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Mand's Pharmacology > Antihypertensive > Flashcards

Antihypertensive Flashcards

1
Q

When would you decide to treat hypertension?

A

When sustained systolic BP is greater than 160mmHg or when sustained diastolic BP is greater than 100mmHg.

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2
Q

If BP=CO x TPR how do you reduce CO and TPR?

A

You can reduce CO by reducing heart rate, stroke volume and plasma volume.
You can reduce TPR by dilating arterioles.

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3
Q

What are the actions of diuretics?

A

Reduce plasma volume, gradually reducing TPR.
Increase sodium excretion (reducing salt reabsorption from glomerular filtrate).
Increases water loss from the body thus reducing cardiac output.
The target of diuretics are the nephron.

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4
Q

What are the actions of vasodilators?

A

Directly lower TPR.
Act on smooth muscle in the arteries and the arterioles.
Lower intracellular clacium concentration causing muscle cell relaxation and vasodilation.

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5
Q

What are the actions of beta blockers?

A

The reduce cardiac output and increase renin secretion.

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6
Q

What are the actions of ACE inhibitors?

A

Inhibit endogenous vasoconstrictor production.

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7
Q

What are the actions of alpha blockers?

A

Reduce TPR by inhibiting noradrenaline action.

Selective blocker of alpha 1 adrenoreceptors.

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8
Q

What are the actions of angiotensin antagonists?

A

Reduce TPR by inhibiting angiotensin action.

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9
Q

Explain thiazide diuretics.

A

Target action is the distal convoluted tubule.
Moderately potent.
Reduces systolic and diastolic BP.
Increases sodium and water excretion.
Increases renin release- contracting various effects.
Vasodilator effects.

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10
Q

List examples of thiazide diuretics.

A

Denzothiadiazine

Drugs that end in thiazide.

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11
Q

What are the adverse effects of thiazides?

A

They cause more frequent urination but otherwise are safe with few effects.

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12
Q

Explain loop diuretics.

A

Side of action is the ascending loop of Henle.
Very potent however is not more effective than thiazides at reducing BP.
Use is reserved for patients with renal insufficiency, resistant hypertension or heart failure.

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13
Q

What are calcium antagonists.

A

Main type of vasodilator.

Block calcium entry through voltage-operated calcium channels in smooth muscle

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14
Q

What are dihydropyridines?

A

A type of calcium antagonist- therefore a vasodilator.

Highly selective for smooth muscle.

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15
Q

What are examples of dihydropyridines?

A

Nifedipine.
Amlodipine
Nicardipine.
Drugs that end in dipine.

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16
Q

What are benzothiazepines?

A

Calcium antagonist- vasodilator that targets the heart.

Block calcium channels in conducting tissues in the heart.

17
Q

What is an example of benzothiazepines?

A

Diltazem.

18
Q

What are the adverse effects of calcium antagonists?

A

Flushing is required.

Oedema.

19
Q

What are the adverse effects of alpha blockers?

A

Postural hypotension- causing dizziness, light headedness.

Risk of hypotension after first dose but is generally well tolerated afterwards.

20
Q

What are examples of alpha blockers?

A

Doxazin
Terazosin
Prazosin- use three times a day

21
Q

Explain the process of action of a beta blocker.

A

Block adrenoreceptor in the heart.
Block action of noradrenaline from the sympathetic nerves.
First response is to reduce heart rate, decreasing cardiac output.
After continued treatment cardiac output returns to normal but BP remains low.

22
Q

What are examples of beta blockers?

A

Atenolol and propanolol.

Drugs that end in olol.

23
Q

What are the adverse effects of beta blockers?

A

Most commonly cause cold hands and fatigue.
Can provoke asthma attack, heart failure.
Can affect blood pool lipids.

24
Q

What are the actions of ACE inhibitors?

A

ACE inhibitors prevent the conversation from angiotensin 1 to 2.
Preventing the conversion of angiotensin 2 is important as it is a potent vasoconstrictor that stimulates aldosterone secretion. This inhibits salt and h20 secretion.
ACE inhibitors reduce renin release in the kidneys.

25
Q

What are the adverse effects of ACE inhibitors?

A

Dry cough.

Hypotension initially- especially combined with a diuretic.

26
Q

What are examples of ACE inhibitors?

A

Captopril- 2x daily.
Enalapril
Lisinopril- analogue of enalapril
Drugs that end in opril.

27
Q

What are examples of angiotensin 2 antagonists?

A

Losartan
Candesartan
Valsartan.
Drugs that end in tartan.

28
Q

When are angiotensin 2 antagonists used.

A

In combination with an ACE inhibitor.

Or an alternative to an ACE inhibitor in intolerant patients.

29
Q

What are the favourable anti-hypertensive drugs

A

First choice- thiazide is first choice.

Second choice-ACE inhibitor or a calcium antagonists.

30
Q

What is effective at treating catecholamine-secreting tumour?

A

Beta-blockers.

31
Q

What are examples of loop diuretics?

A

Drugs that end in mide or nide.
Furosemide
Bumetanide

Mand's Pharmacology (12 decks)

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