Hypertension(Katzung) 1st part lang

Question 1

Bp of 120-135/80-89

Answer 1

Prehypertension

Question 2

Bp of >140/90

Answer 2

Hypertension

Question 3

140-159/90-99

Answer 3

Stage 1

Question 4

> 160/100

Answer 4

Stage 2

Question 5

Starting at what bp pressure does cardiovascular disease risk doubles with each increment of 20/10 mmhg

Answer 5

115/75

Question 6

Patients in whom no specific cause of hypertension can be found

Answer 6

Essential/ primary hypertension

Question 7

Causes o lf hypertension that are amendable to surgical treatment

Answer 7

Renal artery constriction
Coarction of aorta
Pheochromocytoma
Cushing's
Primary aldosteronism

Question 8

Functional variations of the genes of these proteins can cause essential hypertension

Answer 8

Angiotensinogen
ACE
B2 adrenoreceptor
A adducin

Question 9

Formula for BP

Answer 9

BP=CO*PVR

Question 10

Anotomic sites for control of BP

Answer 10

Resistance arterioles
Capacitance venules
Pump output of the heart
Kidney volume

Question 11

Responsible for rapid moment to moment adjustments in bp

Answer 11

Baroreflexes

Question 12

Sympathetic activation of batoreceptor reflex acts through

Answer 12

Arterioles
Heart
Capacitance vessels

Question 13

Decresed pressure in the renal arterioles and decreased sympathetic neural activity through via b adrenoreceptors causes the kidney to release….

Answer 13

Renin

Question 14

Causes direct constriction of resistance vessels. Stimulation of aldosterone synthesis in the adrenal cortex which causes increase renal sodium absorption and intravascular volume

Answer 14

Angiotensin 2

Question 15

Released from the posterion pituitary gland which regulates water reabsorption by the kidneys

Answer 15

Vasopressin

Question 16

Reduces peripheral vascular resistance. Inhibits cardiac function and increases venous pooling.

Answer 16

Sympathoplegic agents

Question 17

Maximal lowering of bp of less than 10 mmhg bust is useful in the long term reduction of renal disease in diabetic persons and reduction of heart failure

Answer 17

ACE inhibitors

Question 18

Reduce mortality after MI and particularly indicated in patients with an infarct and hypertension

Answer 18

B blockers

Question 19

Contribute to vascular resistance by increasing vessel stiffness and neural activity

Answer 19

Sodium

Question 20

Effective in lowering bp by 10-15 mmhg and adequate for treatment of mild to moderate hypertension. In severe hypertension, theses drugs are used in combination with sympathoplegic and vasodilator drugs to control tendency towards Na retention

Answer 20

Diuretics

Question 21

Diminished by sympathoplegic and vasodilator drugs thus vasculature behaves like a inflexible tube

Answer 21

Vascular responsiveness

Question 22

Necessary for severe hypertension when multiple drugs with Na retaining properties are used; renal insufficiency when gfr is less than 30-40 ml/ minute; and cardiac failure and cirrosis in which Na retention is marked

Answer 22

Furosemide ir other powerful diuretics(acts at the loop of henle)

Question 23

Most common adverse effect of diuretics(except for K sparing diuretics)

Answer 23

K depletion

Question 24

Hazardous in patients taking digitalis, in those with chronic arrhythmias and in those with MI or left ventricular dysfunction

Answer 24

Hypokalemia

Question 25

Causes magnesium depletion, impair glucose tolerance and increase serum lipid concentrations. Also increase uric acid concentration and may precipitate gout

Answer 25

Diuretics

Question 26

A steroid associated with gynecomastia

Answer 26

Spironolactone

Question 27

May produce hyperkalemia in patients with renal insufficiency and those taking ACE inhibitors, angiotensin receptor blockers and spironolactone.

Answer 27

K sparing diuretics

Question 28

May cause sedation, mental depression, distirbance in sleep and nightmares

Answer 28

Sympathoplegic drugs that act on CNS

Question 29

Causes effects similar to those of surgical sympathectomy including inhibition of ejaculation and hypotension that is increased by upright posture and after exercise

Answer 29

Sympatheplegic drugs that reduce release of epinephrine

Question 30

Effective in lowering bp in patients resistant to antihypertensive drugs

Answer 30

Renal sympathetic denervation

Question 31

Sympathoplegic agents are most effective in patients when used with these drugs

Answer 31

Diuretics

Question 32

With the exception of clonidine, these drugs are rarely used today

Answer 32

Centrally acting sympathoplegic drugs

Question 33

Antihypertensive action is modulated by stimulation of central a-adrenoreceptors.

Answer 33

Methyldopa(a-methlynorepinephrine, and a-methyldopamine)

Question 34

Antihypertensive action was discovered when it was tested as a nasal decongestant

Answer 34

Clonidine

Question 35

Hypotensive effect is excerted at the a-adrenoreceptors of the medulla. Reduces sympathetic and increases parasympathetic tone producing low bp and bradycardia. It also decreases circulating catecholamine levels.

Answer 35

Clonidine

Question 36

Binds to nonadrenoreceptor site imidazoline which also mediate antihypertensive effects

Answer 36

Clonidine

Question 37

Reduce norepinephrine release and may act on postsynaptic a2 adrenoreceptors to inhibit activity of appropriate neurons

Answer 37

Clonidine and methyldopa

Question 38

Primarily used for hypertension during pregnancy. Reduce bp chiefly by reducing vascular resistance with variable reduction in hr and cardiac output. One potential advantage of this drug is reduction in vascular resitance

Answer 38

Methyldopa

Question 39

Enters the brain via aromatic amino acid transporter and effects can persist for 24 hours

Answer 39

Methyldopa

Question 40

Most common side effect of methyldopa particularly at the onset of therapy

Answer 40

Sedation

Question 41

Long term therapy causes mental lassitude and impaired mental concentration

Answer 41

Methyldopa

Question 42

Use of this drig can cause lactation both in men and women due to increased prolactin levels

Answer 42

Methyldopa

Question 43

Can develop a positive Coombs test and is rarely associated with hemolytic anemia, hepatitis and drug fever.

Answer 43

Methyldopa

Question 44

Bp lowering effects of clonidine are due to

Answer 44

Reduction of cardiac output due to decreased hr. Relaxation of capacitance vessels. Reduction of peripheral vascular resistance

Question 45

Reduces bp in the supine position and only rarely causes postural hypotension

Answer 45

Methyldopa and clonidine

Question 46

Severe hypertension can complicate a massive oversdose

Answer 46

Clonidine

Question 47

Lipid soluble and rapidly enters the brain from the circulation. Anti hypertensive effect is related to blood concentration and must be given twice a day. Increasing the dose of this drug is more effective but also more toxic. A transdermal prep is available

Answer 47

Clonidine

Question 48

Common side effects od clonidine therapy

Answer 48

Sedation and dry mouth

Question 49

Not given in patients who are at risk for mental depression. Concominant administration with tricyclic may block effects of this drug.

Answer 49

Clonidine

Question 50

Withdrawal use of this drug can cause life threatening hypertensive crisis mediated by increased sympathetic nervous activity.

Answer 50

Clonidine

Question 51

Treatment for hypertensive crisis cause by clonidine withdrawal

Answer 51

Reinstitution of clonidine | A and B adrenoreceptor blocking agents

Question 52

Can produce profound sympathoplegia and pharmacologic sympathectomy including marked postural hypotension, diarrhea, impaired ejaculation. It is also too polar to enter the CNS

Answer 52

Guanethidine

Question 53

Replaces norepinephrine at nerve endings. Drugs that block catecholamine uptake including cocaine, amphetamine, tricyclic antidepressants, phenothiazines and phenoxybenzamine block its effects.

Answer 53

Guanethidine

Question 54

Halflife of 5 days

Answer 54

Guanethidine

Question 55

Can produce hypertension in patients taking guanethidine

Answer 55

Sympathomimetic agents

Question 56

Can produce hypertensive crisis by releasing catecholamines in patients with pheochromocytoma

Answer 56

Guanethidine

Question 57

Attenuates antihypertensive effect of guanethidine and can cause severe hypertension.

Answer 57

Tricyclic antidepressants

Question 58

Interferes with vesicular membrane associated transporter(VMAT) resulting in depletion of norepinephrine, dopamine, and serotonin in both PNS and CNS. Chromafgin granules of the adrenal medulla are also depleted by the use of this drug.

Answer 58

Reserpine

Question 59

Readily enters the brain and depletion of cerebral amines causes sedation, mental depression, and parkonsinism symptoms

Answer 59

Reserpine

Question 60

Effects of reserpine for treatment of mild hypertension

Answer 60

Decreased CO and PVR

Question 61

Most of the unwanted effects of reserpine result from the actions of what body parts

Answer 61

GI and Brain