HYPERTENSION 2

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Author:
ssilvis
ID:
194696
Filename:
HYPERTENSION 2
Updated:
2013-01-26 20:49:04
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HYPERTENSION
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Description:
Anti-hypertensive medications
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  1. Classifications of HTN
    1.  optimal BP
    2.  Prehypertension
    3. HTN stage 1-2-3
    • 120/80
    • 130/89
    • 140/90 (one med)
    • 160/100 (one or two meds)
    • 180/110 or greater
  2. CV mortality is more closely related to SBP OR DBP?
    SBP
  3. Hypertensive crisis-
    Marked or shapr increase in  DBP to 120mm Hg
  4. Hypertensive urgency-
    • No end organ damage evident
    • Can reduce BP over hours to days
  5. Hypertensive emergency-
    • End organ damage
    • BP needs decrease within several min to hours
  6. Where are the pressure sensitive neurons located?
    Aortic arch and carotid sinus
  7. Where are the Alpha-1 receptors located?
    Smooth muscle cells within walls of arterioles in  skin, mucosa, viscera, kidneys and within walls of veins- causes vasoconstriction to increase BP.
  8. Where are the Beta-1 receptors located?
    Cells of SA node and AV node.  Increase HR, conductivity, force of contraction and increase CO which increases BP.
  9. 3 things that stimulate Renin secretion?
    • 1.  Decrease in NaCl transport in the ascending limb  of the loop of Henle.
    • 2.  Decrease pressure or stretch within the renal afferent arteriole (baroreceptor mechanism).
    • 3.  Sympathetic NSstimulation of renin secreting cells via  B1 adrenoreceptors.

    RENIN SECRETION IS INHIBITED BY THE OPPOSITE OF THE THE ABOVE FACTORS.
  10. STEPS OF rENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
    • 1.  Low BP detected by juxtaglomuerular cells in renal afferent arterioles.
    • 2.  Renin release by renal affernt arterioles.
    • 3.  Renin stimulates production of Angiotensin I.
    • 4.  Angiotensin I turns into Angiotensin II
    • 5.  ATI (brain, renal, nyocardial, vascular, and adrenal tissue) and ATII (brain, adrenal medulla, and uterine tissue) receptors stimulated.
    • 6.  Sympathetic stimulation of cardia system- direct vasoconstriction, increase epinephrine release from adrenal medulla, and increase in sympathetic activity.
    • 7.  Increased release of aldosterone which stimulates Na and K pumps in renal tubules.
    • *HCTZ and metolazone
    • *MOA- decreases plasma volume
    • *Lowers BP 10-15 mm Hg in most pts
    • *Sometimes used with vasoldilator or sympathomimetic drugs.
    • *Decrease potassium, increase uric acid, increase glucose, increase lipid levels, decrease magnesium levels.
  11. DIURETICS- THIAZIDES
    2.  CLORTHALIDONE (HYGROTON)
    • *Decreases potassium, increase uric acid, increase glucose, increase lipid levels, decreace mag levels
    • * 1-2 times more potent than HCTZ for BP

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