ILE EXAM 1

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what is blood pressure determined by ?

Blood pressure is determined by the cardiac output and the resistance of blood vessels, particularly the diameter of the arteries. It reflects the force exerted by circulating blood on the walls of blood vessels.

heart rate and stroke volume equal ?

cardiac output

what is blood pressure regulation ?

the continuous interaction among the nervous system kidneys vascular tone blood volume and hormonal systems

what do major long term regulators include ?

renal sodium and and water handling and the renin aniotensin aldosterone system or (RAAS)

what does sympathetic activation generally increase ?

heart rate contractility and vascular tone

the symthapthic nervous system is the what ?

major fight or flight branch in your body

what does B1 stimulation in the heart do ?

B1 stimulation increases heart rate and contractility, enhancing cardiac output.

what does A1 stimulation do ?

A1 stimulation causes vasoconstriction, increasing blood pressure and enhancing vascular tone.

what does B1 stimulation in the kidney do ?

B1 stimulation in the kidney increases renin release, which helps regulate blood pressure and fluid balance.

what is parasympathetic activity dominated by ?

by the vagus nerve and this generally slows the heart rate

drugs that block symaptheic effects can do what ?

These drugs can reduce heart rate, lower blood pressure, and decrease cardiac output.

essentail/primary hypertension is

hypertension without a single identifiable secondary cause

what are some componets of multifactoral hypertension ?

age weight smoking, diet, physical activity

pathophysiology commonly invloves what ?

increased vascular resistance and altered renal handling of sodium or fluid

over time elevated pressure can cause ?

increased vascular remodeling and organ damage

hypertenion can be though of as

a chronic condition characterized by consistently elevated blood pressure levels.

secondary hypertension has what ?

an identifiable underlying cause, such as kidney disease or endocrine disorders.

possible causes of secondary hypertenion can include

renal disease , hormonal disorders, and certain medications.

some paitent cases may require you to decide that the hypertension is ?

primary or secondary

what do look for in root causes for HTN 2

condtions and medication

nonmodifiable risk factors include

age, genetics, and family history.

modifiable risk factors would include

lifestyle choices, diet, and exercise.

risk factors matter becuase of

their impact on the development and management of hypertension, influencing both prevention and treatment strategies.

do not treat Bp in a shell

work toward the whole picture

hypertension is often

asymptomatic, making it a silent disease that can lead to serious health complications.

why is routine BP measurements so important

becuase paitents can have high bp and feel totally normal

severe hypertenions can be associated with symptoms of

end organ injury and needs to be evaulated immedatly

absense of symptoms does not mean

absence of risk

when taking bp make sure to document

arm used position cuff size BP values and units

normal bp catigorie is

less than 120 and less than 80

elevated catigore is

120-129 and less than 80

stage 1 catigore is

130-139 and 80-89

stage 2 catiogre is

greater than 140 and 90

long term hypertension increases what ?

the risk of cardiovascular disease and organ damage.

major compications with hypertension can include

heart attack, stroke, kidney failure, and vision loss.

goals for controlling BP should be

realistic safe and individualized

core first line classes are

ACE ARBS thiazide and calcum channel blockers.

first line classes have strong evidence for

reducing cardiovascular events and controlling hypertension.

beta blockers are mostly considered

not first line medications for hypertension treatment, but can be important for specific conditions such as heart failure or arrhythmias.

first line hypertension drugs have a favorable what ?

safety and efficacy profile

different first class drugs can lower BP through

complematary mechanisms

ACE inhibitors include

medications like lisinopril, enalapril, and ramipril, which help relax blood vessels by inhibiting the angiotensin-converting enzyme.

ACE inhibitors decrease

the formation of angiotensin 2

less angiotensin 2 equals

less vasoconstriction and less aldosterone mediated sodium water retention

ACE also decreases the breakdown of

bradykinin

common adverse effects from ACE and ADRS include

cough, hyperkalemia, and angioedema.

ACE inhibitors are contraindicated

for pregnancy

examples of ARBS include

losartan, valsartan, and candesartan and irbesartan

ARBS block what ?

the angiotensin II receptor, thereby reducing vasoconstriction and aldosterone secretion.

ARBS do not inhibit

bradykinin breakdown so cough is generally less common than with ACE inhibitors and there is a lower risk of angioedema.

ARBS provide

RAAS blockade similar in overall efficacy to ACE inhibitors in controlling blood pressure and protecting renal function.

important adverse effects of ARBS include

hyperkalemia and hypotension.

a major contraindication for ARBS is

pregnancy, particularly in the second and third trimesters, due to the risk of fetal harm.

do not routinly combine ACE and ARBS becuase

the risk of increased adverse effects, especially renal impairment and hyperkalemia.

examples of thiazide diuretics

include hydrochlorothiazide and chlorthalidone.

thiazide diaretics act primarliy

at the distal convoluted tubule by inhibiting the sodium-chloride symporter, leading to increased excretion of sodium and water.

thiazide diruetics will

increase urinary sodium water loss and also will lower bp

some common concerns with thiazides are

hypokalemia, hypercalcemia, and dehydration and increased uric acid

with thiazides

glucose and lipid changes can occur particulary wit higher doses

the mechanism connection with thiazides is

the inhibition of sodium chloride reabsorption in the distal convoluted tubule of the nephron.

some examples of DPH calcium channel blockers would be

amlodipine and nifedipine

some examples of NON DPH CCB would be

diltiazem and verapamil

DHPS primaly

relax vascular smooth muscle which equals less vasular resistance

NON DPHS primaliry

have a stronger cardiac effetcs like reducted heart rate and av node conducatiion

non dhp ccbs do ?

they decrease calcium entry in the cardiac tissue and lower the heart rate

some adverese effects from non dhp ccbs include

dizziness, constipation(specificly verapimil), and bradycardia.

avoid inappropriate cominations with other rate slowing drugs becuase of

additive bradycardia and av block risk

some examples of beta blocker would be

metoprolol, atenolol, and propranolol

the B1 blockade does what

It decreases heart rate and contractility which reduces myocardial oxygen demand.

the B1 blockade in the kidney does what

It decreases renin secretion, leading to reduced angiotensin II levels and lower blood pressure.

beta blockers can be highly useful when

a compelling idication exists such as certian cadric conditions

beta blockers are not considered

to be a first line theripudic for hypertension

for beta blockers bradycardia and hypotension are important

does related concerns

nonselective beta blockers can worsen what ?

bronchospasm in certain paitents

for beta blockers some major things to monitor

include heart rate, blood pressure, and signs of heart failure.

some examples of aldosterone antagonists are

spironolactone and eplerenone.

aldosterone antagonist block aldosterone receptors in the

distal nephron

aldosterone antagonist are particualrlly useful in

conditions like heart failure and hypertension, as they promote diuresis and reduce fluid retention.

a major saftey concern with aldosterone antiagonist is

hyperkalemia, which can lead to serious cardiovascular issues.

some examples of major vasodilators are

nitroglycerin, hydralazine, and minoxidil.

major direct vasodialators

directly relax smooth muscle and drecrease vascular resistance, thereby lowering blood pressure.

direct vasodilators are normally reserved for

specific siutations or resistant hypertension rather than a routine first line

direct vasodilators often require what ?

combination therapy to counter compenastory effects

some examples of centally acting alpha antagonist are

clonidine and methyldopa

CAAA do what

reduce sympathetic outflow from the central nervous system.

some adverse effects of CAAAs are

sedation, dry mouth, dizziness and hypotension

clondidine shoudl not be stopped cold turkey because

it can lead to rebound hypertension.

some examples of alpha blockers inculde

prazosin, terazosin, and doxazosin.

alpha blockers block A1 recepotrs in ?

smooth muscle

alpha blockers cause

vasodilation and decreased blood pressure.

some adverse effects of alpha blockers include

orthostatic hypotension, dizziness, and reflex tachycardia.

alpha blockers are generally not considered

first line

different antihypertensive mechaisms can

produce additive BP reduction when combined for effective treatment.

serum creatinine is a mark used to access what ?

kidney function

low sodium equals

hyponatremia

high sodium equals

hypernatremia

low potassium equals

hypokalemia

high potassium equals

hyperkalemia

thiazides can lower

sodium and potassium but mostly potassium

ACES and ARBS can increase

potassium levels in the blood.