Exam 2 - Hypertension and Angina

Question 1

Evaluate blood pressure including procedure, MAP, and category.

Question 2

Describe the regulators of blood pressure including cardiac output and PVR.

Question 3

Define anatomic control sites for blood pressure.

Question 4

Recall non-pharmacologic intervention for elevated blood pressure.

Question 5

List 4 major groups of antihypertensive drugs and give examples of drugs in each group. (Renin inhibitors are not considered an independent major group; can you name the one available drug that acts by this mechanism?)

Question 6

Describe the targets (receptor and location) for the centrally acting sympathoplegics clonidine and methyldopa, overall effects, indications for use, and major side effect.

Question 7

List the major sites of action of peripheral sympathoplegic drugs in clinical use and give examples of drugs that act at each site.

Question 8

List dose for metoprolol, atenolol, and esmolol.

Question 9

List the mechanisms of action of vasodilator drugs, and 4 classifications.

Question 10

Describe the compensatory responses to vasodilators.

Question 11

List the major antihypertensive vasodilator drugs and describe their effects.

Question 12

Describe treatment concerns for using sodium nitroprusside and dosing.

Question 13

List the three classes of CCBs and major target of each.

Question 14

Draw the renin angiotensin aldosterone pathway and treatment targets.

Question 15

Describe the differences between the 2 types of angiotensin antagonists.

Answer 15

• ACE inhibitors
• Angiotensin competitive inhibitors

Question 16

List and describe mechanisms of action for pulmonary hypertension therapeutics.

Answer 16

Endothelin receptor antagonists: receptors are primarily found in vasculature of lungs, and they cause constriction and dilation. People with pHTN these cells proliferate and cause issues. These drugs block those receptors and prevent constriction and over-proliferation.

-sentan drug class

Question 17

Define hypertensive urgency and hypertensive crisis.

Answer 17

Urgency: >180/110, without acute end organ damage. Goal is to lower BP in hours to days.

Crisis (emergency): >180/110 with acute end organ damage, requires immediate lowering of BP.

Question 18

Suggest treatments for mild, moderate, and severe (emergent) hypertension.

Answer 18

Mild: Single first-line drug, low dose diuretic, beta blocker, CCB

Moderate: dual or triple drug therapy

Severe: ICU monitoring with cont. BP, monitor fluid intake, output, body weight.
IV antihypertensives to lower BP rapidly but not too rapidly. Sodium nitroprusside, Labetolol, CCB, hydralazine, fenoldopam

Question 19

Illustrate differences in arterial, capillary, and venous tone.

Answer 19

arterial: smooth muscle layer, primary blood pressure control.

capillary: have sphincters that control blood flow/tone, they can contract and blood will bypass it. e.g. fight or flight, GI capillary sphincters contract.

venous: much less tone in vein, capacitance is much larger.

Question 20

Describe the pathophysiology of effort angina and vasospastic angina and the major determinants of cardiac oxygen consumption.

Answer 20

accumulation of metabolites due to myocardial ischemia

Effort: decreased blood flow to cardiac myocytes, and they exercise. increased O2 requirement, but blood flow does not increase proportionally.

Vasoplastic angina: AKA variant angina, due to coronary vasospasm. 2% of all angina cases.

Question 21

Explain the following: coronary blood flow is directly related to duration of diastole.

Answer 21

during systole, ventricles contract and the smaller vessels will feed into cardiac myocytes, instead of to the coronary arteries.

Question 22

List the strategies and drug targets for relief of anginal pain.

Answer 22

immediate relief would be nitroglycerin, and prophylaxis would be CCB and BB.

Question 23

Draw molecular pathways of vascular tone and drug targets.

Answer 23

Slide 16 of lecture 12

Question 24

Name the primary nitrates and nitrites, MOA, pharmacokinetics, and treatment targets.

Question 25

Define concerns with overexposure to nitrates and nitrites.

Answer 25

Tolerance: become resistant to it with continuous exposure. need an off period to prevent it. Problematic to people who work in processing plants that expose them to nitrates/nitrites.

Question 26

List receptor differences in epicardial arteries.

Question 27

Describe targets of pFOX inhibitors. Is Ranolazine a pFOX inhibitor?

Question 28

Contrast the therapeutic and adverse effects of nitrates, β blockers, and calcium channel blockers when used for angina.

Question 29

Explain why the combination of a nitrate with a β blocker or a calcium channel blocker may be more effective than either alone.

Question 30

Contrast the effects of medical therapy and surgical therapy of angina.