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2060 Pharmacology > Module 13 Hypertension > Flashcards

Module 13 Hypertension Flashcards

1
Q

Blood Pressure

A
  • Force against artery walls
  • Heart pumps blood through body
  • Measured with sphygmomanometer
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1
Q

Hypertension

A
  • Elevated arterial blood pressure
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2
Q

Accurate BP Measurement

A
  • Seated for 5 minutes
  • No caffeine/nicotine 30 mins prior
  • Feet flat on floor
  • Arm elevated to heart level
  • Measure both arms 5 mins apart
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3
Q

Hypertension Diagnosis

A
  • 3 blood pressure measurements
  • Each 2 weeks apart
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4
Q

Systole

A
  • Contraction of heart
  • Top number
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5
Q

Diastole

A
  • Heart fills with blood
  • After contraction/ejection
  • Bottom number
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6
Q

Prehypertension Range

A
  • 120-139 systolic
  • 80-89 diastolic
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7
Q

Stage 1 Hypertension

A
  • 140-159 systolic
  • 90-99 diastolic
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8
Q

Stage 2 Hypertension

A
  • 160+ systolic
  • 100+ diastolic
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9
Q

Primary Hypertension

A
  • No known cause
  • Majority of cases
  • 90% of people over 55
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10
Q

Secondary Hypertension Causes

A
  • Kidney disease
  • Hyperthyroidism
  • Pregnancy
  • Erythropoietin
  • Pheochromocytoma (adrenal tumour)
  • Sleep apnea
  • Contraceptive use
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11
Q

Hypertension Consequences

A
  • Increased morbidity & mortality
  • Myocardial infraction
  • Kidney failure
  • Stroke
  • Retinal damage
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12
Q

BP Determinants

A
  • Cardiac output x peripheral resistance
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13
Q

CO Determinants

A
  • Heart rate, contractility
  • Blood volume
  • Venous return
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14
Q

Peripheral Resistance Determinants

A
  • Arteriolar constriction
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15
Q

Blood Pressure Regulation

A
  • Sympathetic NS
  • Renin-angiotensin-aldosterone system (RAAS)
  • Renal regulation
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16
Q

Sympathetic Nervous System (SYN)

A
  • Fight/flight response
  • Maintain homeostasis
  • Baroreceptor reflex for BP regulation
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17
Q

Baroreceptors

A
  • Aortic arch & carotid sinus
  • Sense blood pressure
  • Relay to brainstem
  • Rapid response
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18
Q

Baroreceptor Reflex Low BP

A
  • Brainstem sends impulses along SYN neurons
  • Stimulate heart
  • Increase CO
  • Vasoconstriction (smooth muscle)
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19
Q

Baroreceptor Reflex High BP

A
  • Decrease sympathetic activity
  • Decrease CO
  • Vasodilation
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20
Q

Renin-Angiotensin-Aldosterone System (RAAS)

A
  • Protein hormones
  • Blood pressure/volume regulation
  • Electrolyte balance
  • Long term response
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21
Q

RAAS Role

A
  • Affects kidney & vascular smooth muscle
  • Target of BP lowering drugs
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22
Q

RAAS Formation

A
  • Angiotensinogen
  • Renin
  • Ang I (inactive)
  • Ang converting enzyme (ACE)
  • Ang II (active)
  • Aldosterone/ADH
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23
Q

Renin

A
  • Formation of Ang I from angiotensinogen
  • Rate limiting step in Ang II formation
  • Juxtaglomerular cells of kidney
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24
Q

Increase Renin Release

A
  • Decrease blood volume
  • Low blood pressure
  • Beta 1 receptor stimulation (juxtaglomerular cells)
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25
Q

Angiotensin Converting Enzyme (ACE)

A
  • Convert inactive Ang I to active Ang II
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26
Q

Angiotensin II Function

A
  • Potent vasoconstrictor (bind to receptor)
  • Stimulates aldosterone release from adrenal cortex
  • ADH release from posterior pituitary
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27
Q

Aldosterone Function

A
  • Acts on kidneys
  • Increase Na+ retention
  • Increase H2O retention
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28
Q

Antidiuretic Hormone (ADH) Function

A
  • Also known as vasopressin
  • Acts on kidneys
  • Increase H2O retention
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29
Q

Renal Regulation of BP

A
  • Decrease in BP causes increase in H2O retention
  • Increase in H20 retention causes increase blood volume
  • Increase blood volume causes increased CO
  • Increased CO causes increase BP
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30
Q

Non-Drug Hypertension Treatment

A
  • Decrease body weight
  • Restriction of sodium intake
  • Physical exercise
  • Potassium supplementation
  • DASH diet
  • Smoking cessation
  • Alcohol restriction
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31
Q

Mechanisms of Obesity causing Hypertension

A
  • Increased insulin secretion
  • Increased reabsorption of Na+
  • Increased H20 absorption
  • Higher blood volume
  • Increase SYN activity
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32
Q

Sodium Intake Restriction

A
  • Increased salt levels cause increase H2O reabsorption
  • Increase in blood volume & pressure
  • Kidney regulates salt, eliminating extra in urine
33
Q

Physical Exercise

A
  • Decrease fluid volume
  • Decrease levels of plasma catecholamines (epinephrine)
  • Pairs with sodium restriction & weight loss
34
Q

Potassium Supplementation

A
  • Inversely correlated with BP
  • Decrease BP
  • Increase Na+ excretion
  • Decrease renin release
  • Vasodilation
  • Don’t mix with ACE inhibitors
35
Q

DASH Diet

A
  • 14 days for results
  • Rich in fruits, vegetables
  • Low fat dairy
  • Lean meats
  • Whole grains
36
Q

Smoking Cessation

A
  • Elevates BP
  • No direct link in causing hypertension
  • Risk for cardiovascular disease
37
Q

Alcohol Restriction

A
  • Excessive consumption increase BP
  • Decrease medication response (antihypertensive)
  • Less than 14 (men)/9 (women) drinks per week
38
Q

Hypertension Medication SItes

A
  • Vascular Smooth muscle
  • RAAS
  • Brainstem
  • Heart
  • Kidney
39
Q

Vascular Smooth Muscle

A
  • Ca+ channel blockers
  • Thiazide diuretics
40
Q

RAAS

A
  • Beta blocker
  • Renin inhibitors
  • ACE inhibitors
  • ARB
  • Aldosterone receptor antagonists
41
Q

Brainstem

A
  • Alpha 2 antagonists
42
Q

Heart

A
  • Beta blockers
  • Ca+ channel blockers
43
Q

Kidney

A
  • Thiazide diuretics
  • Loop diuretics
  • K+ sparing diuretics
44
Q

Diuretics

A
  • Blood Na+/Cl- reabsorption in nephron
  • Prevent H2O reabsorption
  • Promotes excretion of all
45
Q

Loop Diuretics

A
  • Largest BP decrease
  • Blood Na+/Cl- reabsorption
  • Ascending loop of henle
  • Situations of rapid fluid loss
46
Q

Conditions for Loop Diuretics

A
  • Edema
  • Severe hypertension
  • Severe renal failure
47
Q

Adverse Effects of Loop Diuretics

A
  • Hypokalemia (K+ into blood)
  • Hyponatremia
  • Dehydration
  • Hypotension
48
Q

Thiazide Diuretics

A
  • Most common treatment (work on own)
  • Less diuresis than loop diuretics
49
Q

Mechanisms of Thiazide Diuretics

A
  • Block Na+/Cl- reabsorption in distal tubule
  • Decrease vascular resistance
50
Q

Adverse Effects of Thiazide Diuretics

A
  • Hypokalemia
  • Dehydration
  • Hyponatremia
51
Q

K+ Sparing & Aldosterone Antagonists

A
  • Minimal BP lowering
  • Use with other diuretic
  • Don’t combine with ACE/renin inhibitors
  • Inhibiting aldosterone receptors in collecting duct
  • Increase Na+ excretion
  • Increase K+ retention
52
Q

Beta Blockers

A
  • Blocking cardiac beta 1 receptors
  • Blocking juxtaglomerular cell beta 1 receptors
  • Suffix “olol”
53
Q

Cardiac Beta Receptor 1 Block

A
  • Catecholamines bind to cardiac beta receptors
  • Decrease CO
  • Decreases BP
54
Q

Beta 1 Receptors on Juxtaglomerular Cells Block

A
  • Decrease renin release
  • Decreasing RAAS vasoconstriction
55
Q

1st Gen Beta Blockers

A
  • Non-selective blockade
  • Inhibit beta 1 (heart & juxtaglomerular)
  • Inhibit beta 2 (lung)
56
Q

2nd Gen Beta Blockers

A
  • Selective blockade of beta 1 receptors
57
Q

Adverse Effects of Beta 1 Blockers

A
  • Bradycardia
  • Decrease CO
  • Heart failure
  • Hypertension/excitation (abrupt withdrawal)
58
Q

Adverse Effects Non-Selective Beta Blockers

A
  • Bronchoconstriction
  • Hepatic & muscle glycogenolysis inhibition
59
Q

Angiotensin Converting Enzyme Inhibitors (ACEI)

A
  • Decrease Ang II production
  • Inhibit bradykinin breakdown
  • Suffix “pril”
60
Q

Ang II Decrease

A
  • Causes vasodilation
  • Decease blood volume
  • Reduces CO & peripheral resistance
61
Q

Bradykinin Breakdown Inhibition

A
  • Causes vasodilation
62
Q

Adverse Effects of Ang II Decrease

A
  • Hypotension (1st dose emphasis)
  • Hyperkalemia
63
Q

Adverse Effects of Bradykinin Increase

A
  • Persistent cough
  • Angioedema
64
Q

Angiotensin Receptor Blockers (ARB)

A
  • Block Ang II binding to AT1 receptor
  • Cause vasodilation
  • Decrease aldosterone release
  • Increase Na+/H2O excretion
  • Suffix “sartan”
65
Q

ARB Adverse Effects

A
  • Angioedema (less risk than ACEI)
  • Hyperkalemia
66
Q

Direct Renin Inhibitors (DRI)

A
  • Bind to renin
  • Block angiotensinogen to Ang I conversion
  • Limit RAAS pathway
  • Decrease BP
67
Q

DRI Adverse Effects

A
  • Hyperkalemia
  • Persistent cough/angioedema (low)
  • Diarrhea
68
Q

Calcium Channel Blockers

A
  • Block movement of Ca++ into cell
  • Heart/smooth muscle cells
  • Decrease contraction
69
Q

Dihydropyridine Calcium Channel Blockers

A
  • Decrease Ca++ into smooth muscle/arteries
  • Vasodilation/relaxation
  • Suffix “dipine”
  • No action on heart
70
Q

Adverse Effects of Dihydropyridine Blockers

A
  • Flushing
  • Dizziness
  • Headache
  • Peripheral edema
  • Reflex tachycardia
  • Rash
71
Q

Non-Dihydropyridine Calcium Channel Blockers

A
  • Block Ca++ in smooth muscle & heart
  • Vasodilation of arteries
  • Decrease CO
72
Q

Adverse Effects of Non-Dihydropyridine Blockers

A
  • Constipation
  • Dizziness
  • Flushing
  • Headache
  • Edema
  • May compromise cardiac function
73
Q

Centrally Acting Alpha 2 Agonists

A
  • Bind & activate receptors in brainstem
  • Decrease sympathetic activity in heart & vessels
  • Decrease CO & peripheral resistance
74
Q

Adverse Effects of Alpha 2 Agonists

A
  • Drowsiness
  • Dry mouth
  • Hypertension (abrupt withdrawal)
75
Q

Treatment Algorithms

A
  • 140/90mmHg target BP
  • 130/80mmHg target Bp for diabetes/kidney disease
  • Slow disease progression by lowering BP
76
Q

Prehypertension Algorithm

A
  • Lifestyle modifications
  • Thiazide diuretic
77
Q

Stage 1/2 Hypertension Algorithm

A
  • Lifestyle modification
  • Thiazide diuretic
  • Add ACEI, ARB, BB, CCB
78
Q

Moderate Renal Disease/Diabetes Algorithm

A
  • Lifestyle modifications
  • Thiazide diuretic
  • ACE/ARB
79
Q

Severe Renal Disease Algorithm

A
  • Lifestyle modification
  • Loop diuretic
  • ACE/ARC

2060 Pharmacology (18 decks)

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