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76 Cards in this Set
- Front
- Back
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Which hormones can affect blood pressure?
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Circulating hormone: catecholamines, ANP, renin, aldosterone
Local hormones: autacoids (prostaglandins, nitric oxide, endothelin) |
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Which hormone has been implicated in the genesis of hypertension with phaeochromocytoma?
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catecholamines
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What is phaeochromocytoma?
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A tumor of adrenal tissue, usually at the medulla
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How does defective renal sodium excretion cause hypertension?
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Inhibiting tubular and vascular smooth muscle Na+/K+ase, which elevates intracellular calcium --> vasoconstriction
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What is the BP target with medication for those with hypertension with concomittant diabletes, renal disease or arterial disease?
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<130/80mmHg
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What percent reduction in risk factors for stroke and CHD occur when giving pharmacological intervention to those with hypertension?
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40% less stroke risk, 15% less CHD risk
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What are the two types of calcium channel antagonists?
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dihydropyridines, non-dyhydropyridines
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t/f... Nifedipine-like drugs act exclusively on vascular smooth muscle, lowering BP by vasodilation, whereas verapamil and diltiazem have additional effects on the heart, reducing AV nodal conduction and myocardial contractility.
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true
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What suffix do ACE inhibitors end in?
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pril
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What does angiotensin II do to blood vessels?
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vasoconstrict
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Which ACE inhibitors are not prodrugs?
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captopril, lisinopril
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How are ACE inhibitors are prodrug?
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Need to be converted in the liver to their active diacid metabolite
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When are thiazides contraindicated, and what side effects do they produce?
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metabolic side effects, eg hypokalaemia, hyperglycaemia and hyperuricaemia
avoid in patients with diabetes or gout |
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t/f... thiazides solely reduce BP through natriuresis and diuresis.
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false, also have a direct vasodilatory effect
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How do beta adrenoceptor antagonists lower BP?
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lower cardiac output
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When are beta blockers contraindicated?
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obstructive airway disease, diabetes, peripheral vascular disease
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Name two selective b1 receptor antagonists?
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atenolol, metoprolol
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t/f... clonidine and methyldopa are vasodilators
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false. they decrease sympathetic outflow centrally.
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Name two drugs that are alpha-1 andrenoceptor antagonists, and what their effect is
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prazosin, terazosin: vasodilate
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What changes do the arterial baroreceptor reflex compensate for?
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changes in posture, metabolic activity or external threats triggering sympathetic reactions
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Where are the baroreceptors located?
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carotid sinus and aortic arch
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What are arterial chemoreceptors primarily stimulated by?
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pO2 of arterial blood
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Where do the arterial chemoreceptors mainly detect changes?
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in the low pressure part of the circulation (left and right atria)
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t/f... antidiuretic hormone released during hemorrhage is the work of the arterial chemoreceptors
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true
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What are risk factors for hypertension?
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diet (primarily salt, but also other dietary components such as potassium and fish oils), obesity, ethanol, lack of exercise and stress
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In basic life support, what is the ratio of compressions to breaths?
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30:2
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How might an adrenal tumor cause secondary hypertension?
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overproduction of aldosterone
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What is cardiac arrest?
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no CO
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What is asystole?
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no electrical activity
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What is it called when the heart is beating at 300/min
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ventricular flutter
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What is the emergency treatment for bradycardia with syncope?
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beta1 adrenergic stimulant (isopropyl or noradrenaline), then electrical pacing
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What pharmacological agents are important to consider in taking a history of hypertension?
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oral contraceptive pill, NSAIDs, nasal decongestants, corticosteroids, appetite suppresants, anti-depressant MAO inhibitors, cyclosporin, erythropoeitin
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What are the obligatory tests for suspected hypertension?
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urinalysis (blood, protein, glucose), urine sediment (exam and culture), plasma EUC, LFT, thyroid function, FBC, CXR (heart size, rib notches), ECG
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What do you test for Conn's Syndrome?
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plasma aldosterone/renin ratio
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What are the three largest causes of secondary HT?
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OC pill (40%), renal parenchymal disease (30%), renovascular disease (20%)
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t/f... Transplantation of a kidney from a hypertensive donor into a normotensive recipient does not cause HT
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false, it does cause HT
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What is the inheritance pattern of Liddle's Syndrome?
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autosomal dominant
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How does Liddle's Syndrome cause HT?
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excess reabsorption of Na in the renal tubules, leading to K+ and H+ loss, which causes HT, hypokalaemia, alkalosis and low plasma renin
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What is mild hypertension?
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140-150/90-99 mm Hg
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What are the side effects of ACE inhibitors and why?
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dry cough (bradykinin a substrate for ACE)
increase in serum K+ (less aldosterone) worsen renal function (if already impaired) anaphylaxis (rare - related to bradykinin) contraindicated in pregnancy (2.7x risk foetal malformation) |
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How does angiotensin II increase fluid retention?
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releases aldosterone --> Na+ retention --> fluid retention
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What type of drugs are sartans?
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angiotensin II antagonists
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What angiotensin II (AT) receptor subtypes exist in humans?
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AT1, AT2
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Which is more effective in lowering BP - AT1 antagonists or ACE inhibitors?
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they are equally effective
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t/f... an AT antagonist side effect is dry cough
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false, as bradykinin is able to be metabolised by ACE
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What Ca channels do Ca channel blockers act on, and how does that effect VSMCs?
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L-type. relaxes VSMCs
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What are ca channel blocker side effects?
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peripheral oedema, constipation, decreased CO (--> heart failure)
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How do thiazide diuretics work?
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they block Na+ reabsorption
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Where do thiazides act?
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distal convoluted tubule
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what does thiazide's effect on VSMCs do to TPR?
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lowers peripheral resistance
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What are the side effects of thiazides?
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gout (uric acid), hypercalaemia (Ca2+) hypokalaemia (K+)erglycaemia
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How do beta-adrenoceptor blockers inhibit renin release?
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block CNS sympathetic flow
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What are the side effects of beta blockers?
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bradycardia, muscle fatigue, cold hands and feet, bronchospasm, diabetes (when combined with thiazides)
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How effective is atenolol? and with a diuretic as well?
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50-60% --> 60-80%
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What are contraindications for beta adrenoceptor antagonist?
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asthma, peripheral vascular disease, heart failure (bradycardia)
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What is the sodium restriction for appropriate lifestyle modification for hypertensive patients?
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<4mg/day
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What are the three first line treatments for uncomplicated hypertension?
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ACE inhibitors (or AT blockers), dihydropyridine ca channel blockers, thiazide diuretics (in >65 years)
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When should a second agent be used in hypertension?
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minimal response to single agent, or failure to get down to target BP
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When should drug doses be increased in hypertensive medications?
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after 2nd drug is added, and still not at target BP
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How many patients are on 2+ drugs for their hypertension?
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50-75%
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How is obesity defined in men and women?
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>25% body fat in men, >35% body fat in women
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what is an overweight BMI?
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25-29 kg/m^2
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What is an obese BMI?
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>30 kg/m^2
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How many Australian adults are overweight and obese respectively?
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60% overweight
20% obese |
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How many Australian children are overweight and obese respectively?
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20% overweight
5% obese |
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How does hyperinsulinaemia affect BP and CVD risk?
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BP: it directly increases sympathetic activity.
CVD risk: it decreases adrenal medullary activity --> decreasing HDL cholesterol |
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what happens to leptin as a person becomes more obese?
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leptin levels increase, but the person becomes more insensitive to its effects
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What are the effects of atherogenic dyslipidaemia?
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increased serum triglycerides
increased apolipoprotein B increased small LDL reduced HDL |
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Which cardiomypathy is associated with obesity and why?
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eccentric hypertrophy, due to increased intravascular volume
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What is Sydrome Z?
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Syndrome X + obstructive sleep apnea
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Where is renin released?
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kidney juxtaglomerular cells
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Where does angiotensin II act on the brain, and what does it release?
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posterior pituitary; ADH
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What happens to arterial pressure if intake of salt and water is increased?
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increased arterial pressure
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How can renal sympathetic nerve activity affect the renal function curve?
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increasing renal vascular resistance, increasing sodium reabsorption, increasing renin release
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What is a way of increasing long-term activity of renal sympathetic nerve activity (RSNA)?
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chronic resetting of baroreceptor reflex
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What non-baroreceptor mechanisms could increase long-term RSNA?
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chemoreceptor input from chronic intermittent hypoxia (ie. OSA)
angiotensin II acting on circumventricular organs of the brain (but can't cross blood brain barrier) leptin/obesity: also control sympathetic outflow |
