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Physio II > Long Term BP Control-Exam 1 > Flashcards

Long Term BP Control-Exam 1 Flashcards

1
Q

What is the main function of long term bp control?

A

Keeps MAP constant over long period; tied into control of body fluid volume

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2
Q

What does increased volume in arteries and veins result in?

A

Pressure in arteries and veins will increase, assuming no change in vascular compliance

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3
Q

What does increased venous return result in?

A

Increased preload, increased SV, increased CO, increased bp; assuming no change in SVR

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4
Q

Small changes in cardiac output can cause what?

A

Large change in blood pressure

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5
Q

5 to 10 % increase in CO can raise MAP from 100mmHg to what?

A

150 mmHg

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6
Q

What is the relationship between CBV and MAP?

A

Increasing CBV will increased MAP

Decreasing CBV will decrease MAP

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7
Q

Fluid Intake = Fluid Output

A

Constant CBV

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8
Q

Fluid Intake > Fluid Output

A

Increased CBV

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9
Q

Fluid Intake < Fluid Output

A

Decreased CBV

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10
Q

Salt Intake = Salt Output

A

Constant CBV

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11
Q

Salt Intake > Salt Output

A

Increased CBV

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12
Q

Salt Intake < Salt Output

A

Decreased CBV

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13
Q

Under normal circumstances, fluid and salt output is controlled by what organ?

A

Kidneys

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14
Q

What is the normal fluid intake?

A

2300 mls /day

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15
Q

What amount of fluid intake is synthesized by oxidation of carbohydrates?

A

200 mls /day

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16
Q

What amount of fluid intake is ingested fluids?

A

2100 mls/ day

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17
Q

What is the normal fluid loss/ output?

A

2300 mls / day

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18
Q

What amount of fluid loss is insensible loss via respiratory tract and skin (not sweat)?

A

700 mls/ day

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19
Q

What amount of fluid loss is sweat?

A

100 mls / day

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20
Q

What amount of fluid loss is feces?

A

100 mls/ day

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21
Q

What amount of fluid loss is urine?

A

1400 mls/ day

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22
Q

Renal Output Equation

A

Output = Filtration - Reabsorption

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23
Q

What factors affect filtration?

A

MAP, Renal Blood Flow, pressure in glomerular capillaries, oncotic pressure in glomerular capillaries

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24
Q

What factors affect reabsorption?

A

Concentration of angiotensin II, aldosterone, ADH (all increase rate of absorption)

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25
What does 50 mmHg on the pressure diuresis curve refelct?
0 Urine Output
26
What does 90mmHg on the pressure diuresis curve reflect?
Normal U/o
27
What does 150 mmHG on the pressure diuresis curve refelect?
U/O over 4x normal
28
What happens short term and long term with increased SVR?
Acute: Change in MAP Chronic: MAP returns to normal, no change in SVR
29
What will happen to the renal function curve if intrarenal vascular resistance is increased?
Shift of the renal function curve to the right which will result in a change in the baseline MAP; problem is change in renal vascular resistance not the change in overall SVR
30
BeriBeri
body does not have enough thiamine (B1)
31
Paget's disease
involves abnormal bone destruction and regrowth, which results in deformity.
32
What does renin start as?
Prorenin
33
Where is prorenin produced/ stored?
Juxtaglomerular cells (walls of afferent arterioles) of the kidneys
34
What causes the splitting of prorenin into renin?
Decrease in pressure
35
Where is renin released?
Lumen of the afferent arterioles; circulates to the rest of hte body
36
How long does renin remain in the blood?
30 to 60 minutes, where it acts on the plasma protein called renin substrate (angiotensinogen) to release angiotensin I
37
What's another name for renin substrate?
Angiotensinogen
38
Angiotensin I
mild vasoconstrictor; produces minimal changes in vascular constriction
39
Where is angiotensin I carried to?
Lungs
40
What happens to angiotensin I when it is carried to the lungs?
ACE mediates formation of angiotensin II
41
Where is ACE present?
Endothelial cells
42
How long does angiotensin II persist before being deactivated by variety of blood/tissue enzymes known as angiotensinases?
Persists for 1-2 minutes
43
Angiotensin II
potent vasoconstrictor of arterioles/ minor constriction of veins Interacts w/ kidneys resulting in increasing salt and water reabsorption Causes adrenal gland to secrete aldosterone
44
What does aldosterone do?
Increases salt and water reabsorption
45
What is the response time of the renin-angiotensin system vasoconstrictor?
20 minutes; will take secondary effect several days for maximal effect
46
Is it easier to excrete water or salt?
Water
47
What is the definition of hypertension?
MAP greater than 110 mmHg Diastolic > 90 mmHg Systolic > 135 mmHg
48
Why does HTN shorten lifespan?
Excess workload on the heart Damage to blood vessels of brain Injury to kidneys
49
What are the causes of HTN?
Volume loading Renin-Angiotensin imbalance Combination volume loading / vasoconstriction
50
Types of HTN
Primary | Essential
51
Goldblatt HTN
Renin-Angiotensin Imbalance Only one kidney and it has a constriction of renal art. Kidney senses decrease in pressure and renin/angio system stimulated
52
Two-Kidney Goldblatt
HTN will occur even if one kidney normal, other kidney has obstruction of renal artery
53
What will happen to the obstructed kidney in two-kidney Goldblatt?
Increases reabsorption of water and salt due to lower pressure in tubular capillaries; release renin resulting in overall increase in angiotensin ii and aldosterone
54
What occurs with renal pressure in two-kidney goldblatt?
Normal in obstructed kidney Higher than normal in non-obstructed kidney B/c angiotensin ii will increase SVR and MAP
55
What happens with salt and water reabsorption in two-kidney goldblatt?
Angiotensin ii and aldosterone will increase salt and water reabsorption for both kidneys
56
What percent of HTN patients have essential HTN?
90-95%
57
What is the cause of essential HTN?
unknown
58
What are the symptoms of essential HTN?
Excess weight gain/ obesity account for large percentage of risk for developing HTN (65 - 75% )
59
What is typically the first line of Tx in essential HTN?
Weight loss/ exercise
60
What are the main characteristics of essential HTN?
Increased CO Increased sympathetic activity (kidneys) Increased levels of angiotensin ii and aldosterone Impairment of renal function
61
Why is there increased CO in essential HTN?
Support extra fat tissue | Support increased metabolic demand of major organs
62
Why is there increased sympathetic activity of kidneys in essential HTN?
Hormone released from fat cells stimulate regions of hypothalamus that provide excitatory stimulation of vasomotor center
63
How much are levels of angiotensin ii and aldosterone increased in obese patients?
2- 3x normal
64
Why is there impairment of renal function in essential HTN?
Requires higher pressure to remove normal amounts of salt and water Must give drugs that improve renal function, can't just decrease MAP
65
Tx for Essential HTN
Lifestyles modifications Vasodilator drugs Drugs that reduce reabsorption of salt and water
66
What is the primary target of vasodilator drugs in essential HTN?
renal arterioles; inhibits sympathetic signals to kidneys, block sympthetic neurotransmitter on renal vasculature and renal tubules, direct relaxation of renal vasculature smooth muscle, block action of renin-angiotensin system
67
Why do you tx essential htn with drugs that reduce resorption of salt and water?
Blocks active transport of sodium in tubules

Physio II (14 decks)

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