Antihypertensives

Question 1

ACE inhibitors

Answer 1

(-pril) benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril

Question 2

Angiotension-Rceptor Blockers

Answer 2

(-sartan) azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan

Question 3

Renin inhibitor

Answer 3

aliskiren

Question 4

Beta Blockers

Answer 4

atenolol, bisoprolol, carvedilol, labetalol, metoprolol, nadolol, nebivolol, propranolol

Question 5

Which beta blockers are beta 1 selective?

Answer 5

atenolol, bisoprolol, metoprolol, nebivolol

Question 6

Thiazide diuretics

Answer 6

chlorthalidone, hydrochlorothiazide, metolazone

Question 7

Loop diuretics

Answer 7

bumetanide, furosemide, torsemide

Question 8

Potassium-sparing diuretics

Answer 8

amiloride, eplerenone, spironolactone, triamterene

Question 9

Carbonic Anhydrase inhibitors

Answer 9

(-azolamide) acetazolamide, methazolamide

Question 10

Osmotic diuretics

Answer 10

mannitol

Question 11

Calcium channel blockers

Answer 11

(-dipine + 2) amlodipine, diltiazem, felodipine, isradipine, nifedipine, verapamil

Question 12

Vasodilators

Answer 12

calcium channel blockers, hydralazine, minoxidil

Question 13

Parenteral agents

Answer 13

fenoldopam, nitroprusside

Question 14

Centrally acting alpha 2 agonist

Answer 14

clonidine, methyldopa

Question 15

Alpha blockers

Answer 15

doxazosin, prazosin, terazosin

Question 16

How does blood flow?

Answer 16

from atria to ventricle to large arteries

Question 17

What is resistance influenced by indirectly and directly?

Answer 17

indirectly- blood volume// directly- vessel diameter

Question 18

What four organs do sustained arterial hypertension damage?

Answer 18

kidney, heart, brain, and eye

Question 19

Hypertension is caused by increased ___ or ____

Answer 19

cardiac output or peripheral resistance

Question 20

What is the definition of hypertension?

Answer 20

sustained systolic BP>140 mm Hg OR sustained diastolic BP> 90 mm Hg

Question 21

In what instance does peripheral vascular arteriolar smooth muscle tine increase?

Answer 21

with increases arteriolar resistance and reduced capacitance of the venous system

Question 22

What is the cause of HTN?

Answer 22

cause typically unkwn

Question 23

Chronic hypertension causes:

Answer 23

stroke, heart failure, heart disease/heart attack, renal damage

Question 24

What are the four classification categories of blood pressure?

Answer 24

normal, prehypertension, stage I, stage II

Question 25

What is normal blood pressure?

Answer 25

<120 AND <80

Question 26

What is prehypertension?

Answer 26

120-139 or 80-89

Question 27

What is stage I?

Answer 27

140-159 or 90-99

Question 28

What is stage II?

Answer 28

>/=160 0r >=100

Question 29

What percent of patients have essential hypertension?

Answer 29

90%

Question 30

Who has a higher incidence?

Answer 30

AA, middle aged men, prevalence increases with age

Question 31

What are environmental factors that predispose a person for HTN?

Answer 31

stressful lifestyle, high dietary intake of sodium, smoking

Question 32

What is arterial blood pressure proportional to?

Answer 32

cardiac output and peripheral vascular resistance

Question 33

What is cardiac output controlled by?

Answer 33

heart rate, contractility, and filling pressure (blood volume and venous tone)

Question 34

What are four anatomical sites of blood pressure control?

Answer 34

resistance arterioles, capacitance venules, pump output heart, volume kidneys

Question 35

What two systems regulate cardiac output and peripheral resistance?

Answer 35

baroreflexes (rapid) and renin-angiotension-aldosterone (longterm)

Question 36

Which system prevents us from passing out when we stand up quickly?

Answer 36

baroreflexes

Question 37

How do baroreflexes work?

Answer 37

act on the sympathetic system, fall in BP causes baroreceptor to send fewer impulse to cardiovascular centers in the spinal cord, reflex response of increased sympathetic occurs causing vasoconstriction and increased cardiac output

Question 38

What 5 things happen when alpha 1 is stimulated?

Answer 38

vasoconstriction, increased peripheral resistance, increased blood pressure, mydriasis, increased closure of internal sphincter of the bladder

Question 39

What 3 things happen when alpha 2 is stimulated?

Answer 39

inhibition of release of norepinephrine, acetylcholine, an insulin

Question 40

What 4 things happen when beta 1 is stimulated?

Answer 40

tachycardia, increased lipolysis, increased myocardial contractility, increased release of renin

Question 41

What 6 things happen when beta 2 is stimulated?

Answer 41

vasodilation, decreased peripheral resistance, bronchodilation, increased muscle and liver glycogenolysis, increased release of glucagon, relaxed uterine smooth muscle

Question 42

How does the kidney contribute to BP control?

Answer 42

alters blood volume

Question 43

How does the RAAS system work?

Answer 43

baroreceptors in the kidney respond to reduced arterial pressure (and sympathetic stimulation of b1) then increase the release of renin

Question 44

What can increase renin release?

Answer 44

baroreceptors in the kidney or low sodium intake/greater sodium loss

Question 45

What converts angiotensinogen to angiotensin I?

Answer 45

renin

Question 46

What converts angiotensin I to angiotensin II?

Answer 46

angiotensin converting enzyme (ACE)

Question 47

What does angiotensin I do?

Answer 47

nothing

Question 48

What does angiotensin II do?

Answer 48

potent vasoconstrictor (increasing resistance) and stimulates aldosterone secretion

Question 49

What does aldosterone do?

Answer 49

leads to increased renal sodium reabsorption and increased blood volume/pressure

Question 50

What is the treatment goal?

Answer 50

reduce cardiovascular and renal morbidity and mortality

Question 51

How do antihypertensives lower BP?

Answer 51

reduce cardiac output or decrease peripheral resistance

Question 52

What is an example of three drug categories that could be used in combination for HTN?

Answer 52

vasodilator (reduces peripheral resistance), beta blocker (reduces heart rate), and diuretic (decreases sodium and water retention)

Question 53

What are the four categories of antihypertensives?

Answer 53

angiotensin agents, diuretics, sympathoplegic agents, direct vasodilators

Question 54

What do angiotensin agents do?

Answer 54

reduce peripheral resistance and blood volume

Question 55

What do diuretics do?

Answer 55

decrease sodium and reduce blood volume

Question 56

What do sympathoplegic agents do?

Answer 56

reduce peripheral resistance and decrease cardiac output

Question 57

What do direct vasodilators do?

Answer 57

relax vascular smooth muscle and decrease peripheral resistance

Question 58

What is the most common reason for HTN therapy failure?

Answer 58

patient noncompliance

Question 59

What is resistance HTN?

Answer 59

high blood pressure that does not respond to treatment despite three drug regimen

Question 60

What are most common causes of resistant hypertension?

Answer 60

poor compliance, excessive ethanol intake, concomitant conditions, use of sympathomimetics NSAIDs or antidepressants, insufficient dose, use of drugs with similar mechanisms of action (last 2 are Dr error)

Question 61

What does the RAAS system monitor?

Answer 61

Na, K, vascular volume, blood pressure

Question 62

What are the four actions of angiotensin II?

Answer 62

potent vasoconstrictor, enhances release of catecholamines (stimulates sympathetic), increases synthesis of aldosterone, induces cardiac hypertrophy (increased myocardial stiffness)