Hypertension and Heart Diseases (Chapter 12) Flashcards
1
Q
most tissues in the body are connected to the sympathetic and parasympathetic NS. what tissue in the body is predominantly sympathetic?
A
adrenal gland
2
Q
how does signal transmission occur in a parasympathetic nerve ?
A
pre-ganglionic nerve releases ach, detected by nicotinic receptors on post-ganglionic nerve.
then, post-ganglionic nerve releases ach, detected by cholinergic receptors on target tissue
3
Q
what are the three types of cholinergic receptors on target tissue ?
A
muscarinic, nicotinic ganglionic, nicotinic neuromuscular
4
Q
how does signal transmission occur in a sympathetic nerve ?
A
pre-ganglionic nerve releases ach, detected by nicotinic receptors on post-ganglionic nerve.
then, post-ganglionic nerve releases NE, detected by adrenergic receptors on target tissue
5
Q
what are the five types of adrenergic receptors on target tissue ?
A
B1 B2 B3 A1 A2
6
Q
what two NT’s do AR’s sense?
A
NE, and E released by adrenal medulla
7
Q
which nerve signal transmission involve ach release- SNS or PNS?
A
both
PNS: released by pre and post- ganglionic nerve
SNS: released by pre-ganglionic nerve
8
Q
explain what happens after NE binds to a B2 AR.
A
B2 AR acts as a G-Protein coupled receptor. Induces a second messenger pathway. It converts ATP to cAMP (second messenger)
9
Q
what does cAMP do ?
A
causes vasodilation in blood vessel smooth muscle
bronchodilation in lungs
suppresses immune system
10
Q
what is the difference between E and NE ?
A
NE comes from everywhere in the body and can specifically target tissues
E comes from adrenal medulla
11
Q
which nerve decreases HR?
A
vagus nerve
12
Q
which nerves increase HR and force of contraction ?
A
sympathetic cardiac nerves
13
Q
which part of the ANS can control both HR and force of contraction ?
A
SNS
14
Q
by how many bpm can the PNS decrease HR ?
A
10 bpm
15
Q
by how many bpm can the SNS increase HR?
A
usually 10 bpm
in a strong SNS response, by more
16
Q
what is the main adrenergic receptor that controls HR?
A
B1
17
Q
what are the two main adrenergic receptors that control BP ?
A
A1
B2
18
Q
what is the main role of A1 AR ?
A
causes vasoconstriction of blood vessel smooth muscle
therefore binding to it can cause BP increase
19
Q
what is the main role of A2 AR ?
A
some vasoconstriction, also regulates NE by negative feedback
(not that important here)
20
Q
what is the main role of B1 AR ?
A
increase HR and contractility
21
Q
what is the main role of B2 AR?
A
increase BP, heart muscle contraction
22
Q
what is the main role of B3 AR ?
A
thermogenesis
23
Q
what NT is BP mostly controlled by ?
A
NE
24
Q
termination of a neural signal can occur in two ways
A
1) promote reuptake of NT
2) promote destruction of NT by enzymes
25
which enzyme inactivates ach ?
cholinesterase
26
which enzyme inactivate NE ?
monoamine oxidase
27
what is the main mechanism of blood pressure increase ?
vasoconstriction via A1 AR on blood vessel walls.
28
what is the main mechanism of HR increase ?
B1 AR binding, increases rate and force of contraction
29
why don't we use parasympathetic drugs to lower HR or to increase HR?
bc these drugs also modify the pre-ganglionic function in the SNS, leading to adverse effects.
30
what is the normal goal of the renin-angiotension-aldosterone system ?
to increase BP
31
what is renin ?
an enzyme which converts angiotensinogen to angiotensin I
32
what is angiotensin converting enzyme
ACE converts angiotensin I to angiotensin II
33
what does angiotensin II do ?
increase BP
34
what are the 2 ways in which angiotensin II increases BP ?
1) induce vasoconstriction by elevating epinephrine and inactivating bradykinin
2) increases sodium and water retention by causing release of aldosterone
35
what does bradykinin cause in the circulatory system ?
vasodilation
36
what is the role of aldosterone ?
it retains water and sodium, therefore increasing BP
37
what is renin release stimulated by (4) ?
decreased blood flow, drop in BP, diminished sodium and water retention, or increased SNS response on renal cells
38
what is renin released inhibited by ?
high blood pressure
| indirect negative feedback
39
what is chronic high blood pressure called ?
hypertension
40
what is essential hypertension ?
if cause of high BP is unknown
41
what is secondary hypertension ?
high BP symptom that something else is wrong
42
what are the guidelines for high BP classification ?
normal: SBP <120 and DBP <80
prehypertension: SBP 120-139 OR DBP 80-89
stage 1 hypertension: SBP 140-159 OR DBP 90-99
stage 2 hypertension: SBP >160 OR DBP >100
43
what are the treatment options for prehypertension
lifestyle modifiction
| drugs not typically given unless there is also kidney disease or diabetes
44
what are the treatment options for hypertension stage I
lifestyle modification
| single drug prescribed
45
what are the treatment options for hypertension stage II
lifestyle modification
| two drugs prescribed in combination
46
what are lifestyle modifications for hypertension that do not do much ? (3)
changing garlic, magnesium, caffeine intake
47
what are 5 lifestyle modification important in hypertension ?
- lose weight
- exercise aerobically
- no smoking
- less alcohol
- more potassium
48
why is it good to have more potassium in diet ?
eating potassium forces salt into urine. as potassium is absorbed, salt and water will go to kidney
49
what are foods really high in potassium ?
avocado, beans, dates, peanuts, baked potatoes with skin, raisins, plain yogurt
50
what are foods with intermediate potassium ?
apricots, banana, carrots, hamburger, salmon
51
what are foods low with potassium ?
apples, asparagus, blueberries, corn, hot dog, peach, peas, pizza
foods high in Na+ basicallt
52
what is angina ?
a chronic heart diease, where coronary arteries cannot supply adequate blood to heart muscles
53
what is ischemic heart disease ?
another word for angina pectoris
54
what are the three kinds of angina ?
chronic stable angina
variant angina
unstable angina
55
what kind of pain is in angina ?
sudden pain behind sternum, radiates to left shoulder and arm, may be in neck and jaw
56
what is the most common form of angina ?
chronic stable angina
57
what is the cause of chronic stable angina ?
atherosclerosis of coronary arteries- partial occlusion and restricted blood flow
58
what is chronic stable angina pain brought on by ?
exercise, can't meet demand of myocardial muscles
59
what do drugs for chronic stable angina do ?
increase O2 to heart muscles, or reduce demand for oxygen
60
what are two other names for variant angina
vasospastic angina
| Prinzmetal's angina
61
what is the main difference between MI and angina ?
in MI the pain doesn't go away
62
what is the main difference between variant and chronic stable angina ?
in variant, coronary artery spasm can happen at any time, not just during exertion
63
what kind of drugs treat variant angina ?
those that increase O2 to heart muscles
64
what is unstable angina ?
angina symptoms come and go regularly or at rest
| changes in severity of pain or pattern of angina compared to normal
65
what is the most life threatening type of angina ?
unstable angina
66
what kind of drugs treat unstable angina ?
lower oxygen demand, increase oxygen delivery to heart muscle
67
what kind of occlusion occurs in myocardial infarction ?
partial or full occlusion
68
what is MI usually due to ?
atherosclerosis
| plaque breaks off and closes off vessels
69
how does exercise reduce risk of MI ?
more branching, more blood vessels therefore less probability that it will get blocked off
70
what symptoms in MI differ from angina ?
vomiting, chest pressure, numbness/tingling in arm, shortness of breath
71
what are 4 risk factors for MI ?
hyperlipidemia
hypertension
smoking
history of angina
72
what medication would be involved in emergency treating MI ?
aspirin to inhibit clotting
| morphine to reduce pain and reduce oxygen demand in heart
73
are heart disease and heart failure the same ?
no
74
what subset of the population has heart failure more
old people
75
what is the mechanism in heart failure
ventricles fail to eject enough blood for body tissues, which means diastolic filling increases
heart gets 2-3 times larger
heart stretched, therefore enlarged. as a compensation, contractility is increased.
constriction of blood vessels to maintain blood pressure.
76
what is another name for heart failure ?
congestive heart failure
77
what are the three primary symptoms of heart failure ?
fatigue
shortness of breath
tachycardia
78
what is the main treatment for heart failure ?
lifestyle changes (less salt, more exercise)
79
what classes of heart failure are allowed or not allowed exercise ?
allowed : I and II
| not allowed : III and IV
80
what exercise is allowed in heart failure ?
low moderate
81
what do beta blockers do ?
competitive inhibitors of the beta adrenergic receptor (are antagonists)
82
why are adverse reactions an issue with beta blockers ?
because the beta-adrenergic receptors are all over the body
83
people suffering from what diseases should not take beta blockers ?
asthmatics
and diabetics: delays recovery from hypoglycemia, and dampen feeling you get when blood sugar is low
84
how do beta-blockers influence HR and force of contraction ?
decrease it
85
how do beta blockers influence on the heart ?
slow the rate of impulses initiated by SA node and the conduction velocity through the AV node
86
how do beta blockers influence renin ?
decrease its release
87
how do beta blockers act on lungs ?
bronchoconstriction
88
how do beta blockers act on liver and muscle ?
inhibit glycogenolysis
89
how do beta blockers act on fat ?
inhibit lipase activation
90
how do beta blockers affect vascular resistance ?
decrease peripheral vascular resistance
91
when is the beta blocker effect the most prominent ?
when adrenergic effect is high, like in exercise or stress
92
what is one downside to using beta blockers in exercise ?
contribute to exercise induced fatigue
93
what is dysrhythmia ?
when HR in a pathological state
94
what diseases can be treated with beta blockers ?
chronic hypertension
some anginas
heart failure
95
how are beta-blockers administered ?
orally
96
how come beta blockers are good for the angina patients ?
because they reduce heart contractions, therefore diminishing oxygen demand on the heart
97
what is the main mechanism of diuretics ?
increase excretion of Na+ and Cl-
98
What does too much Na+ lead to ?
fluid retention and edema
99
why are diuretics good for the heart ?
decrease workload of heart by decreasing blood volume and peripheral vascular resistance
100
what do thiazide diuretics act on ?
act on early distal convoluted tubule of kidney
| increase excretion of Na+, Cl-, K+
101
what do loop diuretics act on ?
act on loop of Henle
| increase excretion of Na+, Cl-, K+
102
what do potassium sparing diuretics act on ?
act on distal convoluted tubule and collecting duct
| prevents K+ loss
103
which diuretic prioritizes K+ preservation ?
potassium sparing diuretics
104
what disease cannot be treated with an angiotensin converting enzyme inhibitor ?
angina
105
what do ACE-inhibitors do ?
decrease angiotensin II production, which decreases aldosterone, vasoconstriction
increases bradykinin, vasodilation
106
what can ACE-inhibitors be combined with ?
beta-blockers and thiazide and loop diuretics
107
what are adverse effects of ACE-inhibitors ?
cough, edema, rashes
108
why cant pregnant people take ACE-inhibitors ?
fetus malformation
109
what do ACE-inhibitors interact with ?
NSAIDs and antacids
110
what do angiotensin II receptor blockers do ?
increase vasodilation
| increase Na+ and water excretion by suppressing aldosterone
111
what drug is often used instead of ACE-I if ACE-I have too many side effects ?
angiotensin II receptor blockers
112
what do calcium channel blockers do ?
prevent calcium from flowing into heart muscle
| prevent heart muscle contraction
113
what are calcium channel blockers approved for ?
hypertension
chronic stable or vasospastic angina
114
what kind of dosage do calcium channel blockers have to have ?
high dosage because subject to first pass effect
115
what do organic nitrates do ?
dilate peripheral smooth muscle
116
which blood vessels are mostly influenced by organic nitrates ?
veins mostly
117
what is the most common way of administering organic nitrates ?
sublingual because first pass effect prevents oral dosing
118
it can be fatal to combine organic nitrates with these three drugs
alcohol
viagra
calcium channel blockers `
119
what is digoxin ?
group of drugs called cardiac glycosides
120
what is digoxin used for ?
treat heart failure by increasing force of contraction
121
what drug increases the effect of digoxin ?
tetracycline
122
what kind of beta-blockers are better ?
B1- blockers because more specific to the heart, less side effects
123
why are calcium channel blockers used with beta-blockers in angina?
if not, reflex tachycardia may occur
124
what is nitroglycerine ?
organic nitrate
125
what s the drug of choice for acute angina attacks ?
nitroglycerine
126
which drug has a burning sensation under the tongue as a side effect ?
nitroglycerine (administered sublingually)
127
what condition can encourage toxicity of digoxin ?
hypokalemia
128
which drug recommended for stage 1 hypertension ? (first line)
thiazide diuretic
129
which drug recommended for stage 2 hypertension ?
| first line and second line
thiazide diuretic and ACE-inhibitor, ARB, or CCB and maybe third drug
130
what is the dosage recommended for antihypertensive drugs?
initial doses low, gradually increase
131
which drug recommended for angina with hypertension ?
b-blockers or CCB
132
which drug recommended for hypertension with history of MI ?
b-blockers, ACE-inhibitors, maybe CCB
133
which drug recommended for hypertension with heart failure ?
ACE-inhibitors, diuretics
134
which drug recommended for hypertension with renal insufficiency ?
ACE-inhibitors, ARB
135
which drug recommended for hypertension with diabetes ?
ACE inhibitor, ARB
136
which drugs contraindicated while pregnant ?
ACE inhibitors, ARB, DRI
137
what medication do black people respond to better ?
diuretics and CCB
138
which drug recommended for chronic stable angina ?
beta-blockers to reduce oxygen demand
| CCB/organic nitrates to increase oxygen supply
139
which drug recommended for variant angina ?
CCB/organic nitrates to increase oxygen supply
140
why are beta-blockers not useful for variant angina ?
oxygen demand isn't increased in variant angina
141
which drugs decrease mortality risk from MI ?
none
142
which drug recommended for acute angina attack ?
nitroglycerin
143
what is the best long term treatment to prevent MI ?
treatment of underlying conditions of hypertension, angina, hyperlipidemia
144
what kind of therapy is recommended to prevent MI?
anti-platelet (low dose aspirin)
145
following MI, what kind of long term therapy is recommended ?
beta-blockers
146
which drug recommended to prevent recurrent MI and heart failure after MI?
ACE-inhibitors
147
which drug recommended for improving survival and symptoms of heart failure ? (3)
ACE inhibitors, beta-blockers, and spironolactone
148
what drug is the cornerstone in therapy for heart failure ?
ACE-inhibitors
149
what kind of diuretics are preferred to be used with ACE inhibitors or beta-blockers to relieve edema in heart failure ?
thiazide
150
which drug recommended for long term use for class II or III heart failure
beta blockers
151
what is spironolactone / Aldactone ?
potassium sparing diuretic, ued in lower doses as an aldosterone antagonist
152
which drug recommended for long term use for class III or IV heart failure
spironolactone
153
which drugs improve symptoms but not survival in heart failure ? (2)
digoxin, diuretics
154
NSAIDs interact with which drugs?
diminish effects of diuretics, beta blockers, ACE-inhibitors
155
exercise intolerance can happen with which drug ?
beta-blockers
156
exercise intolerance can happen with which drug ?
beta-blockers
157
which drug is effective for congested lungs ?
loop diuretic
158
which drug is used to treat hypokalemia and enlarged heart remodelling ?
potassium sparing diuretic
159
what is the antihypertensive drugs ?
diuretics
160
what is a second line antihypertensive drug ?
beta blockers
161
what are 4 drugs of choice for hypertension ?
diuretics, ACE inhibitors, ARB, CCB
162
what symptoms and diseases do thiazide diuretics treat
high BP - hypertension and
| edema- heart failure
163
what symptoms and diseases do loop diuretics treat
high BP- hypertension
| edema and congested lungs- heart failure
164
why are potassium sparing diuretics usually used with other diuretics ?
bc the others promote K+ excretion
165
which drug acts as an aldosterone antagonist
potassium sparing diuretic
166
what is the first line drugs for heart failure ? (3)
ACE inhibitors, beta blockers, diuretics
167
if diabetes exists, what drugs are counter indicated for hypertension ?
beta blockers and calcium channel blocker
168
if diabetic, what are the recommended drugs for hypertension?
```
ACE-I and ARB first
then diuretics (preferably loop)
```
169
which drugs will improve symptoms, but not survival in heart failure ? 2
digoxin and diuretics
170
what are diuretics used for in heart failure ?
relieve edema
171
What is the priority in treating variant angina as opposed to chronic stable? Why?
Chronic stable: increase oxygen supply AND decrease demand
Variant: priority is to increase oxygen supply
Can't decrease demand since demand not that high (not like chronic stable where attacks happen on exertion)
172
What are the three therapeutic goals of unstable angina?
Decrease demand of O2
Increase supply
Decrease persistent pain
173
What are the three therapeutic goals of unstable angina?
Decrease demand of O2
Increase supply
Decrease persistent pain
174
How is MI different from angina?
In MI, ischemia is PERSISTENT and leads to myocardial cell death
175
Explain the stages of heart failure
1) ventricles fail to eject, increased diastolic filling
2) heart enlarges because of all the excess blood
3) heart muscle stretches
4) compensating mechanism- increase in contractility to increase CO
Increase in HR
176
why is there edema in heart failure?
Water retention due to activated renin-angiotensin system!
177
Which drug should be used to treat a dysrhytmia? Why?
Beta blockers bc they slow the rate of impulses in SA and AV node
178
what do betablockers generic name end with
Lol
179
Why is there a reduced release of renin with beta blockers ?
B1 receptor blockade
| Reduces impact of renin-angiotensin system
180
When are beta blockers useful in heart failure ?
They decrease the sympathetic response that is usually elevated in patients with heart failure
181
Why would diuretics help treat edema in heart failure?
They encourage water excretion
182
What are symptoms in hypokalemia?
Muscle fatigue, cramps, dysrhythmia
183
Are potassium sparing diuretics used with ACE-I? Why or why not
No because hyperkalemia is a concern, and they both encourage that
184
Why can ACE-I be better than beta blockers to treat hypertension?
They do not affect automatic cardio responses
| Do not cause sexual dysfunction, hypokalemia, hyperglycemia
185
What is the main adverse effect of ACE-I? Why
Persistent dry cough in 5-20% of patients from the accumulation of bradykinin (less bradykinin inactivation bc renin-angiotensin system inhibited)
186
How do ARB work? how do they not have the same side effects as ACE I?
Prevent response of angiotensin II after it has been produced
Does not affect bradykinin metabolism, therefore no cough
187
what can CCB treat? what are they mostly used for ?
can treat hypertension and angina
mostly for chronic and variant angina
188
for hypertension, what drug do black people respond to better ? worse ?
worse to b-blockers
| therefore use CCB or diuretics
