Exam 2 18 19 23 24 25 Flashcards
Blood pressure is calculated how?
CO x SVR
Cardiac output x Systemic vascular resistance
HTN is?
Hypertension
Normal blood pressure?
S120/D80
Prehypertension is what pressure?
S120-139/D80-89
Stage 1 hypertension is?
S140-159/D90-99
Stage 2 hypertension is?
S160+/D100+
Beta blockers and Ace inhibitors have been found to be more effective in what patients?
White pts than in african american pts
Calcium channel blockers and diuretics have been shown to be more effective in what pts?
African American than white pts
3 principal functions of the Autonomic Nervous system(ANS)?
- Regulate the heart
- Regulate secretory glands (salivary, gastric, sweat, and bronchial)
- Regulate smooth muscles (bronchi, blood vessels, urogenital system, and GI tract)
2 basic categories of receptors?
PNS - Cholinergic receptors
SNS - Adrenergic receptors
Cholinergic receptors are mediated by?
acetylcholine
Adrenergic receptors are mediated by?
epinephrine and norepinephrine
Epinephrine is released by the?
adrenal medulla
The predominant tone of vascular system is the ?
SNS “Adrenergic” system
What are some objectives of the SNS?
- Maintenance of blood flow to the brain
- Redistribution of blood flow during exercise
- Compensation for loss of blood, primarily by causing vasoconstriction
- Implementation of “fight-or-flight” reaction
The implementation of the fight or flight reaction includes what?
- Increasing heart rate and blood pressure
- Shunting blood away from the skin and viscera to the skeletal mm
- Dilating the bronchi to improve oxygenation
- Dilating the pupils to see better
- Mobilizing stored energy thereby providing glucose for the brain and fatty acids for the muscles
Neurotransmitter for the Adrenergic system?
Epinephrine
Neurotransmitter for the cholinergic system?
acetylcholine
The predominant tone of most organs except for vascular system is the?
PNS - Cholinergic system
What does the Parasympathetic nervous system do? (PNS)
Regulatory functions:
- Slowing the heart rate
- Increased gastric secretion
- Emptying the bladder
- Emptying the bowel
- Focusing the eye for near vision
- Constricting the pupil
- Contracting bronchial smooth muscle
Alpha blockers isn’t used a lot except?
used to treat HTN and benign prostatic hyperplasia ((BPH) - (relaxes smooth mm bladder))
Alpha blockers can decrease BP more when the pt is ?
standing
Give alpha lockers what time of day? and why?
night due to orthostatic hypotension and reflex tachycardia
Alpha 2 takes place in the ___? and inhibits what?
brain and will inhibit the norepinephrine and calm you down
Alpha agonist is used for?
Central acting paradoxically reduces SNS stimulation and also used for pain.
What is the drug used for pain?
clonindine (catapres)
What are some adverse reactions of an catapres?
- severe rebound HTN
- serious if withdrawn in less than 3 days, PT ED is very important
- drowsiness in 1/3 pts population
- Teach the PT not to drive
SAFETY is the biggest concern
Beta 1 affects?
affects the heart
Beta 2 affects?
affects the lungs, also in skeletal muscles, also binds to epinephrine causing vasodilation
Beta blockers block what?
beta 1 and 2
Alpha 1 stimulated by ?
norepinephrine causing vasoconstriction
Alpha 2 found in the?
brain and inhibits norepinephrine and helps calm you down
One of the biggest side affects of prazosin (Minipress) is?
First dose syncope (1% lose of consciousness)
Selective Beta Blockers blocks?
blocks b1 predominantly
Metroprolol is the drug of choice for ?
selective BB
Propranolol is the drug of choice for?
nonselective BB
Propranolol will cause?
more effects on the entire body
Nonselective BB blocks what?
both B1 and B2
Adverse effects of a beta blockade?
They block 1 and 2.
Also SNS response won’t be available when needed during exercise and hypoglycemic episodes
During a hypoglycemic episode, want can it trigger?
normally triggers stress response as signal to encourage eating
Adverse effects of a beta 1 block?
- There is an SA node block which leads to bradycardia
- Negative inotrope leads to reduced cardiac output and can precipitate to HEART FAILURE
- can cause AV heart block leads to heart rhythm changes
- rebound cardiac excitation if withdrawn abruptly and can lead to dysrhythmias and agina
If HR is less than 60, do we give Beta blockers?
NO, since this reduces HR, monitor for heart failure
Coreg is ?
one of the newer drugs for heart failure
Adverse effects of beta 2 blockade?
- All of the B1 blockade SE AND
-Bronchoconstriction
CI for COPD and Asthma
-Inhibits glycogenolysis
(breakdown of glycogen to glucose
for immediate use- B2B may cause hypoglycemia)
-CNS side effects- fatigue, depression
Nonselective B1 and B2 blocker drug is ?
propranolol (inderal)
What is the drug of choice for initial hyperthyroidism?
Propranolol because it blocks the action of the thyroid hormone.
Typical dose of propranolol?
60mg bid
What are some precautions and warnings when pt is using propranolol and have diabetes?
HR slows down; masks hypoglycemia tachycardia
What are some precautions and warnings when pt is using propranolol and have history of anaphylactic allergies?
Pts have issues with epinephrine
What are some precautions and warnings when pt is using propranolol and have COPD or asthmatics?
It can make symptom worse
What are some precautions and warnings when pt is using propranolol and have psychiatric disorders?
It can make depression worse
What are some Drug interactions with nonselective B1 & B2 Blocker: propranolol?
- Calcium channel blockers (CCB)
- Insulin
What does CCB cause?
- causes coronary artery vasodilation
- cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance
- reduces the workload of the heart resulting in decreased myocardial oxygen demand
What is a selective Beta 1 blocker?
Metoprolol (lopressor/Toprol XL)*
When can a B1B become nonselective?
At high enough doses
This drug is safer for asthma and anaphylaxis pts.
Selective B1B : Metoprolol
3 Drug interactions with selective B1B Metoprolol?
- Sinus Bradycardia (<60HR)
- AV Block greater than 1st degree
- Heart Failure (HF)
What is the 3rd generation Beta blocker? (BB)
Labetalol
what does labetalol do?
blocks both alpha and beta receptors and vasodilates
How is labetalol used?
Used IV to get BP down emergently
- HTN crises
- CVA needing thrombolytic tx
What is the dose for labetalol?
-20mg IV over minimum 2 minutres
Freguently dilute and give over 10min
When a pt has a HTN Urgency, why must you bring the blood pressure down over a few days?
To prevent end organ damage. If dropped to rapid can cause ischemia of the brain, heart, kidneys, and eyes, which are used to high pressure to perfuse them.
What is the treatment (Tx) for HTN Urgency crisis?
ICU drugs - labetalol or hydralazine IV; esmolol or nitroprusside drip (ICU)
