CVR 13

Question 1

Define hypertension?

Answer 1

A BP level above which investigation and treatment do more good than harm.

Question 2

How is hypertension classified?

Answer 2

Using systolic and Diastolic pressure.

grades
1 = S(140-159) D(90-99)
10+ per level

Question 3

How is hypertension confirmed?

Answer 3

Ambulatory BP monitor

Question 4

Does smoking cessation lower BP?

Answer 4

No but it reduces cardiovascular risk

Question 5

What are the antihypertensive drugs?

Answer 5

Ace inhibitors / angiotensin 2 antagonists
Calcium channel blockers
Diuretics

Also
direct renin inhibitors
aldosterone antagonists
alpha blockers
vasodilators
central sympathophlegics

Question 6

What are the 3 major determinants of blood pressure?

Answer 6

Blood volume (Renin angio system)

Cardiac Output (Rate and stroke volume by beta1 adrenoreceptors)

Peripheral Resistance - resistance of arteries. regulated by alpha adrenoreceptors in the ANS

Question 7

What are the adrenergic receptors?

Answer 7

Sympathetic receptors.

Alpha receptors are on the arteries when stimulated by epineph are constricted.

Beta 1 receptors increase heart rate via calcium sequestration rate and renin secretion.

Beta 2 receptors are the fight or flight response. Smooth muscle relaxation, lipolysis, dilate arteries

Question 8

Explain the distinction between the beta 1 and 2 adrenoreceptors?

Answer 8

Beta 1 are found in the heart where they have positive ionotropic effects and can be harmful.

The beta 2 receptors are responsible for smooth muscle relaxation and is usually therapeutic.

Question 9

Explain the distinction between alpha 1 and alpha 2 receptors?

Answer 9

Alpha 1 - vasoconstriction, mydriasis (dilation of iris). This determines arterioal and venous tone. Doxazosin and prazosin.

alpha 2 - inhibition of NA release and a fall in BP.

Question 10

What are beta blockers used for?

Answer 10

cardiac arrhythmias, angina, MI.
Propranolol which is non selective

Atenolol is B1 selective

Hyperthyroidism

Glaucoma

Question 11

What are some unwanted effects of beta blockers

Answer 11

bronchospasm
PVD worsens
glucose intolerance
Impotency
Fatigue
CNS

Question 12

Name some ACE inhibitors, their actions, SE and uses?

Answer 12

captopril, ramipril
PRIL

Action - blockade of angio 2 and reduce breakdown of bradykinin

SE - dry cough, angioedema, renal failure, hyperkalaemia

Uses - hypertension, cardiac failure, post MI protection, DM.

Question 13

Name some angiotensin 2 antagonists / angiontensin receptor blockers (ARB’s)

Answer 13

SARTAN
Losartan

A: blocks angiotensin 2 function

SE: renal failure, same as ACE

Use: Same as ACE

Question 14

Name some calcium channel blockers?

Answer 14

DIPINE
nifedipine

A:blocks calcium entry in muscles via type 2 voltage gated channels which is important for smooth muscle contraction and diastolic depolarization

Divided into dihydropyrodine and non dihydropyrodines (cardiac smooth muscle affinity)

Used: hypertension, angina, raynauds

Question 15

What do thiazide diuretics do?

Answer 15

Hydrochlorthiazide

MA - inhibits NaCl reabsorbtion in distal tuble

SE: hypokalemia, impotency, glucose intolerance

Question 16

What are the contraindications of particular anti hypertensives?

Answer 16

thiazides - gout

beta blockers - asthma and AV block

Calcium antagonist dihydropiridines - none

Calcium channel blockers - AV block, heart failure

ACE - pregnancy, aoedema, hyperkaleima, renal artery stenosis

AT1 blocker - pregnancy, hyperkaleima, renal artery stenosis