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Pharm (Marcus) > Exam 3 Chapter 11 (CV antihypertensives) > Flashcards

Exam 3 Chapter 11 (CV antihypertensives) Flashcards

1
Q

The ____ processes the signal of low or high BP & the ____ sends the signal to make the appropriate change.

A

Hypothalamus & brainstem

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2
Q

Capacitance venules best respond to?

A

Nitric oxide

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3
Q

Alpha blockers affect the resistance arterioles & capacitance venules?

A

False only Resistance arterioles

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4
Q

What two effect does Angiotensin 2 have?

A

Directly constrict arterioles & get adrenal cortex to release Aldosterone

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5
Q

What are the 3 centrally acting Sympathoplegics?

A

Methyldopa, Clonidine, & Dexmedetomidine

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6
Q

What two things stimulate Renin release?

A

Low BP & Beta-1 agonism

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7
Q

Diuretics specifically target what structure?

A

Renal tubules

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8
Q

Delineate the pathway of the RAA system.

A

Angiotensinogen -> Renin released by kidneys -> Renin cleaves Angiotensinogen to Angiotensin 1 -> ACE converts Angiotensin 1 to Angiotensin 2

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9
Q

Where is Angiotensin-converting enzyme located?

A

Cell membranes that line the lungs

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10
Q

What is the negative feedback loop for Angiotensin 2?

A

The increase in volume inhibits further release of renin

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11
Q

What are the 4 anatomic control sites for antihypertensives?

A

Heart, arteries, veins, & kidneys

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12
Q

What is the MOA for Methyldopa & Clonidine?

A

Alpha-2 agonist activity in the brainstem

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13
Q

Explain the pathway how Methyldopa & Clonidine achieve their desired effect.

A

Both agonize the Nucleus of the Tractus Solitarius, which stimulates the Vagus nerve & sends a stimulus to the Rostral Ventrolateral Medulla, which sends an inhibitory signal to decrease sympathetic outflow resulting in decreased vasoconstriction, heart rate, & contractility

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14
Q

Methyldopa is useful for what two types of patient poluations?

A

Pregnancy induce HTN (does not affect fetus) & ppl unresponsive to other medications.

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15
Q

What is the major side effect of Clonidine & methyldopa?

A

Sedation

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16
Q

What kind of drug is Clonidine & what will we see initially?

A

A partial agonist. A brief rise in BP followed by hpotension

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17
Q

What are the off label uses for Clonidine?

A

ADHD, Tourette’s, EtOH withdrawal, Anxiety, PTSD

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18
Q

What are all the effects of Propranolol?

A

Lower BP, prevents reflex tachycardia, decreased CO, inhibits renin production

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19
Q

What is the IV dose for Metoprolol?

A

1mg q10min

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20
Q

What is the IV dose for atenolol?

A

5mg q10min

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21
Q

What is the IV dose for Esmolol?

A

20-30mg

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22
Q

What is MAP?

A

The pressure, which is consistently getting to the tissue

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23
Q

What happens to the blood fractions when an individual is hypotensive?

A

More blood is pumped into the venous system

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24
Q

_____% of blood is in the arterial system & _____% of blood is in the venous system.

A

25% & 75%

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25
Q

What 2 items contribute to loss of vessel elasticity?

A

Age & plaque

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26
Q

True or false, higher blood viscosity means lower Hematocrit?

A

False, higher viscosity= higher Hct

27
Q

If you double a blood vessel’s radius, what happens to flow?

A

Flow is 16x higher

28
Q

What happens peripheral resistance in obese people?

A

More vessels= more resistance

29
Q

What is the difference between primary & secondary hypertension?

A

Primary= can point out why. Secondary= don’t know why

30
Q

What are some of the most common causes for Primary HTN?

A

Diet, obesity, Age >40, DM, heredity, stress, smoking, renal failure, cardiac disease, stroke

31
Q

List the 3 initial nonpharmacologic steps to treat HTN.

A

Decrease Na+ intake, exercise, reduce weight

32
Q

What is the goal of a first line low dose diuretic?

A

Reduce BP by 10 – 15mmHg

33
Q

What is the difference between a Hypertensive urgency vs. emergency & the goal?

A

Urgency= no acute organ damage present & lower BP in hours to days. Emergency= acute end organ damage signs present & need for immediate lowering of BP.

34
Q

What percentage of all cases are Hypertensive emergencies?

A

1%

35
Q

How should a hypertensive emergency blood pressure be addressed?

A

Parenteral antihypertensive, not too rapidly to avoid hypotensive emergency. Once in range switch to oral.

36
Q

What are 2 the most common antihypertensive emergency medications?

A

Nitroprusside & Fenoldopam

37
Q

What is the MOA of CCB’s and their effects?

A

MOA: inhibit Ca++ influx in arterial smooth muscle. They dilate peripheral arterioles & additionally they are antianginal & anti-arrhythmic

38
Q

What is the basic function of diuretics?

A

They deplete sodium

39
Q

What is the basic function of Sympathoplegics?

A

Decrease PVR & CO

40
Q

What is the basic function of vasodilators?

A

Relax vascular smooth muscle

41
Q

What kind of drug is usually the fist & safest option for HTN?

A

Diuretics

42
Q

What are the 6 sub classifications of Diuretics?

A

Carbonic anhydrase inhibitors, Loop diuretics, Thiazides, K+ sparing diuretics, Osmotic diuretics, ADH antagonists

43
Q

What is the most common toxicity with diuretics?

A

Potassium depletion

44
Q

The ____ processes the signal of low or high BP & the ____ sends the signal to make the appropriate change.

A

Hypothalamus & brainstem

45
Q

Capacitance venules best respond to?

A

Nitric oxide

46
Q

Alpha blockers affect the resistance arterioles & capacitance venules?

A

False, only Resistance arterioles

47
Q

What two effect does Angiotensin 2 have?

A

Directly constrict arterioles & get adrenal cortex to release Aldosterone

48
Q

What are the 3 centrally acting Sympathoplegics?

A

Methyldopa, Clonidine, & Dexmedetomidine

49
Q

What two things stimulate Renin release?

A

Low BP & Beta-1 agonism

50
Q

Diuretics specifically target what structure?

A

Renal tubules

51
Q

Delineate the pathway of the RAA system.

A

Angiotensinogen -> Renin released by kidneys -> Renin cleaves Angiotensinogen to Angiotensin 1 -> ACE converts Angiotensin 1 to Angiotensin 2

52
Q

Where is Angiotensin-converting enzyme located?

A

Cell membranes that line the lungs

53
Q

What is the negative feedback loop for Angiotensin 2?

A

The increase in volume inhibits further release of renin

54
Q

What are the 4 anatomic control sites for antihypertensives?

A

Heart, arteries, veins, & kidneys

55
Q

What is the MOA for Methyldopa & Clonidine?

A

Alpha-2 agonist activity in the brainstem

56
Q

Explain the pathway how Methyldopa & Clonidine achieve their desired effect.

A

Both agonize the Nucleus of the Tractus Solitarius, which stimulates the Vagus nerve & sends a stimulus to the Rostral Ventrolateral Medulla, which sends an inhibitory signal to decrease sympathetic outflow resulting in decreased vasoconstriction, heart rate, & contractility

57
Q

Methyldopa is useful for what two types of patients?

A

Pregnancy induce HTN (does not affect fetus) & ppl unresponsive to other medications.

58
Q

What is the major side effect of Clonidine & methyldopa?

A

Sedation

59
Q

What kind of drug is Clonidine & what will we see initially?

A

A partial agonist. A brief rise in BP followed by hpotension

60
Q

What are the off label uses for Clonidine?

A

ADHD, Tourette’s, EtOH withdrawal, Anxiety, PTSD

61
Q

What are all the effects of Propranolol?

A

Lower BP, prevents reflex tachycardia, decreased CO, inhibits renin production

62
Q

What is the IV dose for Metoprolol?

A

1mg q10min

63
Q

What is the IV dose for atenolol?

A

5mg q10min

64
Q

What is the IV dose for Esmolol?

A

20-30mg

Pharm (Marcus) (8 decks)

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