) are the adrenergic receptors located in?
GI, pancreas, CNS)
what receptor makes you cum?
a1
which receptors deal with vasoconstriction?
a1 and a2
what receptors deal with cardiac stimulation?
B1 and B2
what receptor secretes renin
B1
what receptor vasodilates
B2
what receptor for bronchodilation
B2
T or F: Epinephrine is more selective for alpha than beta receptors
F, more selective for beta
what receptors innervate the heart
b1 receptors
what receptors innervate blood vessels
a1 receptors
what receptors does phenylephrine work on
alpha
what receptors does epinephrine work on
beta and alpha
what receptors do isoproterenol work on
beta receptors
what are the targets for anti htn drugs?
heart and kidneys
physiologic action of beta blockers (3)
decrease heart rate
cardiac contractility
decrease renin secretion
central a2-agonists physiologic action
decrease sympathetic tone
physiologic action of peripheral a1 antagonists
vascular smooth muscle relaxation
what class of drugs are calcium channel blockers in
vasodilators
what is the physiologic action of calcium channel blockers
decrease peripheral vascular resistance
physiologic action of ace inhibitors
decrease peripheral vascular resistance and?
physiologic action of arbs
decrease sodium retention
physiologic action of direct renin inhibitors
decrease sodium retention
which of the following drug classes can be used in pts with diabetes?
a. ACE I
b. ARB
c. B-blockers
d. diuretics
e. aldosterone antagonists
f. calcium channel blockers
a. ACE i
b. arbs
f. calcium channel blockers
which of the following drug classes can be used in pts with CKD?
a. ACE I
b. ARB
c. B-blockers
d. diuretics
e. aldosterone antagonists
f. calcium channel blockers
a. ACE i
b. Arbs
which of the following drug classes can be used in pts with postmyocardial infarction?
a. ACE I
b. ARB
c. B-blockers
d. diuretics
e. aldosterone antagonists
f. calcium channel blockers
a. ACE i
b. ARB
c. beta blockers
e. aldosterone antagonists
which of the following drug classes can be used in pts with heart failure?
a. ACE I
b. ARB
c. B-blockers
d. diuretics
e. aldosterone antagonists
f. calcium channel blockers
a. ACE I
b. ARB
c. B-blockers
d. diuretics
e. aldosterone antagonists
which receptor is found on:
vascular sm
genitourinary sm
intestinal sm
heart
liver
a1
which receptor mobilizes Ca++ from intracellular stores?
a1
which pathway (also receptor) does something with dag to activate PKC?
gq pathway, a1
which receptor antagonist class has medications that end in “osin”
a1 antagonist
give the following half lives
prazosin
terazosin
doxazosin
prazosin - 3 hrs
terazosin - 12 hrs
doxazosin - 20 hrs
action of a1 antagonist is in ______ and ______
arterioles and venules
what are the two compensatory effects of a1 antagonists?
tachycardia and renin release
which receptor and pathway does the following:
inhibit adenylyl cyclase
activate certain K+ channels
inhibit neuronal Ca++ channels
a2, gi
which receptor is found presynaptically and function as autoreceptors to inhibit sympathetic output?
a2
which of the following is not an a2 agonist?
a. clonidine
b. prazosin
c. methlydopa
d. brimonidine
b. prazosin
how do a2 agonist reduce blood pressure?
reducing sympathetic output from the brain
what are the 2 indications for clonidine
antihypertensive and antiglaucoma
a2 agonists indirectly inhibit the release of ____
norepinephrine
side effects of direct acting a2 agonists
hypotension, sedation, dry mouth
T or F: methyldopa is a prodrug
true
where does the a2 agonist methyldopa act?
at CNS a2 receptors to decrease sympathetic outflow
water soluble, ester hydrochloride salt methyldopate is used for ____ solutions
parenteral
uses of methyldopa
hypertension, especially during pregnancy
which receptor subtypes
activate adenylyl cyclase
increase camp leading to pkc activation
result in phosphorylation of ion channels and other proteins
b1,b2,b3
what are the 5 beta blocker indications?
angina
cardiac arrhythmia
post-MI
htn
congestive HF
beta receptor antagonists- also known as beta blockers, end with what?
-lol
T or F: Beta blockers increase cardiac output and heart rate
F, they decreaes
Beta blockers _____ VLDL and ______ HDL
a. increase increase
b. increase decrease
c. decrease increase
d. decrease decrease
b. increase decrease
Nadolol is (less/more) lipophilic than propranolol
less
T or F: Propranolol and Timolol block B1 AND B2
True
clinical uses of propranolol (5)
htn
angina
cardiac arrhythmias
ischemic heart disease
prophylaxis for migraines (weird)
clinical use of timolol
open-angle glaucoma (decreases production of aqueous humor)
what type of medications do you need to be cautious using in asthma patients?
Beta blockers
what are the four selective B1 blockers?
metoprolol, bisoprolol, atenolol, esmolol, nebivolol
what is the moiety in the structure of B1 selective blockers
para-substituted phenyl derivatives (whatever tf this means)
T or F: Selective b1 blockers have less bronchoconstriction
True
action of metoprolol
selective antagonist at beta 1 receptor
4 clinical uses of metoprolol
htn
angina
cardiac arrhythmias
ischemic heart disease
which beta blocker is considered “cardioselective”
atenolol
what is considered “water-soluble” metoprolol
atenolol
2 uses of atenolol
htn and angina
what is the “very short acting” selective beta blocker
esmolol
what is the B1 selective 3rd generation beta blocker
nebivolol
nitric oxide production would lead to what?
vasodilation
what are the side effects of beta blockers?(5)
Bradycardia, av block, sedation, mask symptoms of hypoglycemia, withdrawal symtpoms
contraindications of beta blockers (3)
asthma, copd, congestive heart failure(type IV)
what are the 2 mixed adrenergic receptor antagonist from the slide
labetalol and carvedilol
clinical use of carvedilol
heart failure
clinical uses of labetalol (2)
hypertensive emergencies, and pheochomocytoma
action of labetalol and carvedilol
a1 antagonism and nonselective B1 and B2 antagonism
what is the dopamine receptor agonist
fenoldopam
clinical use for fenoldopam
severe htn
fenoldopam should not be used in pts with what
glaucoma
