CVS 3 Flashcards
what is hypertention?
- Sustained b.p more than 140/90 mm hg
high bp causes organ damage. TRUE OR FALSE?
TRUE
what is the treatment goal for hypertention?
- To prevent ischemic heart disease, cerebrovascular disease, heart failure, arrythmias
what are the non-pharmacological treatment options?
- Stop smoking
- Diet
- weigth control
- Exercise
what are the three parameters that control b.p?
- Blood volume
- cardiac output
- Vascular resistance
what is cardiac output dependent upon?
- The contractility of the heart and the frequency which the heart beats which is controlled by the sympathetic nervous system - this determines the stroke volume
what is preload?
- The volume of fluid thats returned to the heart
what is preload dependent upon?
- The total blood volume and contractility of the venous capactance vessels returning blood to the heart
the sympathetic nervous system is key to regulating the three parameters that control B.P (blood volume, cardiac output and vascular resistance). TREU OR FALSE?
TRUE
what does the equation MAP=CO*TPR stand for?
- Mean arterial pressure = cardiac output * total peripheral reistance
diuretic drusg cannot be used for the treatment of hypertension. TRUE OR FLASE?
FALSE
Thiaide like diuretics are most efficacious for treating hypertention e.g metolazone. TRUE OR FALSE?
TRUE
How do thiazide like diuretics work as antihypertensive drugs?
- They reduce water volume in blood which leads to a decrease in BP
which of the diuretics are not effective at treating hypertension?
- Loop diuretics
why should K+ sparing diuretics be avoided for treatmet of hypertension? e.g spirinalactone
- Leads to hypokalemia
how do B1 antangonists reduce b.p?
- they reduce heart rate/contractility
- reduce renal renin secretion
- inhibits reflex tachycardia caused by vasodilators
B1 anatagonists are contradinicated in heart block and asthma. TRUE OR FALSE?
TRUE
Dual a1 and b1 antagonists decrease b.p without bradycardia. TRUE OR FALSE?
TRUE
why is gradual withdrawal important for B1 antagonists?
- Can lead to rebound sympathetic stimulation of the heart
B antagonists are not first option except in cases of angina and M.I. TRUE OR FALSE?
TRUE
a1 vasoconstrictors important for prevention of posterol hypertension. TRUE OR FALASE?
TRUE
B1 antagonists are partial agonists. TREU RO FALSE?
TRUE
hwo is reflex tachycardia inhibited?
- By using b1 antagonists
why are B antagonist contraindicated in asthma?
- it causes further breathlessnes by causng further bronchoconstriction (blocks B2 receptors)
why are B antagonist contraindicated in heart block?
- B receptors control AV node, in heart block AV signals are slowed antagonising this will slow them further
how do selective a1 adrenoceptor antagonist work in reducing BP?
- relax arteriolar resistance vessels and dilate venous capacitance
selective a1 adrenoceptor antagonist also indicated for prostatic hyperplasia. TRUE OR FALSE?
TRUE
what are some of the ADRs for selective a1 antagonist?
- reflex tachycardia
- lethargy
- postural hypotension
what are selective a1 adrenoceptor antagonist drug interations?
- B antagonist
- Diuretics
what are a2 adrenergic agonist selective for?
- a2
a2 adrenergic agonist avoids sympathomimetic effects. TREU RO FALSE?
TRUE
how do a2 adrenergic agonist work?
- Inhibit sympathetic output from CNS by inhibiting NE release
Methyldopa (a2 adrenergic agonist) is a pro-drug that is metabolised to methylnorepinephrine in CNS. TRUE OR FALSE?
TRUE
methyldopa has no effect on renal blood flow so can be used in patiets with renal disease. TRUE RO FALSE?
TRUE
methyldopa does not causes hepatoxicity. TRUE RO FFALSE?
FALSE
hwo do imidazoline receptor agonist work?
- Inhibit sympathetic output
1,4 dihydropyridines is a ca2+ channel blocker that is vascular selective. TRUE OR FLASE?
TRUE
1,4 dihydropyridines causes arterial vasodilation. TRUE OR FALSE?
TRUE
verapamil is a ca2+ channel blocker that is less vascular selective. TRUE OR FALSE?
TRUE
what is negative chronotropic?
- Reduced firing of SA and AV block (Reduced CO)
what is a negative inotrop?
- reduced ca2+ influx inhibits contractility (reduced CO)
verapimil is contraindicated in patients with cardiac failure. TREU RO FALSE?
TRUE
How doe ACE inhibitors treat hypertension?
- Reduce angiotensin 2
- Leads to vasoconstriction/ leads to vasodilation
give an example prodrug of ACE inhibitors?
- Enalapril (pro-drug)
- Enalaprilat (active)
WHta are ACE inhibitors indicated for?
- Hypertention
- Heart failure (MI)
- diabetic nepropathy
what are some ADRs for ACE inhibitors?
- hypotension
- Hyerkalemia
- Coughs
what are some drug interactions with ACE inhibitors?
- other drugs that reduce BP
- K+ sparing diuretics (hyperkalemia)
- NSAIDS
Describe the interaction between k+ sparing diuretics and ACE inhibitor leading to hyperkalemia?
- ACE inhibitors and K+ sparing diuretics both reduces adolsterone production which lead to less K+ being excreted and hence hyperkalemia
describe the interactions between NSAIDS and ACE inhibitors?
- ACE inhibitors work on efferent rather afferent, so reduce glomerular pressure and filtration rate
Angiotensin 2 receptor antagonists has similar action to ACE inhibitors but no effect on BK metabolism. treu or false?
true
Losartan is the first angiotensin 2 antangonist to be use dthrapeutically. TREU RO FLASE?
TRUE
what are some ADRs for angiotensin 2 antagonists?
- hypotension
- lower incidence of coughs compared to ACE inhibitors
what are drug intercation of angiotensin 2 antagonists?
- With other bp lowering drugs
- Hyperkalemia with K+ sparing diuretics
- NSAIDs antagonise hypotensive effects of angiotensin 2 antagonists
What are some of the combination therapy used fpr treatment?
- B antagonist and dihydropyridines ca2+ blockers
- ACE inhibitors and diuretics
- ACE inhibitors and ca2+ channel blockers
patients with angina, b blockers or ca2+ blockers would be appropriate but not in patients with cardiac failure. TREU RO FALSE?
TREU
diuretics should be aboided in patients with diabetes and gout. TREU OR FALSE?
TRUE
