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Pharmacology II > Antihypertensives A > Flashcards

Antihypertensives A Flashcards

1
Q

True or False:

Nearly 2 in 3 American adults have Htn.

A

False

(Nearly 1 in 3 American adults has Htn)

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2
Q

True or False:

Htn is 4 times more common in blacks than in whites.

A

True

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3
Q

True or False:

Htn is more common in middle-age females than middle-age males.

A

False

(More common in middle-age males than middle-age females)

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4
Q

Fill in the blanks:

Incidence of morbidity / mortality significantly decreases with _____ diagnosis and ______ treatment.

A

early; effective

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5
Q

When should patients be screened for Htn?

A

Every visit

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6
Q

When will you notice symptoms of Htn?

A

Usually no symptoms until late stages

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7
Q

Sustained hypertension damages blood vessels in what three organs?

A
  • Brain
  • Kidneys
  • Heart
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8
Q

What are five complications which could arise from sustained hypertension?

A
  1. Coronary artery disease (CAD)
  2. Myocardial infarction (MI)
  3. Renal damage
  4. Congestive heart failure (CHF)
  5. CVA (stroke)
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9
Q

The risk of end organ damage increases proportionately with the elevation of what level?

A

Blood pressure

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10
Q

What are nine major CV Disease risk factors?

A
  1. Hypertension
  2. Obesity
  3. Diabetes mellitus
  4. FH of premature CVD
    • Men <55; Women <65
  5. Dyslipidemia
  6. Physical inactivity
  7. Microalbyminuria
  8. Age >55 for men / >65 for women
  9. Cigarette smoking
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11
Q

According to JNC-7 BP category classification, what is normal?

A

Systolic <120

AND

Diastolic <80

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12
Q

According to JNC-7 BP category classification, what is pre-hypertension?

A

Systolic 120-139

OR

Diastolic 80-89

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13
Q

According to JNC-7 BP category classification, what is hypertension stage 1?

A

Systolic 140-159

OR

Diastolic 90-99

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14
Q

According to JNC-7 BP category classification, what is hypertension stage 2?

A

Systolic > 160

OR

Diastolic > 100

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15
Q

According to the JNC-7/8 guidelines, what are the 4 “take-home” items you should remember?

A
  1. BP category classifications
  2. Identifiable causes of Htn
  3. Major CVD risk factors
  4. Recommended lifestyle modifications
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16
Q

True or False:

Pre-hypertension is a disease category.

A

False

(Pre-hypertension is not considered a disease category)

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17
Q

What does pre-hypertension identify?

A

People at high risk for Htn

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18
Q

True or False:

Pre-hypertensive patients are not candidates for drug therapy strictly for BP reduction.

A

True

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19
Q

What is recommended for pre-hypertensive patients?

A

Lifestyle modifications

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20
Q

What are the six recommended lifestyle modifications for pre-hypertensive patients?

A
  1. Maintain weight at BMI 18.5 - 24.9
  2. Limit alcohol intake
  3. No more than 2.4 g sodium / day
  4. Aerobic exercise
  5. Stop smoking
  6. DASH diet
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21
Q

What does the DASH diet stand for?

A

Dietary Approaches to Stop Hypertension

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22
Q

What is BMI?

A

Measurement of weight corrected for individual body surface area.

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23
Q

What is the formula for calculating BMI?

A

Weight in Kg

Height in Meters2

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24
Q

According to the CDC guidelines for BMI in adults, below 18.5 is what?

A

Underweight

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25
Q

According to the CDC guidelines for BMI in adults, 18.5 - 24.9 is what?

A

Normal

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26
Q

According to the CDC guidelines for BMI in adults, 25.0 - 29.9 is what?

A

Overweight

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27
Q

According to the CDC guidelines for BMI in adults, 30.0 and above is what?

A

Obese

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28
Q

What are five identifiable causes of secondary Htn?

A
  1. Sleep apena
  2. Drug induced / related
  3. Chronic renal failure (CRF)
  4. Primary aldosteronism
  5. Renovascular disease
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29
Q

What is sleep apnea?

A

Intermittent episodes of apnea during sleep

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30
Q

What three things during apneic episodes apparently leads to enhanced adrenergic firing - even during waking hours?

A
  1. Intermittent arousal
  2. Hypoxemia
  3. Increase in afterload during apneic episodes
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31
Q

What are four identifiable causes of Htn?

A
  1. Cushing’s syndrome / steroid therapy
  2. Pheochromocytoma (AKA Paraganglioma)
  3. Thyroid / parathyroid disease
  4. Coarctation of aorta
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32
Q

What is coarctatation of aorta?

A

Congenital heart defect - narrowing of aorta

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33
Q

There are 15 clinical presentations of Pheochromocytoma. Name all of them.

A
  1. SEVERE headache
  2. SEVERE hypertension (50% paroxysmal)
  3. Nervousness / irritability
  4. Hand temor
  5. Pallor
  6. Palpitations
  7. Postural hypotension
  8. Pulmonary edema
  9. Tachyarrythmias
  10. Cardiomyopathy
  11. Café au lait spots
  12. Abdominal pain
  13. Weight Loss
  14. Diaphoresis
  15. Neurofibromas
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34
Q

What are the three labs you would run to test for Pheochromocytoma?

A
  1. Hypercalcemia
  2. Hyperglycemia
  3. Erythrocytosis
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35
Q

A patient presents with these spots. What disease might it indicate which would then lead you to test for Htn?

A

Pheochromocytoma

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36
Q

Where are Alpha1 adrenergic receptors located?

A

Postsynaptic effector target

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37
Q

What do Alpha1 adrenergic receptors target?

A
  1. Cell
  2. Muscle
  3. Organ

(stimulated by nerve)

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38
Q

Where are Alpha2 adrenergic receptors located?

A

Presynaptic nerve terminal

39
Q

What do Alpha2 adrenergic receptors control?

A

Release of NE

40
Q

Where are all beta-adrenergic receptors located?

A

Postsynaptic effector cells

41
Q

Where are Beta1 adrenergic receptor primarily found on?

A

Heart

42
Q

Where are Beta2 adrenergic receptors found in?

What are three examples of this?

A

Smooth muscle

  1. Bronchioles
  2. Arterioles
  3. Visceral organs
43
Q

What are six drug effects of alpha-adrenergic agonists?

A
  1. Vasoconstriction of blood vessels
  2. Relaxation of GI smooth muscles
  3. Contraction of the uterus and bladder
  4. Male ejaculation
  5. Decreased insulin release
  6. Contraction of ciliary muscles of the eye (dilated pupils)
44
Q

Beta1 adrenergic receptors are located on the heart. What three places specifically?

A
  1. Myocardium
  2. AV node
  3. SA node
45
Q

Beta1 adrenergic receptors stimulate the heart in three ways. Name them.

A
  1. Positive inotropic effect
  2. Positive chronotropic effect
  3. Positive dromotropic effect
46
Q

What is a positive inotropic effect?

A

Increased force of contraction

47
Q

What is a positive chronotropic effect?

A

Increased heart rate

48
Q

What is a positive dromotropic effect?

A

Increased conduction through AV node

49
Q

What are the two major effects of Beta2 receptor stimulation?

A
  1. Bronchodilation
  2. Vasodilation
50
Q

What is blood pressure?

A

Force exerted by circulating blood on the walls of blood vessels

51
Q

What is systolic BP?

A

Peak pressure in the arteries near the beginning of cardiac cycle

52
Q

What is diastolic BP?

A

Lowest pressure in the arteries at the resting pace of cardiac cycle

53
Q

What is preload?

A

The “load” from the blood returning to the ventricles prior to contraction

54
Q

Is preload concerned with volume or pressure?

A

Volume

55
Q

What is afterload?

A

Force against which heart must pump blood out

56
Q

Is afterload concerned with volume or pressure?

A

Pressure

57
Q

What is afterload also known as?

A

PVR (peripheral vascular resistance)

58
Q

What is compliance?

A

The increase in volume within the vascular system in response to an increase in pressure

59
Q

What is cardiac output (CO)?

A

Volume of blood pumped out by each ventricle in one minute

60
Q

What is stroke volume (SV)?

A

Volume of blood (ml) ejected by each ventricle in one contraction

61
Q

How would you calculate cardiac output (CO)?

A

SV x HR

62
Q

What is peripheral vascular resistance (PVR)?

A

Resistance that must be overcome by peripheral (systemic) vasculature to push blood through circulation

63
Q

What is capacitance?

A

Distensibility of a **blood vessel **

(how much it can stretch out or dilate)

64
Q

What is capacitance inversely related to?

A

Elasticity

(how well it returns to its original state)

65
Q

According to the Frank-Starling Law, the greater the volume of blood entering the heart during diastole (End-diastolic volume), …

A

the greater the volume of blood ejected during systolic contraction (stroke volume).

66
Q

According to the Frank-Sterling Law, as preload is increased, the force of contraction is ______.

A

Increased

67
Q

According to the Frank-Starling Law, what is CO synchronized with?

A

Venous return

68
Q

According to the Frank-Starling Law, the increased force of contraction against the increased PVR causes what?

A

Increase BP

69
Q

What kind of range is arterial blood pressure regulated to?

A

NARROW range

70
Q

Regulation of blood pressure allows for adequate tissue perfusion without what kind of damage?

A

Vascular

71
Q

What part of the artery is especially vulnerable to vascular damage from sustained elelvated BP?

A

Arterial endothelium (intima)

72
Q

Arterial BP is directly proportional to the product of what two things?

A
  1. Cardiac output (CO)
  2. Peripheral vascular resistance (PVR)
73
Q

What two overlapping control mechanisms mainly control CO and PVR?

A
  1. Baroreflexes
  2. Renin-Angiotensin-Aldosterone System
74
Q

What are pressure-sensitive neurons in aortic arch and carotid sinus?

A

Baroreflexes

75
Q

Which control mechanism is short-terme, baroreflexes or Renin-Angiotensin-Aldosterone System?

A

Baroreflexes

76
Q

Which control mechanism is long-term, baroreflexes or Renin-Angiotensin-Aldosterone System?

A

Renin-Angiotensin-Aldosterone System

77
Q

In short-term blood pressure control, baroreceptors sense a drop in what?

A

Blood pressure

78
Q

In short-term blood pressure control, once baroreceptors sense a drop in BP, a signal is sent where?

A

Vasopressor centers in brainstem (medulla)

79
Q

In short-term blood pressure control, once a signal is sent to vasopresspor centers in brainstem (medulla), what part of the nervous system decreases output of ACh? What does this result in?

A

PNS

Increased HR

80
Q

At the same time as the baroreceptors are sending a signal to the PNS to decrease the output ACh, the SNS increases the output of NE. This increases four things which ultimately increases blood pressure. What are these four things?

A
  1. Increased HR
  2. Increased PVR
  3. Increased venous tone
  4. Increased force of heart contraction
81
Q

What are three effects of angiotensin-II?

A
  1. Increased thirst
  2. Increased secretion of ADH from posterior pituitary
  3. Increased Aldosterone from adrenal cortex
82
Q

What is the net result of Angiotensin-II effects?

A
  1. Increased fluid volume
  2. Increased BP
83
Q

What are the four primary sites of regulation of BP?

A
  1. ANS
  2. Heart
  3. Vasculature
  4. Kidneys
84
Q

What two neurotransmitters are used by the autonomic nervous system?

A
  1. Norepinephrine
  2. Epinephrine (adrenal)
85
Q

What three receptors of the autonomic nervous system are found on vascular smooth muscle? What two neurotransmitters bind to these receptors?

A

α1, α2, β2

Norepinephrine, Epinephrine

86
Q

What two receptors of the autonomic nervous system are found on the heart? What two neurotransmitters bind to these receptors?

A

β1, β2

Norepinephrine, Epinephrine

87
Q

Which receptor of the autonomic nervous system controls renin release? What two neurotransmitters bind to this receptor?

A

β1

Norepinephrine, Epinephrine

88
Q

In the parasympathertic nervous system, which neurotransmitter travels via the vagus nerve to target the heart? Does this increase or decrease the heart rate?

A

ACh

Decrease

89
Q

What does the systemic vascular system regulate? What is this known as?

A

The force the heart has to pump against

Afterload

90
Q

Vasoconstriction of arterioles causes what which then raises BP?

A

Increased afterload (PVR)

91
Q

Vasodilation of arterioles causes what which then lowers BP?

A

Decreased Afterload (PVR)

92
Q

True or False:

Veins and venules cannot distend without causing major changes in BP.

A

False

(They can distend without causing major changes in BP)

93
Q

What does it mean when we say veins are capacitance vessels?

A

They regulate amount of blood returning to heart and in ventricles before contraction (preload).

94
Q

What three things do the kidneys regulate?

A
  1. Regulates water and electrolyte balance
  2. Regulates volume of blood in the circulation
  3. Indirectly regulates BP via Renin-Angiotensin-Aldosterone System

Pharmacology II (3 decks)

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