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Hypertension Flashcards

1
Q

What equation tells you what arterial pressure is?

A

cardiac output times total peripheral resistance

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2
Q

What is the role of the reticular substance in regulation of circulation?

A

lateral and superior portions involved in excitation

medial and inferior portions are involved in inhibtion

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3
Q

What is the role of the hypothalamus in circulation?

A

posterior lateral portions cause mainly excitation

anterior portion can cause excitations or inhbition

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4
Q

What is the role of the motor cortex on nervous regulation of circulation?

A

exciation or inhibition

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5
Q

what threee areas of the brain are involved in the regulation of the circulation?

A

reticular substance
hypothalamus
motor cortex

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6
Q

What is the vasomotor center?

A

located bilaterally in the reticular substance of the medulla and lower third of the pons

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7
Q

What is the vasoconstrictor area “C-1” anterolateral upper medulla do?

A

sympathetic discharge

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8
Q

What is the role of vasodilator area “A-1” anterolateral lower medulla?

A

inhibits C-1 area

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9
Q

What is the role of sensory area “A-2” bilateral in nucleus tractus solitarii: receive sensory signal from vagus and glossopharyngeal from barorecepotrs. ?

A

C-1 and A-1 areas

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10
Q

What is the cardiac center do?

A

heart rate and contractility

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11
Q

What are innervated by sympathetic system?

A

sympathetic nerve fibers innervates all vessels except capillaries and precapillary sphincters and some meta arteriorles

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12
Q

What is mainly controled by parasympathetic nervous system?

A

mainly important in control of heart rate via the vagus nerve

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13
Q

What is the effect of total spinal anesthesia on blood pressure?

A

drops it significantly

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14
Q

What does alpha 2 sympathetic activation do on a sympathetic never?

A

ihibit norepinephrine release

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15
Q

What does activation of alpha 1 sympathetic receptors sdo?

A

vasoconstriction

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16
Q

What type of system is a baroreceptor pressure control system?

A

negative feedback control system?

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17
Q

What is the equation for G the strength of feedback

A

G=correction of error signal/error(abnormalilty still remianing)

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18
Q

What is hte range of hte effect of carotid sinus barorecptors?

A

pressures between 60 and 180 mmHg

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19
Q

Where is hte baroreceptor reflex most sensitive?

A

100 mmHg

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20
Q

What occurs as the pressure increases in the carotid baroreceptor as far as nerve impules goes?

A

increase in number of impulees form carotid sinus resulting in inhibtion of vasoconstrictor and activation of vagal center

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21
Q

What occurs at the resetting of baroreceptors?

A

thought to prevent refelx from controling as a control system for changes in pressure that last more than a day

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22
Q

What splits angiotensinogen?

A

renin and splits it to angiotensin I

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23
Q

What splits angiotensin I?

A

ACE to angiotensin II; leading to aldosterone release and sodium retention

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24
Q

What splits kininogen?

A

kallikrein to bradykinin

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25
What does bradykinin do?
cause nitric oxcde release; prostaglandin synthesis and vasodilation sodium excretion
26
What splits active bradykinin?
ACE inactivates bradykinin
27
How is hypertension diagnosed?
average of at least 2 readings per visit obtaned at 3 seperate visits each 2 to 4 weeks apart
28
What is the second leading cause of end stage renal disease?
hypertension | with high normal being associated with a 3 times risk of future development of ESRD
29
What are some exogenous causes of hypertension?
``` oral contraceptives NSAIDs Cocaine,ethanol, amphetamines, decongestants glucocorticoids cyclopsporin erythropoietin ```
30
What are the causes of hypertension for most people
``` primary genetic ~90% secondary Chronic kidney disease 2-4% primary aldoseronism pheochromocytoma cushing ```
31
What is the morphology of large/medium arteries?
accelerated atherogenesis degenerative changes in vascular walls increase risk of aortic dissection and cerebovascular hemorrhage
32
What is the hypertension morphology of small arteries/arterioles?
hyaline arteriolosclerosis | hyperplastic arteriolosclerosis
33
What is hyaline arteriolosclerosis pathology?
elderly pts similar changes in diabetics benign nephrosclerosis homogenus pink thickening of vessels with narrow lumen leakage of plasma across endothelium due to HTN excess matrix production by smooth cells occurs secondarily
34
What are the histology of hyperplastic arteries?
characteristic of malignant htn onion skinning laminated wall with luminal narrowing -replication basement membrane and smooth muscle cells
35
What is necrotoizing arteriolitis?
malignant HTN; term used when these changes are associated with fibrinoid necrosis
36
What is the systemic HTN heart disease: morpoholgy?
cardiomegaly: concentric hypertrophhy without dilation thickness of left ventricular wall impairs diastolic filling and causes left atrial enalrgment myoccyte hypertrophy-- increased myocyte and nuclear enlargement
37
What are the direct arterial vasodilators?
``` hydralazine minoxidil diazoxide nitroprusside fenoldopam ```
38
What is the compensatory mechanism that reduces effectiveness of direct arterial vasodilators?
baroreceptor activation: compensatory increase in sympathetic outflow; tachyphylaxis can cause loss of antihyptertensive as well as reflex rellease ofrenin
39
What can be given with direct arterial vasodilators to counteract compensatory baroreceptor activation?
beta blocker and diuretic for water retention
40
What is hypertensive urgency?
elevated Bp but no acute or progressing target organ injury
41
What is a hypertesnive emergency?
acute or progressing target organ damage from elevated BP
42
What are adverse effects of hydralazine?
lupus like syndrome
43
What are the general adverse effects of arterial vasodilators?
sodium/water retention | tachycardia/angina
44
what is an adverse effect of minoxidil?
hair growth
45
What are teh calcium channel blockers?
nifedipine diltiazem verapamil amlodidpine
46
What are two alpha blockers?
phenoxybenzamine and phentolamine
47
What are teh effect of alpha blockers?
inhibit smooth muscle catecholamine uptake: vasodilation and BP lowering
48
What are the benefits of alpha1 selective blockers?
allow activation of alpha 2 and inhiiton of NE release; and don't stim renin release and smaller increase in heart rate
49
What are the alpha 1 selective blockers?
prazozin terazosin doxazosin
50
What are the addverse effects of alpha1 blockers?
first dose effect -orhtostatic hypotension transient dizziness, faintness, palpitations, syncope reflex tachy
51
Where are hte Beta 1 receptors located?
heart and kidney, stimulate incrased HR, contractility and renin release
52
Where are beta 2 receptors located and what do they do?
lung, liver, pancrease, arteriolar smooth muscle stim bronchodilation and vasodilation mediate insulin secretion and glycogenolysis
53
What are the potential beta blockers adverse effects?
``` glucose intolerance, masked hypoglycemia bradycardia, dizziness bronchospasm up TG and decrease HDL CNS depression, fatigue, sleep disturbance reduce CO, exacerbattion of herat failure impotence exercise intolerance ```
54
What are the central alpha2 agaonists?
clonidine guanabenz alpha-methyldopa
55
What is tehmechansim of action of clonidine?
central alpha 2 agonist - reduces sympathetic outflow from braint o vasomotor sensor - increase vagal tone.
56
What are the adverse effects of cnetral alpha2 agaonists?
``` sodium retention rebound HTN depression orthostatic hypotension dizziness ```
57
What is an adverse effect of clonididne?
anticholinergic side effects
58
What is an adverse effect of methyldopa
hepitisi or rarely hemolytic anemia
59
What are neuronal and ganglionic blockers used to treat HTN??
guanethidine guanadrel resperine trimethaphan--ganglionic
60
What are the adverse effects of reserpine and guanethidine?
``` sedation(reserpine) depression (reserpine0 decreased CO sodium/water increased gastric acid secretion (reserpine) diarrhea bradycardia ```
61
What do you use with reserpine and guanethdine to avoid fluid retention?
a diuretic pref a thiazide
62
What are the potential adverse effects of diuretics?
``` electrolyte disturbance hyperglycemia hypotension lipid abnormalities photosensitvity ototoxicity hyperuricemia ```
63
What are two aldosterone antagonists?
spironolactone | eplerenone
64
What are the mechanism of ACE inhibtitors?
block bradykinin degradation which stimulate syntehsis of other vasodilating substances like PGE2 and prostacyclin blocks conversion of angiotensin I to angiotensin II
65
What disease can ACE inhibitiors it prevent or regress?
left ventricular hypertrophy
66
What are the adverse effects associated with ACE inhibitors?
cough angioedema hyperkalemia neutropenia, agranulocytosis, proteinuria, glomerulonephritis, acute renal failure
67
What is the angiotensin II receptor blocker?
ARB, don't block bradykinin breakdown | less cough than ACE inhibitor
68
What is the renin inhibitor?
aliskiren; angiotensinogen to angiotensin I inhibitor
69
What are the precautions needed to be taken with ACE inhibitor or arbs?
can cause kidney failure in pts with severe bilateral renal artery steoniss pregnancy
70
What drug should you use in hypertensive emergency?
``` sodium nitroprusside or -nicardipine -clevidipine -fenoldopam -nitro -hydralazine -labetalol -esmolol ```
71
Combination therapy usually involves what?
two or more agents to control HTN | one should be a thiazide unelss contraindicated
72
What is resistant HTN?
fialure to achieve BP goal on 3 drug regimen

Cardiology (12 decks)

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