Questions Flashcards
JNC normal BP
< 120 and < 80
JNC PreHTN
120-139 or 80-89
JNC Stage 1 HTN
140-159 or 90-99
JNC Stage 2 HTN
>160 or >100
How should you treat stage 1 HTN?
Thiazide
How should you treat stage 2 HTN?
Thiazide + ACEi
What is target BP for HTN treatment?
< 140/90
Name risk factors associated with HTN
Male, smoker, glucose 102-125, obesity, FH, age (men > 65), dyslipidemia
How to treat african americans with HTN
CCB and diuretic
How to treat pregnant women with HTN
methyldopa, BB, vasodilators
How to treat children/adolescents with HTN
lower doses, same drugs as adults
JNC recommendations for combination choice
BP >20/10 above treatment goal, includes a diuretic, caution in elderly - combinations can mask side effects
How does hexamethonium work?
block Ach at nicotinic receptors at sympathetic and parasympathetic autonomic ganglia, reduce arteriolar and vasomotor tone, can paralyze you = DIE!
Name the effects of the ganglionic blockade
Sympathetic: arterioles and veins, Parasympathetic: heart, GI tract, bladder
How does reserpine work?
NT reuptake blockade - can lead to sedation, tremors - only used in 3rd world countries
How does guanethidine work?
inhibits NE release - can cause HOTN - GONE!
What do alpha-1 receptors mediate?
vasoconstriction
What do Beta-1 receptors mediate?
tachycardia (BB work here)
What do Beta-2 receptors mediate?
vasodilation, bronchodilation
How can BP be affected by the SNS?
Blocking beta-1 receptors, blocking peripheral alpha-1 receptors, triggering central alpha-2 receptors
What happens after blocking beta-1 receptors?
reduce HR and renin release
What happens after blocking peripheral alpha-1 receptors?
vasodilation, decreased peripheral resistance
What happens when you trigger central aplhpa-2 receptors?
reduce sympathetic outflow of heart
How do BB work?
reduce renin, decrease beta-1 activation = decreased CO
Who do you use BB in?
younger pts, pts with cardiac disease
Are BB effective at primary prevention of HTN?
No
How are BB excreted/metabolized?
Renally (adjust if CrCl <35), Hepatic - first pass effect with oral drugs
What are side effects of BB?
can penetrate BBB - lethargy, confusion, nightmares, bradycardia, hypotension, AV conduction block, bronchoconstriction, hypoglycemia, increased LDL, decreased HDL
Name the 3 BB you need to know
Metoprolol ER (Lopressor), Carvedilol (Coreg), Nebivolol (Bystolic)
Name a non-selective BB
Propanolol
Name a selective BB
Metoprolol
Name a BB that aids in alpha-1 blockade
Labetolol. Carvedilol