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Pharmacy Practice 720 Year 1 Term 1 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is Cardiac Output (CO)

A

Heart rate (HR) X Stroke Volume (SV)

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2
Q

What is Mean Arterial Pressure (MAP)

A

CO X Peripheral Resistance (PR)

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3
Q

Systolic Pressure

A

High Number (want to be around 120mmHg)

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4
Q

Diastolic Pressure

A

Low Number (want to be around 80mmHg)

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5
Q

What affects peripheral resistance

4

A

Aging
Endothelial dysfunction
vasoactive substances
sympathetic NS stimulation

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6
Q

What are some Vasodilating Systems?

5

A 
Parasympathetic
Bradykinin 
Prostaglandins
Endothelial derived relaxant factor (NO)
Atrial natriuretc factor
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7
Q

What are some Vasoconstricting Systems?

A

Sympathetic
Calcium channels
Renin-angiotensin-aldosterone
Endothelin

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8
Q

What does Sympathetic (Adreneric) system have to do with HTN

A

Norepinephrine (noradrenaline) and Epinephrine (adrenaline) bind to adrenergic receptors
causing
pupil dilation, sweating, heart rate, blood pressure

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9
Q

What beta receptors control smooth muscle contraction?

A

Beta 1

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10
Q

What do calcium channels do?

A

Allow entry of Calcium ++ which causes muscle contraction

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11
Q

Renin Angiotension Aldosterone System

A

Liver produces angiotensinogen
Renin turns angiotensinogen into Angiotensin I
ACE turns Angiotensin I into Angiotensin II
Angiotensin II activates Adrenal cortex which makes Aldosteron

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12
Q

What does Angiotensin II do?

A 
Increases sympathetic activity
Increases Na, Cl, K and water retention
causes aldosterone production 
Arteriolar vasconstriction
Activate pituitary gland to make ADH which increase water absorption
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13
Q

How do ARB’s work?

A

medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels.

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14
Q

How do ACE’s work?

A

They inhibit the angiotensin-converting enzyme, an important component of the renin-angiotensin-aldosterone system.

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15
Q

What are the Endothelins?

A

Family of peptides (ET-1, ET-2, ET-3)
Potent vasoconstrictors
Influence Na+ and water homeostasis

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16
Q

What is hypertension

A

Sustained, elevated blood pressure

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17
Q

What is primary hypertension

%?

A

is high blood pressure that does not have a known cause.
90-95% of people

aka essential or idiopathic

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18
Q

secondary hypertension

A

is high blood pressure where we know the cause

Renal, Endocrine, Neoplastic, Neurologic, Cardiovascular

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19
Q

When does Hypertension occur?

A

Onset typically between 20-50 y.o.

Most common diagnosis made in family practice (U.S.)

Estimated > 50 million Americans

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20
Q

Prevalence

A

total number of cases of a disease in an existing population

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21
Q

Incidence

A

number of newly diagnosed cases.

22
Q

What are symptoms of HTN?

A

Asymptomatic

23
Q

What are signs of HTN

A

2 elevated readings on 2 different visits

24
Q

Symptom

A

subjective evidence, something a patient feels, describes

25
Q

Sign

A

objective evidence, something observed or measured

26
Q

Etiology (what causes) HTN

A

Genetics, Age

27
Q

What are factors that can cause hypertension

A 
Increased body mass
Insulin resistance
High alcohol intake
High sodium intake
Sedentary lifestyle
Low K+ or Ca++ intake
Stress
28
Q

What are some factors that can cause high blood pressure?

A
  • Oral contraceptive
  • Inadequate Sleep
  • Frequent analgesic use (particularly in females)
  • High red meat intake
  • High lead lvels
29
Q

What is Framingham Disease Risk ?

A

The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual.

30
Q

What are the Framingham Disease Risk Factors

A 
Total Cholesterol greater than 240
HDL less than 40
Smoking
Elevated SBP
Age 
SEx
31
Q

What are JNC 8 Guidelines

A

Greater than 60 treat to 150 over 90
Age under 60 treat to 140 over 90
Adults with CKD or diabetes 140 over 90

32
Q

JNC 8 Guidelines: Initial treatment

General nonblack population

A

Thiazide-type diuretic
Calcium channel blocker (CCB)
Angiotensin converting enzyme inhibitor (ACEI)
Angiotensin receptor blocker (ARB)

33
Q

JNC 8 Guidelines: Initial treatment

General black population

A

Thiazide-type diuretic

CCB

34
Q

JNC 8 Guidelines: Initial treatment

Adults with CKD

A

Chronic Kidney Disease

ACEI or ARB

35
Q

JNC 8 Guidelines Hypertension Management

A

If not reached in 1 month, increase dose or add on drug from a different class

If goal not reached with 2 drugs, may add and titrate

If goal not achieved with 3 drugs, may use drugs from other classes, or refer to specialist

36
Q

Why not use ACEI and ARB together

A

Does pretty much same thing.

37
Q

Medications for Hypertension

A 
Thiazide-type diuretics
ACE inhibitors
Angiotensin II Receptor blockers
Calcium channel blockers
Beta Blockers*
38
Q

Problems with Beta Blockers?

A

For diabetes can mask low blood sugar warnings

39
Q

Diet Recommendations for Hypertension

A

Emphasize vegetables, fruits, whole grains, low-fat dairy, poultry, fish, legumes, nontropical vegetable oils and nuts

Limit sweets, sugar-sweetened beverages, red meats

Lower sodium intake (

40
Q

Activity Recommendations for Hypertension

A

Engage in aerobic physical activity
3 to 4 times a week
lasting on average 40 minutes per session
moderate to vigorous intensity

41
Q

Weight loss for hypertension

A

Can help a lot

10 kg weight loss can low SBP 6 DBP by 4.6

42
Q

What are some reasons to self moniter HTN

A

Monitor at different times, different circumstances (whitecoat)
Monitor effects of medications

43
Q

Renin

A

secreted in kidneys in response to glomerular underperfusion or reduced NaCl. Converts angiotensinogen to angiotensin I

44
Q

Angiotensin I-

A

rapidly converted to angiotensin II by ACE

45
Q

Angiotensin II

A

potent vasoconstrictor. Also causes the release of aldosterone

46
Q

Aldosterone

A

hormone which causes resorption of Na+ and water in the tubules of the kidney

47
Q

Bradykinin

A

vasodilator inactivated by ACE

48
Q

Nitric oxide-

A

vasodilator in vascular endothelial cells

49
Q

Endothelin

A

vasoconstrictor in vascular endothelial cells

50
Q

Atrial natriuretc peptide-

A

secreted in atria in response to increased blood volume. Causes increased Na+ and water excretion in kidneys

Pharmacy Practice 720 Year 1 Term 1 (11 decks)

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