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CVS > L12: Hypertension And Hypotension Interventions > Flashcards

L12: Hypertension And Hypotension Interventions Flashcards

1
Q

What are the values to diagnose hypertension

A

140/90 +

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2
Q

What are advised to individuals who are just above the hypertension value

A

Change lifestyle such as through diet exercise, alcohol and smoking

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3
Q

What is the equation for arterial blood pressure (ABP)

A

ABP=CO X TPR

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4
Q

Therefore to decrease ABP what can we do

A

Decrease CO

Decrease TPR

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5
Q

In normal situations what is involved to control the blood pressure

A

Baroreceptor reflex
Renin angiotensin and aldosterone
Autonomic control by heart and vessels

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6
Q

What increases the cardiac output

A

Increased SV

Increased HR

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7
Q

How can we increase SV to increase CO

A

Increase venous return by venous constriction

Or increase pre-load volume by increasing blood volume

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8
Q

How can we increase the HR

A

Increase contractility by:
Decreasing PNS via vagus nerve
Increase SNS via pre/post ganglionic fibres

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9
Q

How can we increase TPR

A

Arterial constriction

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10
Q

What causes arterial constriction

A

SNS activity

Angiotensin 2

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11
Q

What guideline do we use to determine the treatment for hypertension

A

NICE guidelines

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12
Q

What are the characteristic of 2 groups that are split into for treating hypertension

A

Individuals younger than 55 years old

Individuals older than 55 years old or are African/Caribbean

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13
Q

What is the first line of treatment of class of drug to treat individuals younger than 55 years old with hypertension

A

Class A

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14
Q

What are class A drugs also known as

A

ACE inhibitors

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15
Q

Name ACE inhibitors

A

Lisinopril

Enalopril

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16
Q

What is the role of ace inhibitors

A

To inhibit the enzyme ACE which usually converts angiotensin 1 to angiotensin 2
Angiotensin 2 causes arterial vasoconstriction and increases the TPR

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17
Q

What is the role of ACE with bradykinin

A

ACE usually causes the degrading of vasodilator kinins such as bradykinin

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18
Q

When we use ACE inhibitors what happens to the levels of bradykinin

A

Increase

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19
Q

How does the ace inhibitor by acting to reduce angiotensin 2 also reduce venous return and CO as well as causing arterial constriction

A

1) Angiotensin 2 is required in making aldosterone
2) Aldosterone causes salt and venous retention
3) With ace inhibitors aldosterone is not produced so venous return decreases as water and sodium become excreted.

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20
Q

What are the side effects of ACE inhibitors

A

Dry cough

Sudden hypotension with diuretics

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21
Q

Why is there a dry cough with ACE inhibitors

A

Bradykinin increases deposits in the lungs causing a dry cough

22
Q

Name another class A drug

A

Angiotensin 2 receptor antagonist

23
Q

What is the mechanism of action of AT2 receptor antagonists i.e ARBs

A

It bins to angiotensin 2 receptors so angiotensin 2 cannot bind to cause its effect

24
Q

What does ARBs cause

A

Reduces arterial constriction and causes a decrease in TPR

25
Q

Does ARBs allow the production of aldosterone

A

Yes because they only block the effect of angiotensin 2 on the vessels not on aldosterone

26
Q

How does ARBS reduces venous return

A

By acting on AT2 receptors on venous so it reduce constriction so venous return is decreased as veins are not squished to pump blood to the heart.

27
Q

When are ARBs used

A

When ACE inhibitors are not tolerated by the patient

28
Q

Wha are the 2 classes of drugs used to treat patients with hypertension who are over 55 years old and/or are African/Caribbean

A

Class C

Class D

29
Q

What are class C drugs

A

Calcium channel blockers

30
Q

What is the mechanism of action of calcium channel blockers

A

To block calcium channels in smooth muscles in the blood vessel as and therefore stop them from contracting
This reduces TPR

31
Q

What are the side effects of calcium channel blockers

A

Affect the GIT activity by decreasing it

32
Q

What are class D drugs

A

Diuretics

33
Q

Where do diuretics act on

A

The kidney nephron

34
Q

What is the mechanism of action of diuretics

A

Increase sodium and water excretion in the urine
This decreases the blood volume
Decrease in blood volume decreases stroke volume and therefore co.

35
Q

What is the 2nd mechanism of diuretics

A

Diuretics can result in arterial vasodilation which decreases TPR.
As sodium is depleted calcium also become depleted so smooth muscles cannot contract.

36
Q

What are the side effects of diuretic

A

Hypokalaemia

37
Q

When do we use drugs that affects the SNS in hypertension

A

As a step 4 line treatments (very last option)

38
Q

Name a drug that decreases the SNS activity

A

Beta adrenoceptor antagonist

39
Q

Name a beta blocker

A

Propanolol

Atenolol

40
Q

What is the mechanism of action of beta blockers

A

Reduce CO by reducing contractility

Decrease renin secretion and therefore angiotensin 2 os vasoconstriction cannot occur and this decreases TPR

41
Q

What are the side effects of beta blockers

A

Bronchospasm due to beta 2 receptors in the lungs

Excercise intolerance

42
Q

Name another drug that affects the SNS activity

A

Alpha 1 adrenoceptor antagonist

43
Q

Name an alpha 1 antagonist

A

Prazosin

Doxazosin

44
Q

What is the mechanism of action of alpha 1 adrenoceptor antagonist

A

Blocks alpha 1 receptors so vasoconstriction cannot occur

This decreases TPR

45
Q

What are the side effects of alpha 1 adrenoceptor

A

Postural hypotension

46
Q

What are the 2 options when people get worsening hypertension despite them being on a drug

A

Increase the dose

Combine therapy

47
Q

How do combine class drugs

A 
Combine them that covers the 2 types 
E.g
A+C
A+D
C+D
48
Q

Why might hypotension occur

A

Haemorrhage
Burns
Shock

49
Q

How do we treat shock

A

Give adrenaline

50
Q

How do we treat chonic hypotension

A

Increase salt intake.

CVS (19 decks)

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