HTN Lecture Flashcards
What is epinephrine and what does it stimulate
hormone released from adrenals
- stimulates: alpha 1, beta 1, beta 2 agonist
What is norepinephrine and what does it stimulate
neurotransmitter released in brain and sympathetic ganglia of spinal cord OR hormone released from adrenals
- stimulates alpha 1 and beta 1agonist
Where are alpha 1 receptors located and what do they do
vascular smooth muscle
stimulates arterial smooth muscle contraction (vasoconstriction)
(phenylephrine, midodrine, nor/epinephrine)
Where are beta-1 receptors located and what do they do
cardiac muscle, JG cells on kidneys
stimulates inotropic response (increases force of contractility) or chronotropic response (increase heart rate) in the heart
stimulates JG and renin release activating RAAS (renin angiotensin aldosterone system)
(dobutamine, dopamine, norepinephrine, epinephrine)
Where are beta-2 receptors located and what do they do
smooth muscle of bronchioles, other organs
stimulates relaxation of bronchioles (bronchodilator)
(albuterol, salmeterol, epinephrine)
What is the cholinergic system responsible for
rest and digest
what are muscarinic receptors and where are they found
What are the 2 main parasympathetic neurotransmitter agonists and what do they do
What is ADH (aka vasopressin) and what is its action on blood pressure
What are the 4 main classes of first line anti-hypertensives
What is the MOA of thiazide diuretics
What is the MOA of Ca channel blockers
What is the MOA of ACE inhibitors
What is the MOA of angiotensin receptor blockers
What is the MOA of aldosterone receptor agonists (2nd line)
What is the MOA of potassium sparing diuretics (2nd line)
What is the MOA of direct renin inhibitors (2nd line)
What is the MOA of beta blockers (2nd line) and some examples
What are the 3 main types of HTN
primary, secondary, resistant
Which type of HTN is the most common
primary - not from an underlying disease state/source
What may be seen on PE for HTN
bruits/murmurs, ocular/ ophthalmologic signs, CHF signs, BP or pulse discrepancy
What are the categories of BP readings from normal to HTN stage II
Normal 120/80
Elevated 120-129/80+
HTN stage I 130-139/80-89
HTN stage II 140+/90+
What labs could be ordered for HTN
Fasting blood sugar, BMP (Cr, K+, Na+), TSH, UA (blood, protein), EKG (LVH, LAE, strain, infarct), echo (LVH, LAE, coarctation)
Describe malignant HTN
Malignant HTN
- HTN urgency: +200/+120
- HTN emergency: urgency level BP + sx of encephalopathy (h/a, n/v, visual disturbances, non-focal neuro sx)
- RF: 70+, F, longstanding HTN untreated
- r/o stroke with non-con CT
- admit to hosp with IV then PO labetolol & combo therapy
What are some non-pharm treatments for HTN
weight loss, minimize/eliminate EtOH, exercise, tx sleep apnea, low Na diet, K+ supplements, reduce stress, DASH diet
What are the 4 main classes & examples of 1st line antihypertensives
- thiazide/thiazide-like diuretics
- HCTZ, chlorthalidone
- Ca channel blockers (dihydropyridines)
- amlodipine, nifedipine
- angiotensin-converting enzyme inhibitors (ACE)
- lisinopril, ramipril, captopril
- angiotensin II receptor blockers (ARB)
- losartan, valsartan
What are some causes of secondary HTN
OSA, renal artery stenosis, hyperaldosteronism, polycystic kidney disease, cushing’s, etc.
Describe the treatment of stage 1 HTN
Stage I with evidence of ASCVD or 10yr risk 10%+:
- non-pharm, + one 1st line anti-HTN med
Describe the treatment of stage 2 HTN
non-pharm & combo therapy of 1st line meds
Describe the treatment for resistant HTN
combo 3+ anti-hypertensive meds
