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The Cardiovascular System > Cardiovascular Pharmacology > Flashcards

Cardiovascular Pharmacology Flashcards

1
Q

What is the cardiac output produced by the left ventricle at rest

A

5L/min

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2
Q

What is the result of the loss of elasticity of arteries as you grow older

A

Increased blood pressure and increased strain on the left ventricle.

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3
Q

What is the importance of the elastic recoil of arteries

A

To maintain blood pressure during diastole.

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4
Q

What vessels are the major source of resistance to blood flow

A

Arterioles

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5
Q

What dictates where cardiac output is directed

A

Changes in resistance as a result in change of vessel tone and diameter

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6
Q

What factors regulate muscle tone

A

Hormones such as angiotensin II and local factors such as nitric oxide.

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7
Q

Where does gas exchange into tissues occur

A

Capillary beds

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8
Q

What products enter the capillary beds

A

Oxygen and nutrients

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9
Q

What products are removed from the capillary beds

A

Carbon dioxide and waste products

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10
Q

What equilibrium do capillaries have a role In controlling

A

Water in the intravascular compartment and water in the interstitial space of every tissue.

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11
Q

Down what kind of gradient does blood flow from the arteriole end to the venular end

A

A large hydrostatic pressure gradient

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12
Q

What gradient tends to favour reabsorption of water from interstitial fluid back into the plasma

A

An oncotic gradient

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13
Q

What creates the oncotic pressure

A

The high concentration of albumin and other proteins in the plasma

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14
Q

What does oncotic pressure cause

A

Reabsorption of water

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15
Q

How do hydrostatic and oncotic pressures compare to one another

A

They are usually equally matched

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16
Q

At what end does hydrostatic pressure dominate

A

The arterial end

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17
Q

At what end does the osmotic pressure dominate

A

The venular end

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18
Q

How do the hydrostatic and osmotic pressures work moving from the arterial end to the venular end

A

At the arterial end the hydrostatic pressure dominates and water filters into the interstitial fluid. At the venular end the osmotic pressure dominates and this is reversed - the water is reabsorbed

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19
Q

What is the role of lymphatic vessels

A

To return excess fluid to the circulation

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20
Q

What does the disruption of the equilibrium of hydrostatic and osmotic pressure lead to

A

Excess interstitial fluid and therefore oedema.

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21
Q

What pulls the water back from the interstitial fluid to the plasma

A

The high concentration of proteins left in the plasma at the venular end.

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22
Q

What are the four things which can disrupt the equilibrium between hydrostatic and osmotic pressure

A

1) A reduction in oncotic pressure due to low plasma protein conditions such as malnutrition, chronic liver disease or nephrotic syndrome
2) An increased in interstitial oncotic pressure due to leakage of protein from the plasma
3) An increase in venous hydrostatic pressure due to venous obstruction
4) An increase in arteriolar hydrostatic pressure due to vasodilators

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23
Q

How do hydrostatic and oncotic pressure work to increase blood volume if this is deplete

A

If circulation is deplete or arteriolar pressure falls, hydrostatic pressure is lower so oncotic pressure is dominant and this causes fluid to be pulled out of the interstitial space and back into the plasma to increase blood volume.

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24
Q

Which organs are the most vital to keep perfused

A

The heart and the brain. These can only last without perfusion for a very short period of time and this results in a great loss of function.

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25
Q

Which tissues will survive hours without perfusion before becoming permanently damaged

A

Muscles and skin

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26
Q

Where does afferent information for the regulation of blood pressure come from

A

Arterial baroreceptors in the carotid sinus and aortic arch

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27
Q

Where does afferent information for the regulation of blood volume come from

A

Stretch receptors in the right heart and juxtaglomerular cells in the kidney

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28
Q

What factors bring about an efferent response to effect blood pressure

A

Hormones such as those in the renin-angiotensin system (angiotensin II), adrenaline and ADH as well as local factors such as nitric oxide and endothelin

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29
Q

What are the factors which bring about an efferent response to effect blood volume

A

The sympathetic and parasympathetic nervous system. Circulating hormones such as those in the renin-angiotensin system (aldosterone), natriuretic peptides and ADH.

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30
Q

What are the effector organs for blood pressure

A

The heart and the arterioles.

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31
Q

What is the response time for the change in blood pressure by the heart and the arterioles

A

Almost instantaneous

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32
Q

What is the effector organ for the change in blood volume

A

The kidney which influences the water and salt content of the body

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33
Q

What is the response time for change in blood volume

A

The influence may take a while.

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34
Q

What are responses to need for change in blood pressure and blood volume brought about by

A

Receptors to which agonists bind and bring about signal transduction

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35
Q

Give three examples of G-protein coupled receptors

A

Beta-adrenergic, alpha-adrenergic and muscarinic cholinergic receptors.

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36
Q

What is an example of an intermediate molecule that may be produced by signal transduction

A

cAMP

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37
Q

What does an intracellular cascade do in signal transduction

A

Amplifies the signal and brings about an intracellular response.

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38
Q

What is blood pressure

A

The hydrostatic pressure of the circulatory system

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39
Q

What is the typical blood pressure for an adult (systolic/diastolic)

A

120/80 mmHg

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40
Q

How do you work out arterial blood pressure

A

Blood pressure - cardiac output X systemic vascular resistance

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41
Q

How do you work out cardiac output

A

CO = HR X SV

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42
Q

What is arterial blood pressure dependent upon

A

Heart rate, contractility and arteriolar tone

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43
Q

What molecules act to increase heart rate

A

Noradrenaline released from sympathetic post ganglionic fibres and acting as an agonist of beta-1 receptors and adrenaline released from the adrenal medulla and acting as a beta-1 agonist.

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44
Q

What molecules act to decrease heart rate

A

Acetylcholine which agonises muscarinic cholinergic receptors.

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45
Q

What is the effect of increasing contractility on stroke volume

A

Stroke volume increases

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46
Q

What innervates smooth muscle of blood vessels

A

Postganglionic sympathetic nerve endings which release noradrenaline to act on alpha-1 adrenoceptors ion the surface of blood vessels.

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47
Q

What is the effect of the binding of noradrenaline to alpha-1 adrenoceptors on blood vessels

A

Vasoconstriction

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48
Q

What factors act on smooth muscle to cause vasodilation

A

Adrenaline, vasopressin, angiotensin II

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49
Q

Where does adrenaline bind to cause vasodilation

A

Beta-2 adrenoceptors

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50
Q

What afferent information is received from the baroreceptors in the carotid sinus

A

The blood pressure seen by the cerebral circulation

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51
Q

What afferent information is received from the baroreceptors in the aortic arch

A

The blood pressure seen by the heart and other major organs

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52
Q

What do baroreceptors respond to

A

Stretch in the adventitial layer of blood vessels.

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53
Q

What nerve do signals from the carotid baroreceptors travel along

A

The glossopharyngeal nerve

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54
Q

What nerve do signals from the aortic arch baroreceptors travel along

A

The vagus nerve

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55
Q

Where do signals from the baroreceptors travel to

A

The vasomotor centre in the medulla oblongata

56
Q

What is the vasomotor centre in the medulla oblongata responsible for

A

Homeostatic reflexes

57
Q

What will the efferent response to decreased blood volume and pressure include

A
  • reduced blood pressure will be sensed
  • the heart rate and contractility will increase due to the effect of noradrenaline at the beta-1 receptors in the heart
  • systemic vascular resistance will be increased by the action of noradrenaline at alpha-1 receptors on the blood vessels
58
Q

How does the sympathetic nervous system affect the kidneys

A

The arteriolar contraction by the action of noradrenaline at alpha-1 receptors will decrease renal blood flow and glomerular capillary pressure and this will decrease glomerular filtration and urine production to increase blood volume and pressure.

59
Q

How does the sympathetic nervous system affect the renin-angiotensin system

A

The secretion of renin at juxtaglomerular cells is stimulated. This increases the concentration and action of angiotensin II - a vasoconstrictor and aldosterone - a sodium retaining hormone to increase blood volume and pressure.

60
Q

What effect does lower blood pressure have on the parasympathetic nervous system

A

It decreases the activity of the parasympathetic nervous system.

61
Q

What pharmalogical means can be used to increase blood pressure

A

Use of a vasoconstrictor such as phenylepherine

62
Q

What pharmalogical means can be used to decrease blood pressure

A

Use of a vasodilator such as glycerylnitrate.

63
Q

At what age is the baroreceptor reflex most sensitive

A

In younger people. The elderly have less sensitive baroreceptor reflexes so are less able to respond to drop in blood pressure,

64
Q

How does hypertension develop with the baroreceptor reflex

A

Because the baroreceptors must reset to maintain blood pressure at a higher baseline.

65
Q

What is blood volume

A

The volume of blood in all of the circulation

66
Q

What is the typical blood volume of a 70kg male

A

4L

67
Q

Around how much of the blood volume is found in the venous system at rest

A

Half - it acts as a reservoir

68
Q

What is the intravascular volume in equilibrium with across capillaries

A

Interstitial volume

69
Q

Which compartment - interstitial or intracellular - fluid contains most of the body’s water content

A

The intracellular compartment

70
Q

What is the volume of interstitial (extracellular) fluid

A

12L

71
Q

What is the volume of the intracellular fluid

A

32L

72
Q

What is the organ with the greatest control over fluid loss and hydration

A

The kidney

73
Q

What is the average daily urine output

A

Around 1.5L

74
Q

What is one of the waste products excreted in the urine

A

Urea

75
Q

Why is regulation of blood volume important

A

To maintain the venous return to the heart and enable it to produce enough cardiac output to support perfusion of all the body organs

76
Q

Which two sources does afferent information regarding control of blood volume come from

A

the juxtaglomerular cells in the kidney and low pressure stretch receptors in the right atrium of the heart

77
Q

What do juxtaglomerular cells sense in relation to blood pressure

A

Sodium and water delivery to the distal tubule of the kidney

78
Q

How do juxtaglomerular cells respond to low delivery of sodium and water to the distal tubule of the kidney

A

They release renin which activates the renin-angiotensin system for the production of angiotensin II

79
Q

What happens when the stretch receptors in the right atrium detect low blood volume

A

The sympathetic nervous system is activated.

80
Q

What are the efferent responses to a detection of low blood volume

A

The activation of the renin-angiotensin system and the sympathetic nervous system.

81
Q

What are the main products of the renin-angiotensin system

A

Aldosterone and angiotensin II

82
Q

What does angiotensin II do

A

Causes vasoconstriction and release of aldosterone from the adrenal cortex. Also stimulates the release of vasopressin from the pituitary gland and thirst.

83
Q

What does aldosterone do

A

Conserves sodium in the body often in exchange for loss of potassium and hydrogen ions.

84
Q

What are the sites of action of aldosterone

A

The distal tubules of the kidney and to a lesser extent the gastrointestinal tract.

85
Q

What does vasopressin do

A

Conserves water and causes vasoconstriction

86
Q

What happens when the sympathetic nervous system is activated due to detection of low blood volume by stretch receptors in the right atrium

A

Noradrenaline is released which acts on beta-1 receptors in the heart to increase contractility and rate.

87
Q

Which receptors does noradrenaline act at to cause increased systemic vascular resistance

A

Alpha-1 receptors on blood vessels.

88
Q

How does the constriction of veins help in increasing blood volume

A

It reduces the reservoir function of the veins and expands the blood volume in the arterial circulation.

89
Q

What effect does the sympathetic nervous system have on the kidney when blood volume is detected to be low

A

Postganglionic neurons have the effect of arteriolar constriction which decreases blood flow and glomerular capillary pressure. This reduced glomerular filtration and urine production.

90
Q

What effect do ANP and BNP have on the kidney

A

Retention of sodium and water

91
Q

What is the macula densa

A

An area of tightly packed cells lining the wall of the ascending limb at the transition to the distal convoluted tubule of the kidney

92
Q

What system is the macula densa part of

A

The renin-angiotensin system

93
Q

What is the role of the macula densa in increasing glomerular capillary hydrostatic pressure

A

When there is a decrease in sodium chloride concentration, the macula densa signals for a decreased resistance to flood flow in the afferent arterioles by vasodilatation which increases glomerular capillary hydrostatic pressure.

94
Q

What is the role of the macula densa in the renin angiotensin system

A

The macula densa causes an increase in renin production from juxtaglomerular cells and subsequent increased concentration and action of angiotensin II, aldosterone and vasopressin.

95
Q

What are the causes of excessive fluid loss that threaten intravascular volume

A

Haemorrhage, vomiting, diarrhoea, burns and excessive use of diuretics.

96
Q

What are the subsequent effects of rapid loss of blood

A

Decreased venous return to the heart, decreased ventricular filling, reduced cardiac output, reduced arterial blood pressure and reduced renal perfusion.

97
Q

The perfusion of which organs are sacrificed first

A

Organs which are less vital for survival such as skin, muscle and the GI tract before the kidney, heart and brain which are more important.

98
Q

What are all the systems which detect and act up reduced blood volume

A
  • Baroreceptors in the carotid sinus
  • Baroreceptors in the aortic arch
  • Stretch receptors in the right atrium of the heart
  • Juxtaglomerular cells which activate the renin-angiotensin system
99
Q

What causes sweating in the response to decreased blood volume

A

The action of the sympathetic nervous system on the adrenal medulla.

100
Q

What are the early signs and symptoms of haemorrhage

A

Tachycardia, palpitation, pallor, coldness of the skin, sweating

101
Q

What causes the early signs and symptoms of haemorrhage

A

The sympathetic nervous system

102
Q

What happens in the blood vessels when there is decreased arteriolar and venular pressure

A

The oncotic pressure dominates and this favours reabsorption of fluid back into the intravascular compartment to increase the depleted blood volume.

103
Q

What will be the result of continued blood loss due to haemorrhage

A

Hypotension which may then reduce renal perfusion leading to reduction or halting of urine output. It can ultimately lead to confusion and reduced consciousness.

104
Q

What is hypovolemic shock

A

Failure to preserve sufficient intravascular volume to maintain blood pressure.

105
Q

How do you treat hypovolemic shock

A

IV fluid infusion and if there is a haemorrhage then blood transfusion.

106
Q

What is the most important risk factor for cardiovascular disease

A

Hypertension

107
Q

What are the risk factors for atherosclerosis

A

Age, male sex, genetics, smoking, cholesterol, diabetes

108
Q

What is the result of a stable atheroma

A

Obstruction to blood flow that limits amount of blood and oxygen that can be delivered to tissue.

109
Q

What is the result of a stable atheroma in the coronary arteries

A

Angina pectoris.

110
Q

What may happen when a stable atheroma becomes unstable

A

Rupture

111
Q

What does an unstable atheroma lead to in the coronary arteries

A

Unstable angina or a myocardial infarction

112
Q

What does an atheroma lead to in the cerebral circulation

A

Stroke or TIA.

113
Q

What is preload

A

The end diastolic volume of the heart

114
Q

What is afterload

A

The peripheral resistance to blood flow.

115
Q

What are the key pathological problems underlying cardiovascular disease

A
  • maladaptive increases in the activity of the sympathetic nervous system and renin-angiotensin system
  • endothelial dysfunction of blood vessels
  • volume overload
  • hypertension
  • cardiac ischaemia
  • changes in structure of blood vessels
  • high levels of circulating cholesterol
  • platelet stickiness
  • tendency to thrombosis
116
Q

What are the drug solutions for cardiac disease that target the underlying pathologies

A

Diuretics, beta-blockers, alpha-blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers, lipid-lowering drugs, anti-platelets, anti-coagulants, nitrates

117
Q

What do diuretics do

A

Reduce water and sodium overload - increase loss of water and sodium.

118
Q

What is an example of a diuretic

A

Furosemide

119
Q

What do beta-blockers do

A

Act to inhibit the beta-1 receptors of the heart therefore reducing the effects of the sympathetic nervous system on the heart

120
Q

What is an example of a beta-blocker

A

Atenolol

121
Q

What do alpha blockers do

A

Act to inhibit the alpha-1 receptors on blood vessels to reduce the effect of the sympathetic nervous system in vasoconstriction of arterioles.

122
Q

What is an example of an alpha-blocker

A

Doxazosin

123
Q

What do calcium channel blockers do

A

Block the entry of calcium through voltage gated calcium channels in myocytes, therefore reducing contractility of the heart. They also cause relaxation of arteriolar smooth muscle.

124
Q

What is an example of a calcium channel blocker

A

Amlodipine

125
Q

What do ACE inhibitors do

A

Inhibit the action of angiotensin converting enzyme, therefore reducing the concentration of angiotensin II in the blood and reducing the effects of the renin-angiotensin system

126
Q

What is an example of ACE inhibitor

A

Ramipril

127
Q

What do nitrates do

A

Relax veins and arteries to reduce the resistance against which the heart has to work. This works as they are cleaved to produce nitric oxide, the vasodilator.

128
Q

What is an example of a nitrate

A

Glyceryl trinitrate

129
Q

What do lipid-lowering drugs do

A

Reduce cholesterol levels in the circulation

130
Q

What are two examples of lipid lowering drugs

A

Statins and fibrates

131
Q

What do anti-platelet drugs do

A

Reduce platelet adherence to the vascular wall

132
Q

What is an example of an anti-platelet drug

A

Aspirin

133
Q

How does aspirin work

A

It is a COX inhibitor

134
Q

What do anti-coagulant drugs do

A

Reduce the tendency towards blood clot formation in diseased vessles

135
Q

What is an example of an anti-coagulant drug

A

Warfarin

136
Q

How does warfarin work

A

It is a vitamin K inhibitor which means it inhibits the vitamin K dependent clotting factors in the clotting cascade. These are factors 2, 7, 9 and 10.

The Cardiovascular System (15 decks)

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