HTN Lecture

Question 1

What is epinephrine and what does it stimulate

Answer 1

hormone released from adrenals
- stimulates: alpha 1, beta 1, beta 2 agonist

Question 2

What is norepinephrine and what does it stimulate

Answer 2

neurotransmitter released in brain and sympathetic ganglia of spinal cord OR hormone released from adrenals
- stimulates alpha 1 and beta 1agonist

Question 3

Where are alpha 1 receptors located and what do they do

Answer 3

vascular smooth muscle

stimulates arterial smooth muscle contraction (vasoconstriction)

(phenylephrine, midodrine, nor/epinephrine)

Question 4

Where are beta-1 receptors located and what do they do

Answer 4

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)

Question 5

Where are beta-2 receptors located and what do they do

Answer 5

smooth muscle of bronchioles, other organs

stimulates relaxation of bronchioles (bronchodilator)

(albuterol, salmeterol, epinephrine)

Question 6

What is the cholinergic system responsible for

Answer 6

rest and digest

Question 7

what are muscarinic receptors and where are they found

Answer 7

Question 8

What are the 2 main parasympathetic neurotransmitter agonists and what do they do

Answer 8

Question 9

What is ADH (aka vasopressin) and what is its action on blood pressure

Answer 9

Question 10

What are the 4 main classes of first line anti-hypertensives

Answer 10

Question 11

What is the MOA of thiazide diuretics

Answer 11

Question 12

What is the MOA of Ca channel blockers

Answer 12

Question 13

What is the MOA of ACE inhibitors

Answer 13

Question 14

What is the MOA of angiotensin receptor blockers

Answer 14

Question 15

What is the MOA of aldosterone receptor agonists (2nd line)

Answer 15

Question 16

What is the MOA of potassium sparing diuretics (2nd line)

Answer 16

Question 17

What is the MOA of direct renin inhibitors (2nd line)

Answer 17

Question 18

What is the MOA of beta blockers (2nd line) and some examples

Answer 18

Question 19

What are the 3 main types of HTN

Answer 19

primary, secondary, resistant

Question 20

Which type of HTN is the most common

Answer 20

primary - not from an underlying disease state/source

Question 21

What may be seen on PE for HTN

Answer 21

bruits/murmurs, ocular/ ophthalmologic signs, CHF signs, BP or pulse discrepancy

Question 22

What are the categories of BP readings from normal to HTN stage II

Answer 22

Normal 120/80
Elevated 120-129/80+
HTN stage I 130-139/80-89
HTN stage II 140+/90+

Question 23

What labs could be ordered for HTN

Answer 23

Fasting blood sugar, BMP (Cr, K+, Na+), TSH, UA (blood, protein), EKG (LVH, LAE, strain, infarct), echo (LVH, LAE, coarctation)

Question 24

Describe malignant HTN

Answer 24

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

Question 25

What are some non-pharm treatments for HTN

Answer 25

weight loss, minimize/eliminate EtOH, exercise, tx sleep apnea, low Na diet, K+ supplements, reduce stress, DASH diet

Question 26

What are the 4 main classes & examples of 1st line antihypertensives

Answer 26

• 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

Question 27

What are some causes of secondary HTN

Answer 27

OSA, renal artery stenosis, hyperaldosteronism, polycystic kidney disease, cushing’s, etc.

Question 28

Describe the treatment of stage 1 HTN

Answer 28

Stage I with evidence of ASCVD or 10yr risk 10%+:
- non-pharm, + one 1st line anti-HTN med

Question 29

Describe the treatment of stage 2 HTN

Answer 29

non-pharm & combo therapy of 1st line meds

Question 30

Describe the treatment for resistant HTN

Answer 30

combo 3+ anti-hypertensive meds