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A. Blood Pressure
1. What is Blood Pressure?
a.k.a: Arterial Pressure the pressure exerted by the circulating volume of blood on the walls of the arteries and veins and on the chambers of the
heart
pressure exerted by the blood on the walls of a blood vessel
2. Types of Blood Pressure
a. Systole pressure exerted by the heart to pump out blood
contraction of the heart driving blood into the aorta and pulmonary arteries
refers to the upper number, in mmHg
ventricular contraction
b. Diastole pressure when the heart is at rest; exerted against the walls of the blood vessels
period within contractions of the atria or the ventricles during which blood enters the relaxed chambers from the systemic circulation and
the lungs
refers to the lower number, in mmHg
ventricular relaxation
Normal: 120/80 Range:
3. Hydrostatic equation
According to the hydrostatic equation, arterial blood pressure (BP) is directly proportional to the product of the blood flow (CO) and the
resistance to passage of blood through precapillary arterioles (PVR).
BP = CO x PVR
*Cardiac Output volume of blood ejected from the left ventricle/right ventricle into the aorta/pulmonary trunk each minute. Cardiac output equals
the stroke volume (volume of blood ejected by the ventricle during each contraction) multiplied by the heart rate (number of heartbeats per
minute)
CO = SV x HR
*Peripheral Vascular Resistance force of the blood pressure; the opposition to blood flow due to friction between blood and the walls of blood
vessels. (size of BV lumen, blood viscosity, total BV length)
4. Classification of Blood Pressure by JNC (Joint National Committee)
Systole Diastole
Normal 120 80
Prehypertension 121 - 139 81 89
Stage 1 140 - 159 90 99
Stage 2 160 100
5. Regulation of BP
Organs involved include: heart, blood vessels, ANS-SANS
Neural Regulation of Blood Pressure
a. Baroreceptor Reflexes - a sensory receptor located in the aorta, internal carotid arteries (found in the neck that supplies blood in the
brain), and other large arteries in the neck and chest; regulate BP
Stimuli BP Baroreceptors CV Center (+)inotropy-F of contraction SV & HR BP
(+)chronotropy-HR PVR
(+)dromotropy-conduction of impulse
(+)bathmotropy-excitability,sensitive impulse
change in body position particularly form sitting to standing position blood will rush below the heart detected by baroreceptors
b. Chemoreceptor Reflexes - a sensory receptor that monitor the chemical composition of blood, are located close to the baroreceptors of
the carotid sinus and arch of aorta
Diuzid
Urilzid
ThalitoneTenoretic
(+Atenolol)
Natrilix
Zaroxolyn
Loop Diuretics ototoxicity
hyperuricemia
acute hypovolemia
hypokalemia
hypomagnesemia
Furosemide
Torsemide
Bumetanide
Ethacrynic acid
Metazolide
Lasix
Fretic
Frusema
Demadex
Bumex
BurinexFontego
Edecrin
Potassium-sparing Diuretics gastric upset
gynecomastia
menstrual irregularities
hyperkalemia
nausea
lethargy
mental confusion
Spirinolactone
Eplerenone
Aldactone
Inspra
2. Sympatholytics
aka anti-adrenergics (targets the SANS)
MOA ADR Agents Brand Name
-Blockers
Types:
a. Cardioselective
b. Non-cardioselective
Blocks / receptors
preventing the reaction of
catecholamines
CO by (-)inotropy,
chronotropy, dromotropy,
bathmotropy
BP
renin = angiotensinogen
to aldosterone
hypotension
bradycardia
arrhythmia
bronchospasm
dyspnea
sedation
HDL
fatigue
insomnia
sexual dysfunction
Acebutolol
Atenolol
Carvedilol
Labetalol
Metoprolol
Nadolol
Propranolol
Timolol
Sectral
Tenormin
Coreg
Carvid
Normodyne
Trandate
Neobloc
Corgard
Inderal
Hemangeol
InnoPran
Blocadren
-Blockers
DI: Sit for 10-15 min before
getting up to avoid postural
hypotension
Best given at HS
Inhibit/block asdrenergic
receptors at vascular
tissues (blood vessels)
causing vasodilation
PVR
BP
orthostatic hypotension
edema
bradycardia
lightheadedness
syncope
HA
reflex tachycardia
salt and water retention
Prazosin
Terazosin
Doxazosin
Phentolamine
Phenoxybenzamine
Minipress
Hytrin
Cardura
OraVerse
Regitine
Dibenzyline
Centrally-acting
agonists
Blocks sympathetic
outflow in the brain stem
to cause vasodilation
PVR
BP
sedation
drowsiness
hemolytic anemia
bradycardia
constipation
dry mouth
edema
Clonidine with renal dse
Methyldopa PIH
Guanfacine
Guanabenz
Catapres
Kapvay
Jenloga
Aldomet
Aldoclor
Medopa
Intuniv
Tenex
Estulic
Wytensin
Adrenergic Neuron Depletes norepinephrine depression (CI to Px with Reserpine
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Blocker from circulation
depression)
sexual dysfunction
(libido)
orthostatic hypotension
angina
bradycardia
3. Agents that suppress RAAS
MOA ADR Agents Brand Name
ACE Inhibitors
prils
Inhibits conversion of
Angiotensin I to Angiotensin
II to Aldosterone
hyperkalemia
dry cough
angioedema
proteinuria
dysgeusia
ACE: rash, fever
ARB: diarrhea
Benazepril
Captopril
Enalapril
Fosinopril
Lisinopril
Moexipril
Quinalapril
Ramipril
Trandolapril
Lotensin
Capoten
Vasotec
Epaned
Monopril
Zestril
Prinivil
Univasc
Accupril
Altace
Mavik
ARBs
sartans
Inhibits release of renin so
no conversion of
angiotensinogen into
aldosterone
Candesartan
Eprosartan
Irbesartan
Losartan
Olmesartan
Telmisartan
Valsartan
Blopress
Atacand
Candez
Teveten
Aprovel
Avapro
Cozaar
Losart
Benicar
Micardis
Diovan
4. Calcium Channel Blockers
usually non-selective since it affects all muscles
MOA ADR Agents Brand Name
Dihydropyridines
Inhibits entry of Ca
2+
Inhibit rxn with contractile
CHONs into myocardial and
vascular cells to promote
vasodilation
Also cause relaxation of
other cells skeletal and
smooth muscles
Constipation
Weakness
Periopheral edema
Reflex tachycardia
(-)inotropy can lead to HF
Amlodipine
Felodipine
Isradipine
Nicardipine
Nifedipine
Nimodipine
Nisoldipine
Norvasc
Amvasc
Plendil
Dynacirc
Cardene
Adalat
Procardia
Nifediac
Nimodin
Nymalize
Sular
Non-dihydropyridines
Diphenylalkylamine
Verapamil
Benzothiazepines
Diltiazem
Diltiazem
Verapamil
Dilzem
Cardizem
Dilacor
Isoptin
Covera-HS
Calan
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5. Vasodilators
MOA: acts directly on blood vessels (arteries and veins) to PVR leading to BP
Brand Name Notes Specific ADR General ADR
Hydralazine Apresoline
Drug that undergoes
acetylation polymorphism
which is a part of Phase II
metabolism
Rapid/slow acetylators
Drug-induced SLE
Type II allergic reactions
postural hypotension
epinephrine reversal
reflex tachycardia
palpitation
HA
arrhythmia
peripheral neuropathy
edema
Minoxidil Loniten
Hyoertrichosis
Hirsutism
Diazoxide Proglycem
Hyperstat
Inhibits insulin release from
the pancreas
Hyperglycemia
Fenoldapam Corlopam
Nitroprusside = enzyme
rhodanase, liver metabolize
to inactive substance
Rhodanase ]= metabolize
to toxic subs
*Thiocyanate has the
tendency to accumulate in
the blood causing
methemoglobinemia
(0xidize)
Reducing agent:
Methylene blue urine blue
CN toxicity
Antidote: Na2S2O3