Antihypertensives (slides)

Question 1

pre htn. values

Answer 1

120-130/80-90

Question 2

stage 1 htn. values

Answer 2

140-160/90-100

Question 3

stage 2 htn. values

Answer 3

> 160/100

Question 4

essential htn. is

Answer 4

idiopathic and is 90% of all htn.

Question 5

secondary htn. is caused by a specific

Answer 5

etiology. 10% of all htn.

Question 6

specific htn. etiologies.

Answer 6

coarctation of the aorta, pregnancy (primary htn.) kidney disease, hyperthyroidism, cushing syndrome (hyper adrenal)

Question 7

cushings disease

Answer 7

hyper secretion of ACTH

Question 8

natural bp control

Answer 8

arterioles, venules, heart, renin/angiotensin

Question 9

external bp control

Answer 9

the pump , anesthetic depth, drugs

Question 10

anti hypertensive work to alter bp by

Answer 10

decreasing CO or decreasing SVR

Question 11

CO SVR are generally controlled by

Answer 11

SNS and baroreceptor feedback, or renin/angiotensin system

Question 12

first line Rx for HTN.

Answer 12

DIURETICS (INEXPENSIVE/SAFE)

Question 13

110% OF NORMAL BV can cause

Answer 13

profound htn. in patients with stiff arteries. while 95% can mean normotensive

Question 14

diuretics are superior for treatment in

Answer 14

the elderly

Question 15

b blocker decrease bp by

Answer 15

decreasing CO, SNS TONE, RENAL RENIN RELEASE

Question 16

ARBS

Answer 16

angiotensin receptor blockers

Question 17

beta 1 selective are being

Answer 17

used more and more because of less side effects

Question 18

bystolic

Answer 18

nebivolol b1 selective and potent vasodilator.

Question 19

results of ace inhibitors

Answer 19

decrease sym. activity, aldosterone secretion, tubular nacl/water reabsrorption, k excretion, vasocontriction, adh secretion

Question 20

rate limiting factor of ace inhibitors

Answer 20

the inhibition of bradykinin degradation. vasodilator but causes problems

Question 21

commonly used as a first line drug post-MI for HTN

Answer 21

ace inhibitors

Question 22

ace inhibitors cannot be used

Answer 22

in pregnant women

Question 23

problems from bradykinin from ace inhibitors

Answer 23

dry heaving because they get caught in lungs

Question 24

ARBs advantage over ACE inhibitors

Answer 24

don’t cause bradykinin release. fewer respiratory problems

Question 25

why ARBs more effective then ACE

Answer 25

ore effective than ACE-Inhibitors in blocking Angiotensin since there are other chemicals that also convert Angiotensin-I into Angiotensin-II (understand?)

Question 26

A2 AGONIST WORK BY

Answer 26

decrease sympathetic firing from CNS, decrease vascular tone, used with other drugs because of sedative side effect

Question 27

clonidine

Answer 27

(catapres,duraclon) dilates peripheral vessels but not renal arteries. useful in HTN. complicated with renal disease

Question 28

a-methyldopa (aldomet)

Answer 28

like clonidine but less tranplacental passage

Question 29

1 to control bp on bypass

Answer 29

flow

Question 30

more anesthetized the

Answer 30

lower the bp

Question 31

when giving drugs on bypass its different because

Answer 31

there is no cardiac reflex, urgent, reversal agents

Question 32

hydralazine

Answer 32

apresoline. arterial and arteriole effect > venous effect. causes endothelial cell to releases NO (vasodilator muscle relaxant) can be used in pregnant girls

Question 33

nitroglycerin

Answer 33

• Used for treatment of angina for > 100 years! • At lower doses venous dilation>arterial • At higher doses arterial dilation>venous

Question 34

forms of NTG

Answer 34

NTG tablets, Nitro Bid ointment, translucent NITREK patch,

Question 35

NTG in body

Answer 35

• Converted to nitric oxide by mitochondrial enzymes.
• Commonly used as a bolus (what’s this?) or IV drip on CPB to treat “HTN”.
• Decreases B.P., pulmonary capillary wedge pressure, and SVR.
• decreases myocardial O2 demand during ischemia while leaving contractility unaffected.

Question 36

two ways to blow air out of coronaries

Answer 36

changes in EKG indicates injury or MI. half of surgeons will want to increase BP. some will give NTG to dilate

Question 37

NITROPRUSSIDE

Answer 37

NIPRIDE OR NITROPRESS. *Potent arterial & capacitance dilator.
…so it decreases both preload and afterload (explain) which helps increase C.O. in patients with heart failure.

Question 38

nitroprusside must be

Answer 38

iven parenterally
*Very commonly used to control BP on CPB (both bolus and IV drip) Breaks down in the blood stream into nitric oxide…
• and cyanide

Question 39

nitroprusside half life

Answer 39

• Although nitroprusside has a half-life of 1-2 minutes…

* It’s toxic metabolite thiocyanate has a half- life of many days. babies susceptible

Question 40

nitroprusside dose

Answer 40

***Normal adult dosage is 0.5-10.0 μg/kg/min (peds receive the low end of this dose
BUT
DO NOT give at higher dosages for more than ten minutes or toxicity can result!!!

Question 41

*Cyanide “shuts down” cellular metabolism. Why would this be problematic on bypass??

Answer 41

you can poison a patient because you are flying blind on bypass. because if you keep giving it and no decrease in BP

Question 42

NITROPRUSSIDE AND NTG USED ON TERMINATION BUT..

Answer 42

you can transfuse a vast majority of volume this way??