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pharmacology BM322 > anti-hypertensives > Flashcards

anti-hypertensives Flashcards

1
Q

what is hypertension?

A

high blood pressure

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2
Q

what makes up the double circulatory system?

A

pulmonary and systemic circulation

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3
Q

what is systemic circulation?

A

it is the system that provides the functional blood supply for all body tissues

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4
Q

what is pulmonary circulation?

A

its the system made up of blood travelling to and from the lungs

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5
Q

what is bronchial circulation?

A

its complimentary to the pulmonary circulation and it supplies lung cells with oxygen and nutrients

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6
Q

what is the vascular system made up of?

A

endothelial cells
smooth muscle cells
fibroblasts
PVAT

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7
Q

what does blood pressure depend on?

A

peripheral vascular resistance
cardiac output

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8
Q

what is cardiac output?

A

its the amount of blood ejected by the heart each min
HR x stroke volume

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9
Q

what is peripheral vascular resistance?

A

its the resistance in the circulatory system

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10
Q

what factors affect arterial blood pressure?

A

stroke volume
heart rate
peripheral resistance
elastic vessels
blood volume
ventricular ejection

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11
Q

what factors affect systemic blood pressure?

A

autonomic nervous system
renin-angiotensin-system
local mediators released from the vascular endothelium such as NO
beta-1-adrenoceptors
vasoconstriction via alpha-1-adrenoceptors
stimulation of alpha-adrenoceptors - vasoconstriction

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12
Q

how do beta-1-adrenoceptors affect hypertension?

A

they increase cardiac contractility and heart rate therefore increasing cardiac output and blood pressure

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13
Q

what does vasoconstriction via alpha-1-adrenocptors cause?

A

it increases blood pressure and afterload on the heart

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14
Q

in a healthy heart, how is cardiac output maintained?

A

its maintained by beta-1-adrenoceptor stimulation and increased contractility

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15
Q

what does stimulation of alpha-adrenoceptors cause?

A

it causes an increase in venous return to the heart (preload) and increase in cardiac output and blood pressure

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16
Q

what are some examples of beta blockers?

A

atenolol and propranolol

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17
Q

what effects do beta blockers cause in the systemic nervous system?

A

they decrease cardiac output
reduce renin production (reduce angiotensin II)
can indirectly cause vasodilation of peripheral arteries

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18
Q

what are some examples of alpha blockers?

A

prazosin

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19
Q

what effects do alpha blockers cause in the systemic nervous system?

A

block post-synaptic alpha-1 adrenoceptors leading to the dilation of arteriolar resistance vessels and lower peripheral resistance
they dilate venous capacitance vessels reducing venous return and cardiac output

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20
Q

what are endothelium derived factors? (EDRFs)

A

they’re endogenous factors produced by endothelial cells released in response to various changes to normal physiological and pathophysiologic changes
they modulate vascualr smooth muscle and therefore vessel diameter

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21
Q

what are some examples of endothelium derived relaxing factors?

A

Nitric oxide (NO)
Prostacyclin (PGI2)
Hyperpolarising factor (EDHF)

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22
Q

what are the two types of endothelium derived factors?

A

EDRFs- endothelium derived relaxing factors
EDCFs - endothelium derived contracting factors

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23
Q

what are some examples of endothelium derived contracting factors?

A

endothelin (ET-1)
thromboxane A2 (TxA2)

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24
Q

what happens when vessels are dilated?

A

dilated > low resistance to flow > low peripheral vascular resistance > low blood pressure

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25
Q

what can hypertension increase the risk of?

A

heart, brain, kidney and other diseases

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26
Q

name some of the factors that interact to raise blood pressure and cause end-organ damage?

A

altered redox signalling/ oxidative stress
innate and adaptive immunity
genetics
sodium intake/ storage
sympathetic activation
microbiome
renal mechanisms
vascular/ endothelial dysfunction

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27
Q

what is systolic pressure?

A

(SP) its the maxiumum arterial pressure reached during peak ventricular ejection

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28
Q

what is diastolic pressure?

A

its the minimum arterial pressure just before ventricular injection begins

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29
Q

what is pulse pressure (PP)?

A

its the difference between systolic and diastolic pressure

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30
Q

what is mean arterial pressure (MAP)?

A

its the average pressure in the cardiac cycle

31
Q

how do you measure blood pressure? and how does it work

A

using a sphygmomanometer
it works by pressure being released from an inflatable cuff on the upper arm while listening via stethoscope (placed over the brachial artery) as blood flow returns to the lower arm

32
Q

what is the blood pressure guidelines for normal blood pressure?

A

systolic- <130mmHg
diastolic- <85mmHg

33
Q

what is the blood pressure guidelines for high-normal BP?

A

systolic - 130-139mmHg and/or
diastolic 85-89mmHg

34
Q

what is the blood pressure guidlines for grade I hypertension?

A

systolic- 140-159 and/or
diastolic - 90-99mmHg

35
Q

what is the blood pressure guidelines for grade II hypertension?

A

systolic- >160mmHg and/or
diastolic- >100mmHg

36
Q

what are the symptoms for systematic hypertension?

A

its usulally asymptomatic and often diagnosed when patient presents with another condition and with age, the monitoring of blood pressure becomes more important

37
Q

who most commonly has pulmonary hypertension? and what symptoms come with it?

A

in patients with COPD where the pulmonary vasculature has been affected leading to increased vascular resistance
shortness of breath and sometimes chest pain
sustained increase in pulmonary vascular resistance leads to progressive right heart failure

38
Q

what are the primary risk factors of hypertension?

A

high salt consumption
excessive alcohol use
overweight
age
sex
lack of exercise
tobacco
diabetes
lipid disorders

39
Q

what are the secondary risk factors for blood pressure initiated by other diseases?

A

Aortic coarctation
Renal disease
Mineralocorticoid excess
Thyroid disease
Eclampsia
Cancer treatment

40
Q

what are the effects of hypertension?

A

-Progressive structural changes in vasculature – thickening and narrowing of lumen of arteries
-Acceleration of atherosclerosis
-Kidney failure
-Left ventricular hypertrophy (risk factor for ischaemic heart disease and heart failure
-Stroke, aneurisms, vascular dementia

41
Q

what causes the remodelling of an artery?

A

hypertension

42
Q

what happens in the remodelling of an artery?

A
  • proliferation of fibroblasts and infiltration of immune cells in adventitial layer
  • Vascular smooth muscle cell proliferation and migration in media
  • Double elastic lamina develops due to increased muscularisation
  • Proliferation of apoptosis-resistant endothelial cells
  • Narrowing/ occlusion of vessel lumen
43
Q

what are the four categories of antihypertensive drugs?

A
  • vasodilators
  • sympathetic inhibitors
  • RAAS inhibitors
  • diuretics
44
Q

what are the sites of action for beta blockers?

A

the heart and kidney

45
Q

what are some examples of beta blockers?

A

propanolol and atenolol

46
Q

what are the effects of beta blockers?

A

they deacrease cardiac output, reduce renin production (reduce ang II)
can indirectly cause vasodilation of peripheral arteries

47
Q

what is an example of an alpha blocker?

A

prazosin

48
Q

what effects do alpha blockers cause?

A

they block post-synaptic alpha-1-adrenoceptors leading to dilation of arteriolar resistance vessels and lower peripheral resistance
they dilate venous capacitance vessels reducing venous return and cardiac output

49
Q

what antihypertensive drugs act on the renin-angiotensin-aldosterone system?

A

ACE inhihitors
Ang II receptor antagonists (ARB- angiotensin recpeptor blocker)
diuretics

50
Q

what is an example of an ACE inhibitor?

A

captopril or rampril

51
Q

how do ACE inhibitors work?

A

Ang I is cleaved by ACE into Ang II when it passes through the lungs, Ang II constricts blood vessels, raising the blood pressure, inhibiting ACE reduces the levels of Ang II being produced`

52
Q

what is Ang II implicated in in hypertension?

A

its implicated in the development of left ventricular hypertrophy

53
Q

name some angiotensin recepor blockers?

A

losartan and valsartan

54
Q

what does ARB stand for?

A

angiotensin receptor blockers
they can also be called angiotensin II receptor antagonists

55
Q

how do angiotensin II receptor antagonists work?

A

they selectively block AT1 receptors which mediate the vasoconstrictive, cardiac/ vascular hypertrophy effects of angiotensin II

56
Q

whats and example of a diuretic?

A

thiazide

57
Q

how do diuretics work?

A

they act on varying sites in the kidney to increase Na+ and water depletion leading to a hypotensive effect

58
Q

what are some examples of calcium channel blockers?

A

verapamil, amlodipine and Diltiazem

59
Q

how do calcium channel blockers work?

A

they block Ca2+ entry into vascular smooth muscle cells and/or cardiac muscle cells. this promotes relaxation of the muscle and vasodilation

60
Q

what are some examples of vasodilators?

A

Hydralazine, Minoxidil, Nitrates, Nitroprusside, calcium channel blockers and angiotensin I receptor antagonists

61
Q

once you get an established diagnosis of hypertension, what is the first advice you get?

A

lifestyle advice

62
Q

what does HMOD stand for?

A

hypertension-mediated organ damage

63
Q

what is step one of treatment for people under 55?

A

treatment with an angiotensin converting enzyme or angiotensin II receptor blocker

64
Q

what is step one of treatment for people over 55 and all back people or people of caribbean or african decent?

A

calcium channel blocker is preferred but thiazide-like diuretics in people with oedema or high risk of heart failure must be considered

65
Q

what is step 2 of treatment guidelines for hypertension?

A

ACE inhibitor or angiotensin II recpceptor blocker AND calcium channel blocker

66
Q

what is step 3 of hypertension treatment?

A

ACE inhibitor, calcium channel blocker and thiaside-like diuretic

67
Q

what type of hypertension is treated in step 4 of hypertension treatment?

A

resistant hypertension

68
Q

what is the treatment for resistant hypertension?

A

ACE inhibtor, calcium channel blocker, thiazide-like diuretic and a further diuretic such as low dose spironolactone or a higher dose of thiazide-like diuretic
or an alpha or beta blocker if further diuretic treatment isnt tolerated or is contradicted or ineffective

69
Q

what is the memory tool ABCD-ARB?

A

A–ACE inhibitor (e.g.,ramipril)
B–Beta blocker (e.g.,bisoprolol)
C–Calcium channel blocker (e.g.,amlodipine)
D– Thiazide-likeDiuretic (e.g.,indapamide)
ARB –Angiotensin IIReceptorBlocker (e.g.,candesartan)

70
Q

how do vasopeptidase inhibitors work?

A

they simultaneously inhibit both neutral endopeptidase and angiotensin-converting enzyme (ACE). They increase the availability of peptides that have vasodilatory and other vascular effects; they also inhibit production of angiotensin II, reducing the contraction of the blood vessels, reducing blood pressure`

71
Q

if theres an 88-year old female being treated for long-term hypertension which has been well managed with losartan, whats its mechanism of action to lower blood pressure?

A

it blocks angiotensin II effects by the prevention of angiotensin II binding causes vascular smooth muscle relaxation, lowering blood pressure. Angiotensin II would otherwise bind to the AT1 receptor and induce vasoconstriction, raising blood pressure.

72
Q

what can happen if hypertension remains untreated?

A

it increases the risk of arthleroscleorsis, coronary thrombosis, stroke and heart failure

73
Q
A

pharmacology BM322 (7 decks)

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