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Blood Pressure > Hypotension And Hypertension > Flashcards

Hypotension And Hypertension Flashcards

1
Q

What is the most common general cause of hypotension?

A

Loss of blood volume

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2
Q

What are the common ways in which hypotension can occur?

A 
Blood loss due to:
Haemorrhage
Severe burns / sweating
GI tract problems e.g. diarrhoea
Unusual kidney losses
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3
Q

What are the other circumstances, other than blood loss, which can result in hypotension?

A

Allergic reactions
Emotional responses (possibly leading to fainting)
Decrease in cardiac contractility (due to heart attack)

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4
Q

How is hypertension defined?

A

A chronically increased systemic arterial blood pressure.

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5
Q

Between what values of bp is grade one hypertension?

A

140/90 - 159/99 mmHg

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6
Q

Between what values of bp is grade two hypertension?

A

160/100 - 179/109 mmHg

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7
Q

Between what values of bp is grade three hypertension?

A

Greater than 180/110 mmHg

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8
Q

What is the difference between primary and secondary hypertension?

A

Primary hypertension - no known cause though may be linked to genetic and environmental factors
Secondary hypertension - caused by another condition such as kidney damage, endocrine disorders, medications

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9
Q

What are the common treatments of hypertension?

A

ACE inhibitors
Angiotensin II receptor blocker
Beta blocker
Calcium channel blocker

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10
Q

Describe how the myogenic response maintains rate fo blood flow.

A

A rise in pressure in a vessel causes it to distend slightly so that the smooth muscle of the vessel wall is stretched - the muscle responds by contracting (this is the myogenic response), which narrows the vessels, increasing their resistance and restoring blood floe to its original value

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11
Q

How does the myogenic response work?

A

5e myogenic response to stretching depends on the activation of specific mechnorcepctor channels which increase the permeability of the membrane to sodium and potassium ions which leads to depolarisation and contraction of the smooth muscle of blood vessel walls

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12
Q

What is functional hyperaemia?

A

The phenomenon where the metabolic products of a cdll cause vasodilation - these products can be ATP,carbon dioxide and lactic acid for example

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13
Q

80% of patients have primary hypertension rather than secondary hypertension. T/F?

A

False - it is 90%

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14
Q

What are the risk factors for primary hypertension?

A 
Obesity
Increasing age
Low level of fitness
Moderate or high alcohol intake
Metabolic syndromes
Diabetes mellitus
Black ancestry
Poor diet
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15
Q

What are the possible causes of secondary hypertension?

A

Endocrine disorders such as cushings syndrome, conns syndrome and pharochromocytoma
Renal disease
Vascular pathology

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16
Q

What is the effect of chronic hypertension on the heart muscle?

A

The left ventricular wall hypertrophies

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17
Q

What are the possible chronic complications of hypertension?

A 
Atherosclerosis
Stroke
MI
Heart failure
Renal failure
Retinopathy
18
Q

How do beta adrenoceptor blockers act as antihypertensives?

A

The block beta one sympathetic tone on the heart and reduce renin release from the kidney
This leads to a decrease in heart rate and stroke volume which decreases cardiac output and thus blood pressure

19
Q

Give an example of a non selective beta adrenoceptor blocker

A

Propranolol

20
Q

Give an example of a beta one elective beta adrenoceptor blocker

A

Atenolol

21
Q

What are the possible side effects of beta adrenoceptor blockers?

A

Intolerance to exercise
Hypoglycaemia
Vivid dreams
Non selective drugs can exacerbate asthma

22
Q

How do alpha adenoceptor blocks work as antihypertensives?

A

They decrease sympathetic gone in the arterioles by blocking alpha one receptors which decreases total peripheral resistance to decrease blood pressure

23
Q

Give an example of a non selective alpha adrenoceptor blocker

A

Phentolamine

24
Q

Give an example of an alpha one selective adrenoceptor blocker

A

Doxazosin

Prazosin

25
Q

What are the adverse effects of alpha adrnoceptor blockers?

A

Postural hypotension
Loss of sympathetic vasoconstriction
Reflex tachycardia

26
Q

How do ACE inhibitors work as antihypertensives?

A

They reduce the formation of the vasoconstrictor angiotensin II which decreases total peripheral resistance. It prevents an increase in blood volume by the loss of angiotensin II stimulated release of aldosterone and ADH

27
Q

Give examples of ACE inhibitors

A

Captopril

Enalopril

28
Q

ACE inhibitors have the adverse effect of a persistent irritant cough. How does this come about?

A

By the reduced breakdown of bradykinin which activates sensory nerves in the lung tissue

29
Q

What type of angiotensin ii receptor mediates the vasoconstriction and aldosterone releasing reactions of angiotensin II?

A

AT1

30
Q

Give examples of AT1 angiotensin II receptor blockers

A

Candesartan

Losartan

31
Q

What is the advantage if using angiotensin II receptor blockers over ACE inhibitors?

A

They do not have the same persistent irritant cough side effect

32
Q

Give an example of a diuretic used to treat hypertension

A

Benzoflumethiazide

33
Q

How do diuretics act as antihypertensives?

A

The reduce renal reabsorption of sodium and water to decrease blood volume and therefore decrease blood pressure

34
Q

What channels allow calcium entry into cardiac and smooth muscle?

A

L type voltage operated calcium channels

35
Q

How do verapamil and diltiazem work to reduce blood pressure?

A

They bind to and block L type calcium channels on smooth muscle to decrease heart rate and decrease vasoconstriction

36
Q

How does nifedipine work to reduce blood pressure?

A

It binds to an allosteric site of an L type calcium channel to prevent its action on smooth and cardiac muscle and decrease heart rate and vasoconstriction

37
Q

Which calcium channel blocker is most effective on smooth muscle?

A

Nifedipine

38
Q

Which calcium channel blocker is most effective on cardiac muscle?

A

Verapamil

39
Q

Wh at are the adverse effects of calcium channel blockers?

A

Headaches
Constipation
Cardiac dysrhythmias

40
Q

Which drug category should be used as first line treatment for hypertension for a white patient under 55?

A

ACE inhibitor or angiotensin II receptor blocker

41
Q

Which drug category should be used as first line treatment for hypertension for a patient over 55 and/or of Caribbean or African descent?

A

Calcium channel blocker

Blood Pressure (7 decks)

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