Antihypertensive question set 8

Anesthesia Pharmacology Chapter 8: Antihypertensive Drug Practice Questions

Pheochromocytoma:
1. singular adrenal tumor
2. may be found along with thyroidal nodular carcinoma
3. usually associated with above normal intravascular blood volume
4. phentolamine (Regitine) may be used to control blood-pressure prior to definitive surgical intervention
5. beta adrenergic receptor blockade should precede alpha-adrenergic blockade in order to prevent severe hypertension in management of pheochromocytoma
Cardiac function and hypertension:
1. early, possibly subclinical, change: diastolic relaxation anomalies
2. increased left ventricular compliance
3. angina in the absence of coronary vascular disease
4. left ventricular hypertrophy
Useful in management of left ventricular hypertrophy associated with hypertension:
1. phenylephrine (Neo-Synephrine)
2. methoxamine (Vasoxyl)
3. captopril (Capoten)
4. methyldopa (Aldomet)
Methyldopa (Aldomet):
1. parent compound is the active agent
2. associated with an increase in stroke volume and a decrease in heart rate
3. maintenance of renal blood flow
4. associated with a reduction in adrenergic outflow from brain stem
Calcium channel blockade:
1. associate with a reduction in peripheral resistance
2. all calcium channel blockers appear similarly effective for management of mild to moderate hypertension
3. verapamil (Isoptin, Calan) tends to increase myocardial contractility, particularly in patients with preexisting left ventricular dysfunction
Potentiation of depolarizing and nondepolarizing neuromuscular-blocking drug effects:
1. neostigmine (Prostigmin)
2. physostigmine (Antilirium)
3. tetracyclines
4. gentamicin (Garamycin)
5. verapamil (Isoptin, Calan)
Major characteristic hypertensive cardiomyopathy is abnormal ventricular compliance
1. true
2. false
Probably the antihypertensive drug of choice in the treatment of hypertensive patients who have hypertrophic left ventricles
1. drugs such as captopril (Capoten)
2. drugs such as diltiazem (Cardiazem)
3. drugs such as metoprolol (Lopressor)
4. drugs such as phenylephrine (Neo-Synephrine)
5. drugs such as ephedrine
Effect/effects associated with angiotensin II:
1. slow pressor responses
2. vascular remodeling
3. ventricular hypertrophy
4. rapid pressor responses due to increased aldosterone secretion
Example/ examples of inhibitors of angiotensin converting enzyme:
1. losartin (Cozaar)
2. alpha-methyltyrosine
3. enalapril (Vasotec)
4. fosinopril (Monopril)
5. neostigmine (Prostigmin)
Adverse effect/effects: angiotensin converting enzyme inhibitors
1. angioedema
2. profound hypotension
3. dry cough
4. pulmonary fibrosis
5. coronary vasospasms
Predisposing factor/factors for embolic stroke:
1. atrial fibrillation
2. hypertension
3. aspirin use
Watershed stroke:
1. area between anterior & middle cerebral artery
2. associated with hypertensive states
3. linear infarcts
Hypertension: renal effects:malignant nephrosclerosis
1. associated with malignant hypertension
2. may cause renal failure
3. treatment: IV nitroprusside sodium (Nipride)
Renal histological changes associated with malignant hypertension:
1. glomerulitis in the hypercellular glomerulus
2. hyperplastic arteriosclerosis
3. arteriolar fibroid necrosis
Myocardial ischemia: in the perioperative setting -- most likely to occur during:
1. prior to sedative-hypnotic administration in the holding area
2. during intubation
3. after transfer from the recovery room to the patient's in-hospital room
4. during anesthesia emergence
Hypertension and organ transplantation:
1. precipitated by glucocorticoids due to vasoconstriction
2. precipitated by cyclosporine (Sandimmune, Neoral) due to in hand sympathetic nervous system activity (probably)
Antihypertensive drug treatment is associated with improvement in renal graft survival
1. true
2. false
Aneurysmal subarachnoid hemorrhage:
1. hypertension management may increase cerebral infarction risk
2. hypertension management may reduce the likelihood of re-bleeding
3. nimodipine (Nimotop) is a limited value in preventing neurological defects secondary to cerebral vasospasm in this patient population
Elective surgery should be canceled the diastolic pressure is greater than 115 mm Hg
1. true
2. false
Nitroprusside sodium (Nipride):
1. effective but low-potency
2. long duration drug
3. action mediated through nitric oxide
4. danger of cyanide toxicities with long-term use
Nitroprusside sodium (Nipride):
1. venous & arterial vasodilation
2. increase in cardiac output
3. hypotensive response associated with improved real function
In patients with COPD or other pulmonary disease, nitroprusside sodium (Nipride) may reduce arterial oxygen saturation
1. true
2. false
Nitroprusside sodium (Nipride) is likely to worsen ventilation/perfusion mismatching
1. true
2. false
Nitroprusside sodium (Nipride): cerebrovascular effect/effects
1. with increased intracranial compliance, increased intracranial pressure results
2. increases in intracranial pressure are most apparent when systemic mean arterial pressure decreases by less than 30%
3. contraindicated in patients with carotid artery stenosis