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Pharm Exam > Hypertension Cards > Flashcards

Hypertension Cards Flashcards

1
Q

What is hypertension?

A

High blood pressure (pressure on blood vessels).

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2
Q

Hypertension is ______ cardiovascular disease.

A

Hypertension is the most common cardiovascular disease

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3
Q

What percent of Canadian adults are diagnosed with hypertension?

A

23% of canadian adults have hypertension

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4
Q

Risk factors of hypertension include… (4)

A

Genetic factors, environmental factors, stress, diet

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5
Q

Hypertension can cause…

A

blood vessel damage, renal failure, heart disease, strokes

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6
Q

Treatment for hypertension will…

A

slow blood vessel damage, decrease morbidity and mortality

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7
Q

What is the equation for blood pressure?

A

BP = CO x PVR

BP - blood pressure

CO - cardiac output

PVR - peripheral vascular resistance

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8
Q

The 4 main players in blood pressure control are…

A

arteries, veins, the heart, and the kidneys.

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9
Q

The arteries control blood pressure by…

A

controlling resistance of blood out of the heart

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10
Q

Veins control blood pressure by

A

acting as a capacity to return blood
(veins can expand to hold more blood)

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11
Q

The heart controls blood pressure by…

A

cardiac output and cardiac rate

(rate of beats and volume moved)

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12
Q

Kidneys control blood pressure by…

A

Directly influencing the volume of blood in the body

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13
Q

Baroreceptors are responsible for?

A

Regulation of blood pressure on a short-term basis.

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14
Q

Baroreceptors are found in the _____ and ____.

A

found in the carotid artery and aorta

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15
Q

Baroreceptors monitor BP by monitoring the “___” of blood vessels.

A

the stretch.

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16
Q

Increased stretch of blood vessels leads to…

A

Increased baroreceptor firing

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17
Q

Decreased stretch of blood vessels leads to…

A

decreased baroreceptor firing

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18
Q

In order to raise blood pressure, baroreceptors will stimulate the ___ and reduce activity in the ___

A

Stimulate the Sympathetic NS and reduce PSNS activity

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19
Q

In order to lower blood pressure, baroreceptors will stimulate the ___ and reduce activity in the ___

A

stimulate the PSNS and reduce activity in the SNS

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20
Q

Increased SNS activity…

A

typically raises heart rate

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21
Q

Increased PSNS activity…

A

usually lowers heart rate.

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22
Q

The kidney controls __-__ blood pressure.

A

The kidney controls long term blood pressure

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23
Q

How do the kidneys control blood pressure?

A

Through blood volume and vascular tone

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24
Q

When blood pressure in the renal arteries drops, the kidneys begin to produce ___

A

The kidneys produce renin when blood pressure drops.

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25
Q

What does renin do?

A

Renin is an enzyme which converts angiotensinogen into angiotensin 1 which is further converted to angiotensin 2 by ACE.

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26
Q

What are the steps which turn angiotensinogen into angiotensin II?

A

Angiotensinogen -> angiotensin I (catalyzed by renin released from kidneys )

Angiotensin I -> Angiotensin II (catalyzed by ACE)

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27
Q

What is ACE (kidney blood pressure enzyme)

A

ACE is the angiotensin-converting enzyme which converts Angiotensin I -> Angiotensin II

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28
Q

Renin production can be stimulated by ___ or ___

A

Renal arterial pressure decrease or SNS stimulation of B1 receptors in the kidneys can produce renin.

*This makes sense because SNS stimulation typically raises blood pressure

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29
Q

What is aldosterone?

A

Aldosterone is a hormone secreted by the adrenal gland. It is released in the presence of Angiotensin II

30
Q

What does aldosterone do?

A

Aldosterone increases sodium retention and water retention in the kidneys. This increases blood volume.

31
Q

What is the ideal blood pressure?

A

90 - 120 over 60 - 80

90-120/60-79

32
Q

What is a pre-hypertensive blood pressure?

A

120-130/60-79

33
Q

What are stage 1 and stage 2 hypertension BPs?

A

Stage 1: 130-139/80-89

Stage 2: 140/90 or higher

34
Q

What are the goals of antihypertensive therapy?

A
  • Decrease blood pressure to prevent organ damage
  • Balance between risk of drug toxicity and not treating the issue
  • done through monotherapy or combined therapy
35
Q

In the central nervous system, ___ neurons regulate BP

A

adrenergic neurons regulate blood pressure in the CNS

36
Q

Stimulating alpha 2 receptors in the CNS will ____ NE release.

A

alpha 2 receptors are generally inhibitory receptors. So NE release is reduced.

37
Q

What are sympatholytics?

A

Drugs that act on, and reduce activity in the sympathetic nervous system.

38
Q

What is an example of a centrally acting sympatholytic?

A

Clonidine is an Alpha 2 agonist which will reduce NE in the CNS, this reduces SNS activity which will reduce blood pressure.

39
Q

What are the adverse effects of using centrally-acting sympatholytics?

A

alpha 2 agonists in the CNS can cause bradycardia, constipation, and sedation/impaired concentration.

40
Q

What are peripherally acting sympatholytics?

A

Beta-blockers and alpha-blockers.

41
Q

What are the 2 beta blocker peripheral sympatholytics?

A

Propanolol (non-selective) and Metoprolol (selective beta 1)

42
Q

How does blocking b1 receptors influence blood pressure?

A

Blocking b1 receptors in the heart reduces cardiac output (CO) which reduces BP

Blocking b1 receptors in the Juxta-glomerular region of the kidneys reduces renin release.

43
Q

What are the toxicities associated with beta-blockers used to treat hypertension?

A

Bradycardia, due to b1 antagonism

All side effects associated with b2 antagonism (when non-selective b1 blockers (propranolol) are used)

44
Q

All vasodilators ____, some also ___.

A

All vasodilators relax arterial smooth muscle, some also relax venous smooth muscle.

45
Q

What’s the main caveat of vasodilators?

A

Baroreceptors and the renin-angiotensin system will compensate for the effects.

46
Q

Due to the compensatory effects of BRs and the renin-angiotensin system…

A

vasodilators work best when paired with an additional anti-hypertensive medication which oppose those systems.

47
Q

Sodium nitroprusside dilates arterial and venous vessels by…

A

Diffusing NO into endothelial cells which leads to increased production of cGMP which causes muscle relaxation.

48
Q

Sodium nitroprusside is given ___ for ____ because it is _____

A

Sodium nitroprusside is given IV for emergencies because it is “short-acting”

49
Q

Verapamil is a vasodilator which inhibits ____.

A

Verapamil is a vasodilator which inhibits Ca+2 influx into arterial smooth muscle, leading to muscle relaxation.

50
Q

What is the issue with verapamil?

A

It also inhibits cardiac Ca2+ channels leading to bradycardia

51
Q

What does aldosterone do?

A

It increases NA+ reabsorption in the distal tubule and collecting tubule (Water follows salt)

52
Q

What are the 2 angiotensin inhibitors?

A

Enalapril and Losartan

53
Q

What is enalapril?

A

Enalapril inhibits the ACE enzyme. This prevents the conversion of Angiotensin I to Angiotensin II.

54
Q

What are the side effects of Enalapril?

A

Cough, hypotension, hyperkalemia, dizziness, headache

55
Q

What is Losartan?

A

Losartan is an ARB, an angiotensin receptor blocker. Prevents the binding of angiotensin II which increases blood pressure.

56
Q

What are the side effects of Losartan?

A

Same as Enalapril without the cough

hypotension, hyperkalemia, dizziness, headache

57
Q

What are diuretics?

A

Diuretics reduce blood pressure.

Diuretics prevent fluid buildup in the body (they make you pee by depleting Na+ levels.

58
Q

What is hydrochlorothiazide?

A

Hydrochlorothiazide is a medium potency diuretic. It can be used to cure mild-moderate hypertension

59
Q

What is Furosemide?

A

Furosemide is a powerful diuretic, it can be used to cure severe hypertension either alone or with a sympatholytic and vasodilator.

60
Q

____ inhibitors enhance the effect of diuretics

A

ACE inhibitors enhance diuretics.

Angiotensin II stimulates aldosterone which promotes NA+ and Water reabsorption.

61
Q

Specifics of hydrochlorothiazide.

A

Hydrochlorothiazide is a thiazide diuretic

Absorbs well orally, is cheap and effective.

62
Q

What are the toxicities of hydrochlorothiazide?

A

Hypokalemia (potassium deficiency), gout, hyponatremia (dehydration)

Hypokalemia is bad for people suffering from arrhythmias, acute myocardial infarction (heart attack), and people taking digitalis

Digitalis is a medication which influences heart rhythm.

63
Q

Specifics of furosemide

A

Furosemide is a loop diuretic, meaning it prevents NaCl reabsorption in the loop of Henle

Rapid and short-acting, it is usually used for severe hypertension and pulmonary edema (fluid in lungs)

64
Q

What are the toxicities of furosemide?

A

Same as the toxicities of thiazide diuretics but can also cause dose-dependent ototoxicity (hearing loss)

  • Hypokalemia, gout, hyponatremia
65
Q

What are some non-medical treatments for hypertension?

A

Low salt diet, weight loss, exercise.

66
Q

Initial monotherapy for hypertension often looks like…

A
  1. A thiazide diuretic if mild or moderate
  2. ACE inhibitors or ARBs
    3.Ca2+ channel blockers
  3. Beta-blockers
  4. Alpha-blockers
67
Q

Monotherapy is better because it is…

A

Simple, more compliance, low incidence of toxicity

68
Q

Stepped therapy is used when…

A

Hypertension is more severe or cant be treated with one drug.

Drugs are added in a stepwise fashion until optimal BP reached.

69
Q

What is the treatment order of combination/stepped therapy for hypertension?

A
  1. Lifestyle changes
  2. diuretics
  3. ACE inhibitor/ARB
  4. Calcium channel blocker
  5. Sympathilytics/vasodilators
70
Q

What is the problem with combination therapy?

A

Patient compliance is low due to price, number of meds, and side effects.

71
Q

How is patient compliance with hypertension therapy raised?

A

Fixed-dose combinations are available.

These increase compliance but we can’t titrate individual drug doses.

Pharm Exam (11 decks)

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