Antihypertensive Medications Quiz

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Questions and Answers

What are the two stages of systemic hypertension according to the text? Briefly explain each stage.

Stage 1 systemic hypertension is characterized by a blood pressure range of 130/80 to 139/89, while stage 2 systemic hypertension is defined by a blood pressure of 140/90 or higher. Stage 1 indicates mild hypertension, while stage 2 represents more severe hypertension.

What are the management strategies for primary hypertension mentioned in the text? Provide examples of lifestyle modifications and medications.

The management strategies for primary hypertension include lifestyle modifications such as diet, exercise, weight reduction, smoking cessation, and salt restriction, along with medications such as thiazide diuretics. These medications help decrease vascular volume and tone, while lifestyle modifications aim to reduce risk factors and improve overall health.

What anesthesia implications are mentioned for patients with systemic hypertension? How should the anesthesia team approach patients with systemic hypertension?

The text mentions that anesthesia implications for patients with systemic hypertension include assessing pre-existing conditions and routine medications, evaluating the control of hypertension, and being aware of any recent changes in status or medications. The anesthesia team should assess the patient's status, including the date of their last visit, recent changes in status or medications, and results. It is important to monitor and manage systemic hypertension effectively to ensure safe perioperative care.

Explain the initial therapy options for essential hypertension and mention a potential side effect of thiazide diuretics.

The initial therapy for essential hypertension includes thiazide diuretics, calcium channel blockers, ACE inhibitors, ARBs, and beta blockers. Thiazide diuretics can lead to decreased potassium levels, requiring supplemental potassium. Signup and view all the answers

Why are beta blockers not routinely used as first-line treatment for hypertension, and what are some of their potential side effects?

Beta blockers are not routinely used as first-line treatment for hypertension due to potential side effects. They are indicated for long-term treatment of coronary artery disease and heart failure. Side effects of beta blockers include bradycardia, heart block, bronchospasm, claudication, and masking of hypoglycemia. Signup and view all the answers

What are the specific considerations related to the use of alpha-1 receptor blockers and alpha-2 agonists in the management of hypertension and anesthesia?

Alpha-1 receptor blockers like prazosin and terazosin result in vasodilation and have specific side effects such as orthostatic hypotension and fluid retention. Alpha-2 agonists like clonidine are used for severe hypertension and may be continued until the time of surgery, but abrupt discontinuation can lead to rebound hypertension. Both alpha-1 blockers and alpha-2 agonists have specific pharmacokinetics, cardiovascular effects, and side effects that need to be considered in the management of hypertension and anesthesia. Signup and view all the answers

What are the two relevant classes of pulmonary vasodilators mentioned in the text?

PDE 3 inhibitors and PDE 5 inhibitors Signup and view all the answers

Describe the mechanism of action of nitrovasodilators.

Nitrovasodilators work by generating NO throughout the vasculature, inducing vasodilation in precapillary resistance arterioles. Signup and view all the answers

What is the toxicity associated with inhaled NO, and why is monitoring for arterial line and cyanide accumulation necessary for nitrodilators like Sodium Nitroprusside (SNP)?

Toxicity of inhaled NO includes increased methemoglobin levels, rebound arterial hypoxemia, and pulmonary edema upon discontinuation. Monitoring for arterial line and cyanide accumulation is necessary for nitrodilators like SNP due to their direct-acting peripheral vasodilation causing relaxation of arterial and venous vascular smooth muscle. Signup and view all the answers

What is the mechanism of action of sodium nitroprusside (SNP) and how does it lead to vasodilation?

Sodium nitroprusside (SNP) interacts with oxyhemoglobin to form methemoglobin and releases cyanide and nitric oxide (NO). NO activates the enzyme guanylate cyclase, resulting in increased intracellular cGMP. cGMP inhibits calcium entry into vascular smooth muscle cells and increases calcium uptake by smooth endoplasmic reticulum (SER) to produce vasodilation. Signup and view all the answers

What are the organ-specific effects and toxicities associated with sodium nitroprusside (SNP)?

Organ-specific effects of SNP include cardiovascular effects such as tachycardia, increased contractility, and coronary steal, renal effects leading to decreased renal function, hepatic effects being largely maintained, cerebral effects increasing cerebral blood flow and volume, pulmonary effects decreasing PaO2, and hematological effects inhibiting platelet aggregation and increasing bleeding time. Toxicities include cyanide toxicity, which can lead to tissue anoxia and lactic acidosis, and thiocyanate toxicity, which can cause symptoms such as fatigue, tinnitus, and neurotoxicity. Signup and view all the answers

How does nitroglycerin (NTG) differ from sodium nitroprusside (SNP) in terms of mechanism of action, clinical use, and contraindications?

Nitroglycerin (NTG) generates nitric oxide (NO) which stimulates the production of cGMP to cause peripheral vasodilation. It primarily acts on venous capacitance vessels and large coronary arteries, leading to peripheral pooling of blood and decreased cardiac ventricular wall tension. NTG is used for angina due to vessel spasm or atherosclerosis, and for controlled hypotension. Contraindications for NTG include hypertrophic obstructive cardiomyopathy and severe aortic stenosis. Unlike SNP, NTG is not recommended in patients with hypertrophic obstructive cardiomyopathy or severe aortic stenosis due to the potential adverse effects on venous pooling and syncope. Signup and view all the answers

In the context of nitroglycerin and isosorbide dinitrate, what are the clinical uses and potential adverse effects of these medications?

Nitroglycerin and isosorbide dinitrate are used for the treatment of myocardial ischemia, volume overload in right heart failure, and systemic hypertension. Adverse effects may include methemoglobinemia, orthostatic hypotension, and reflex sympathetic nervous system stimulation. Signup and view all the answers

Explain the mechanism of action of hydralazine and its potential limitations in certain patient populations.

Hydralazine is a direct systemic arterial vasodilator that hyperpolarizes smooth muscle cells and activates guanylate cyclase to vasorelax. It is not recommended in coronary artery disease or myocardial ischemia due to its potential to cause reflex sympathetic nervous system stimulation, which may increase heart rate and myocardial contractility, thereby increasing oxygen demand without increasing supply. Signup and view all the answers

What is the order of medications to decrease blood pressure, and what are the specific mechanisms of action for each medication?

The order of medications to decrease blood pressure is Esmolol (beta-blocker), Labetalol (alpha-beta blocker), and Hydralazine (direct arterial vasodilator). Esmolol acts as a beta-blocker, Labetalol acts as an alpha-beta blocker, and Hydralazine acts as a direct arterial vasodilator. Signup and view all the answers

What is the mechanism of action of fenoldopam, and what are its effects on blood pressure and organ perfusion?

Fenoldopam is a dopamine type 1 receptor agonist that causes systemic arterial dilation by increasing cAMP. It increases renal blood flow, urinary output, and splanchnic blood flow. Its effects are mediated by baroreflex and it has a rapid onset of action. Signup and view all the answers

Explain the potential adverse effects and clinical considerations associated with the use of fenoldopam.

Fenoldopam may cause increased intraocular pressure and is not recommended for patients with glaucoma. It works on dopamine type 1 receptors in the kidneys, causing dilation of the renal arteries and decreasing resistance to increase urinary output and renal blood flow. Signup and view all the answers

What are the key differences between ACEIs and ARBs in terms of their effects and side effects?

ACEIs and ARBs both target the renin-angiotensin-aldosterone system to lower blood pressure, but they have different mechanisms of action. ACEIs block the conversion of angiotensin I to angiotensin II, leading to vasodilation and increased sodium excretion. They also block the breakdown of bradykinin. ARBs, on the other hand, block the binding of angiotensin II to its receptors. In terms of side effects, ACEIs can cause cough, upper respiratory congestion, and allergic-like symptoms due to increased bradykinin levels, while ARBs do not cause cough. Signup and view all the answers

What are the specific indications for using ACEIs in the treatment of various conditions?

ACEIs are indicated as first-line treatment for systemic hypertension, congestive heart failure (CHF), and mitral regurgitation. They are also safer for diabetics and can delay the progression of diabetic renal disease. Signup and view all the answers

Explain the different subtypes of calcium channel blocking drugs and their specific effects on the cardiovascular system.

Calcium channel blocking drugs have different subtypes, including dihydropyridines and non-dihydropyridines. Dihydropyridines, such as nifedipine and amlodipine, are potent vasodilators and safe in heart failure and conduction defects. Non-dihydropyridines, like verapamil and diltiazem, are less potent vasodilators and have negative inotropic and chronotropic effects, making them more suitable for antiarrhythmic patients. Signup and view all the answers

Flashcards

What is the mechanism of action of ACEIs?

Angiotensin-converting enzyme inhibitors (ACEIs) block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduces blood pressure by decreasing peripheral vascular resistance.

How do ARBs reduce blood pressure?

Angiotensin II receptor blockers (ARBs) directly block the binding of angiotensin II to its receptors in the vascular smooth muscle, leading to vasodilation and lower blood pressure.

What conditions are ACEIs particularly effective for?

ACEIs are especially effective in treating hypertension related to high renin levels, making them the first choice for this condition. They are also a primary treatment for congestive heart failure and mitral regurgitation.

What is the advantage of ACEIs for diabetic patients?

ACEIs are safer for patients with diabetes as they delay the progression of diabetic kidney disease.