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Pharmacology > Blood Pressure > Flashcards

Blood Pressure Flashcards

1
Q

Define Hypertension

A

Persistent diastolic blood pressure greater than 90 mmHg and systolic pressure greater than 140 mmHg

Categories
Stage 1 – Mild (140-159/90-99mmHg)
Stage 2 – Moderate (160-179 /100-109 mmHg)
Stage 3 – Severe ( >180/ >110 mmHg)

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2
Q

List drugs used to treat hypertension

A
  • Diuretics: thiazides, loop diuretics, potassium-sparing diuretics, inhibitors of urine acidification
  • ACE inhibitors & angiotensin II receptor antagonists
  • Centrally acting drugs: beta receptor blockers
  • ß1-adrenoceptor antagonists
  • α1-adrenoceptor antagonists
  • Ca++ channel antagonists
  • Vasodilators
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3
Q

Diuretics mechanism

A
  • Reduce blood volume to reduce pressure
  • Keep sodium and water inside tubule to move into urinary system to excrete
  • Sodium most important in diuretics
  • Note the effectiveness of different types- used for different severity
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4
Q

Diuretics -Thiazides mechanism

A
  • Most common: thiazides (hydrochlorothiazide)
  • Oral
  • Inhibit reabsorption of Na+ and Cl- in distal convoluted tubule
  • Low dose for chronic control (12.5-25mg hydodiuril)
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5
Q

Diuretics - Loop diuretics

A
  • Only use to treat hypertensive crisis= most powerful
  • Oral or parenteral
  • Inhibit Na/ K/ Cl co transport in ascending loop of Henle
  • Loop diuetics: Lasix, Uremide
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6
Q

Diuretics - K-sparing diuretics

A
  • Use when potassium remains low on others
  • K-sparing diuretics: Spironolactone (Aldactone, Spiractin and Amiloride (Midamor)
  • Combined K-sparing and thiazide: Moduretic
  • Inhibit aldosterone (spironolactone) or directly inhibit reabsorption of Na in DCT and collecting duct
  • Oral
  • Often combined with K-waster to balance Na and K
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7
Q

Diuretics - Interactions of K-sparing

A
  • NSAID’s cause sodium retention, interact with contracurrent mechanism
  • counteracts the effect of diuretics
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8
Q

ACE Inhibitor

A
  • First line defense
  • Increase dilation of blood vessels to reduce pressure
  • Reduce peripheral resistance and reduce reabsorption of Na by the kidney
  • Oral
  • Block ACE so less angiotension II is available to cause vasoconstriction, salt
  • ACE inhibitor family name is Pril
  • Significant reduction of BP in 50% of patients (some people ended up with a non-productive cough or headache) if can’t give ACE inhibitor then block receptor for angiotensin II- family name is Sartan
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9
Q

ACE inhibitor advantages

A
  • Cardiovascular reflexes less affected
  • Safe in asthmatics
  • Enhance efficacy of diuretics
  • Fever adverse effects on K+
  • Beneficial effects on cardiovascular remodelling
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10
Q

Selective AT1 receptor (angiotensin II antagonists)

A
  • Reduce effects of angiotensin II
  • family name is Sartan
  • Selective AT1 receptor antagonists: Losartan and Ibesartan
  • Other name
  • Adverse effects
  • Renal impairment
  • Hyperkalaemia
  • BUT NO DRY COUGH!

Harder to get potassium from food source compared to sodium
• Potassium can affect the heart rhythm
• Don’t want to get rid of too much potassium with a diuretic

If block anti-diuretic hormone then will excrete more water (i.e. reducing blood volume)

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11
Q

Beta receptor blockers

A
  • Reduced the effects of the sympathetic nerve stimulation or circulation catecholamine
  • 99% bind to B1 (reducing heart rate), however some with bronchoconstriction (B2)- can aggravate pre-existing asthma (contraindications)
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12
Q

Pharmocokinetics

A
  • Extensive first past metabolism (propranol)- eliminated by liver
  • Water soluble eliminated by kidney (atenolol)
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13
Q

• Adverse effectsof beta blockers

A
  • Bradycardia & impairment of myocardial contractility
  • Peripheral vsoconstriction ( beta2 receptors in muscle beds) = cold hands & feet
  • Malaise – CNS effect, nightmares
  • Bronchospasm
  • Tiredness & fatigue
  • Hypoglycaemia
  • Hyperlipidemia
  • Impotence
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14
Q

Beta Adrenergic blockers

A
  • Reduce frequency and severity of angina attacks
  • Can be used with nitrates
  • Contraindicated in peripheral vascular disease and COPD
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15
Q

Calcium channel blockers

A
  • Decrease myocardial contractions and dilate peripheral blood vessels
  • Ca channel blocker:
  • Nifedipine (Adalat and Adipine): peripheral vascular selective
  • Diltiazem and Cardizem: depress SA and AV nodes
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16
Q

Vasodilators

A
  • Relax vascular smooth muscle
  • Reflexively stimulate the heart, increasing contractility, rate and O2 consumption
  • Generally reserved for patients not adequately managed by a diuretic and two other antihypertensives
  • Nitrate oxide relaxes (dilates) blood vessels> therefore reducing blood pressure
17
Q

Treatment for hypertension

A
  • Lifestyle changes: DASH diet and exercise
  • Monotherapy (better compliance)
  • Diuretics
  • ACE inhibitors
  • AT1 antagonists
  • Use drugs in combination
  • Aim for additive/synergistic effects
  • severe hypertension
  • Combination of drugs with different mechanisms
18
Q

Combinations to avoid

A
  • Verapamil/diltiazem and beta blockers
  • Compromise cardiac function
  • ACE inhibitors and K sparing diuretics
  • hyperkalaemia
  • Beta blocker and central inhibitor
19
Q

Antithrombotic agents

A 
•	Reduce risk factors: high cholesterol, high HT, poor exercise, free radicals
Factors which promote blood fluidity:
•	Natural anticoagulants
Protein C
Antithrombin III
Heparin 
Warfarin 
•	Endothelial-derived anti platelet substances
Nitric oxide
Prostacyclin (PGI2)
Aspirin 
NSAID
Dipyridamole
Ticlopidine
clopidigerl
•	Fibrinolytic system
Plasmin
Plasminogen
Tissue plasminogen Activator tPA
Streptokinase
20
Q

Anticoagulants - List

A 
•	Altepase
•	Streptokinase
•	Anistreplase
•	Urokinaze
Warfarin
21
Q 
Anthonyopril is 
	An ARB
	An ACEi
	A Beta blocker
	A Ca channel blocker
	A diuretic
A

An ACEi

22
Q 
Zullisartan is 
	An ARB
	An ACEi
	A Beta blocker
	A Ca channel blocker
	A diuretic
A

An ARB

23
Q

Nifedipine is

k. An ARB
l. An ACEi
m. A Beta blocker
n. A Ca channel blocker
o. A diuretic

A

A Ca channel blocker

24
Q

Osteolol is

p. An ARB
q. An ACEi
r. A Beta blocker
s. A Ca channel blocker
t. A diuretic

A

A Beta blocker

25
Q

Frusemide is

u. An ARB
v. An ACEi
w. A Beta blocker
x. A Ca channel blocker
y. A diuretic

A

A diuretic

Pharmacology (3 decks)

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