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robbypowell's version from 2016-10-24 23:11

Hypertension

Question Answer
According to Joint National Commission report ____ million ppl in the US are are affected by HTN80 million
BP Classification of <120 / < 80?Normal (recheck in 2 years)
BP Classification of (120-139) / (80-89)Pre-hypertension (recheck in a year)
BP Classification of (140-159) / (90-99)Stage 1 hypertension (confirm within 2 months)
BP Classification of (>160) / (>100)Stage 2 hypertension (evaluate or refer to MD within 1 month)
For this with blood pressure > _____ / ______ need medical eval/tx within 1 week depending on clinical situation and complications> 180/110
Metabolic syndrome/ syndrome X = inc HTN that is an early sign of ______diabetes
______ syndrome aka syndrome ____ is increased hypertension that is an early sign of diabetesMetabolic syndrome/Syndrome X (This is an important cause of PREHYPERTENSION readings)
The 2 determinants of increased BP are ____ _____ and ____ _____Cardiac Output & Peripheral Resistance
____ ____ is determined by Force of Contraction * Stroke VolumeCardiac Output
Stroke volume is influenced by ______, contractility of heart, and resistance type (peripheral?)Preload (volume)
Determinants of preload are _____ functionKidney ( bc it causes venous rate)
Determinants of Heart Rate: ______ vasomotor center and ________ centers control Heart RateMedullary vasomotor center; Cardiac centers
Peripheral Vascular resistance: decreasing BV diameter by 1/2 will increase resistance by a factor of _____16
_______ acts as an anti-hypertensive by inhibiting ReninAliskiren ***
_______ receptors are important for cardio meds bc their antagonism is mechanism of anti-ARR, anti-AP, and anti-HTN'sB-Adrenergic
Can affect vasculature (peripheral) ___-adrenergic antagonists such as ______A1-antagonists, such as Prazosin
T/F: Many pathways regulate BP, so targeting more than 1 pathway (via diff meds) can get additive/synergistic effectTrue
ACE is found where?lungs and vascular beds (especially lungs)
AT-1 receptor main effects are ______: stimulates aldosterone secretion (losartan, valsartan are blockers)Vasoconstriction
_______ blockers dec vasoconstriction, Na retention, and aldosterone secretionAT1-R blockers (losartan & valsartan)
What class of HTN drugs that cause dry cough?ACE inhibitors
What class of HTN drugs cause angioedema, neutropenia, bone marrow depression*, COUGH**, dysgeusia**, LICHEN PLANUS**ACE inhibitors
ACE inhibitors can react with ______ over the long-termNSAID's
2 Anti-hypertensive drug classes that are good for diabetic nephropathyACE Ihibitors and AT1R Blockers (both protect kidney by decreasing albumin loss)
Calcium channel blockers are mainly used for _____ HypertensionRenin (aka salt-sensitive) (mainly seen in african americans)
Which adrenergic receptors are found in the heart, and so targeted by some drugs to affect HR?Beta-1 receptors
list 2 centrally acting antiadrenergicsClonidine (A2 agonist) and methyldopa (prodrug)
Methyldopa is a prodrug that gets converted to a-methyldopa and then to ___________ (similar effects as clonidine)a-methylnorepinephrine
List 2 A1 selective adrenergic blockersPrazosin, Doxazosin; (block A1 recep in arterioles/venules)
List 2 Postganglionic sympathetic blockersGuanethidine (false NT, inhibits release of NE) & Reserpine (not used anymore** bc can cause clinical depression and sedation)
What postganglionic sympathetic blocker Can cause postural hypotension, diarrhea, impaired ejaculation?Guanathedine
This drug is often given with diuretics because the kidney doesn't excrete as well when BP is lowHydralazine (vasodilator)
Which Postganglionic Sympathetic blocker is not used anymore because it can cause sedation and depression?Reserpine
the combination of epinephrine and what adrenergic blocker that starts with a P results in Hypotension (epinephrine reversal)Prazosin (alpha 1 blocker)
the combination of epinephrine and what adrenergic blocker that starts with a P results in HypertensionPropanolol (non-selective Beta blocker)
memorize

Initial mono therapy for hypertension

Question Answer
no other relevant conditions and patient is Non-black (4 classes of drugs)Thiazides, ACE inhibitors, Angiotensin Receptor Blockers or Calcium Channel Blockers
no other relevant conditions and patient is Black (2 classes)Thiazides or Calcium Channel Blockers
Hypertension and Chronic Kindey disease for non-black patientACE-Inhibitor or Angiotensin Receptor blocker (same for all ethnicities)
Hypertension and Chronic Kindey disease for black patientACE-Inhibitor or Angiotensin Receptor blocker (same for all ethnicities)
Diabetes and Hypertension, black patientACE-Inhibitor or Angiotensin Receptor blocker (same for all ethnicities)
diabetes and hypertension for nonblack patientACE-Inhibitor or Angiotensin Receptor blocker (same for all ethnicities)
memorize

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