Week 4:Cardiovascular-Renal Drugs: Antihypertensive Agents/ ACE, ARBs, CCBs, Direct Renin Inh.

Question 1

patients in whom no specific cause of hypertension can be found are said to have ______ hypertension.

Answer 1

essential or primary

Question 2

patients with a specific etiology for their hypertension are said to have ______ hypertension.

Answer 2

secondary hypertension

Question 3

pt with labile HTN appears more likely than normal controls to have blood pressure elevations after what?

Answer 3

salt loading

Question 4

formula for BP

Answer 4

CO x PVR = BP

Question 5

parameters for normal blood pressure:

Answer 5

systolic: <120mmHg
and
diastolic: <80 mmHg

Question 6

parameters for elevated blood pressure:

Answer 6

systolic: 120-129mmHg
and
diastolic: <80mmHg

Question 7

parameters for Stage 1 hypertension:

Answer 7

systolic: 130-139 mmHg
or
diastolic: 80-89 mmHg

Question 8

parameters for Stage 2 hypertension:

Answer 8

systolic: >140 mmHg
or diastolic: >90 mmHg

Question 9

Physiologically, in both normal and hypertensive individuals, BP is maintained by moment-to-moment regulation of CO and PVR, exerted at what 4 anatomic sites:

Answer 9

arterioles, post-capillary venules , heart, and kidney

Question 10

the kidney contributes to the maintenance of BP by regulating the volume of ______ fluid

Answer 10

intravascular fluid

Question 11

are responsible for rapid, moment-to-moment adjustments in blood pressure.

Answer 11

postural baroreflexes

Question 12

In increased BP, baroreceptor activation ______ central sympathetic discharge.

Answer 12

inhibit

Question 13

In decreased BP, baroreceptor activation _______ central sympathetic discharge

Answer 13

stimulate

Question 14

the kidney is primarily responsible for _______-______ pressure control

Answer 14

long term

Question 15

a reduction in renal perfusion pressure causes what to happen? (2)

Answer 15

intra-renal redistribution of blood flow and increased reabsorption of salt and water

Question 16

Decreased pressure in renal arterioles as well as sympathetic neural activity stimulates the production of what?

Answer 16

renin

Question 17

renin increases the production of what chemical?

Answer 17

angiotensin II

Question 18

what does angiotensin II cause to happen in the body? (2)

Answer 18

1. direct constriction of resistance vessels
2. stimulating aldosterone synthesis in the adrenal cortex –> increases sodium absorption and intravascular blood volume

Question 19

_______ is released from the posterior pituitary gland and also plays a role in maintenance of BP through its ability to regulate water reabsorption by the kidneys

Answer 19

vasopressin

Question 20

dietary factors that increase BP:

Answer 20

increase intake of salt
decrease intake of potassium
decrease intake of calcium

Question 21

diagnosis of hypertension is based on what?

Answer 21

repeated, reproducible measurements of elevated blood pressure

Question 22

a potent endothelium-dependent vasodilator and mild diuretic, which may cause a lowering of the blood pressure – works in part my stimulating the release of nitric oxide and prostayclin

Answer 22

bradykinin

Question 23

angiotensin II inhibitors lower BP principally be decreasing what?

Answer 23

peripheral vascular resistance (PVR)

Question 24

ACE inhibitors (-pril) do not result in reflex sympathetic activation and can be used safely in persons with what?

Answer 24

ischemic heart disease

Question 25

ACE inhibitors block the synthesis of what?

Answer 25

angiotensin II

Question 26

angiotensin II has what kind of activity?

Answer 26

vasoconstrictor and sodium-retaining activity, and stimulate aldosterone release

Question 27

ACE inhibitors have been useful in treating patients with _______ because they diminish proteinuria and stabilize renal function. this is valuable in patients with ______.

Answer 27

chronic kidney disease, diabetes

Question 28

ACE inhibitors are also useful in the treatment of HF and treatment after MI. and there is evidence that ACE inhibitors reduce the incidence of ______ in patients with high cardiovascular risk

Answer 28

diabetes

Question 29

_______ can occur after initial dose of ACE inhibitors

Answer 29

severe hypotension

Question 30

with ACE inhibitors, hyperkalemia is more likely to occur in what patients?

Answer 30

patients with renal insufficiency or diabetes

Question 31

what two chemicals are responsible for the cough and angioedema seen with ACE inhibitors.

Answer 31

Bradykinin and substance P

Question 32

captopril when given in high doses to patients with renal insufficiency, may cause what?

Answer 32

neutropenia or protenuria

Question 33

ARBs are _______ ______ of the AT1 angiotensin receptor

Answer 33

competitive antagonists

Question 34

angiotensin receptor blockers provide benefits like those of ACE inhibitors in patients with ___ and _____

Answer 34

HF and chronic kidney disease

Question 35

valsartan in combination with sacubitril is marketed for what?

Answer 35

heart failure

Question 36

CCBs inhibit the entry of calcium into muscle cells through _____ channels

Answer 36

L-Type

Question 37

the ________CCBs have a relatively greater effect on vascular smooth muscle, so are used for hypertension

Answer 37

dihydropridine CCBs

Question 38

the ________ have great effects on the heart and are used for arrhythmias

Answer 38

non-dihydropyridines CCBs

Question 39

the most common side effects of CCBs (headache, dizziness, hypotension) are related to what?

Answer 39

vasodilation

Question 40

CCBs can cause cardiac depression, including:

Answer 40

bradycardia
AV block
cardiac arrest
heart failure

Question 41

renin release from the kidney cortex is stimulated by:

Answer 41

reduce arterial pressure
sympathetic neural stimulation
reduced sodium delivery or increased sodium concentration at the distal renal tubule