Drug therapies for hypertension and angina

Question 1

Hypertension increases your risk of what disease?

Answer 1

Cardiovascular disease

Question 2

What is a greater risk factor for cardiovascular disease?

a) increased systolic BP
b) increased diastolic BP

Answer 2

Systolic

Question 3

What is the difference between systolic and diastolic BP?

Answer 3

Systolic = pressure your heart exerts whilst beating
Diastolic = amount of pressure in your arteries between beats

Question 4

What are the symptoms of hypertension?

Answer 4

usually no symptoms unless very severe = silent killer

Question 5

What causes hypertension? (5)

Answer 5

Complex interaction of genes and environment
Renal or endocrine disease
Vascular disease (renal artery stenosis)
Drugs (amphetamines)

Question 6

Describe the renin-angiotensin system?

Answer 6

Reduced glomerular filtration leads to reduced sodium in distal tubule.
This cases increased renin release.
Renin converts angiotensinogen to angiotensin I
Angiotensin I converted to Angiotensin II by ACE.
Angiotensin II cuases negative feedback loop to reduce renin release

Question 7

What is the function of angiotensin II?

Answer 7

Peripheral vasoconstriction and aldosterone secretion.

Causes negative feedback loop to reduce renin release

Question 8

What is the function of aldosterone?

Answer 8

Increase peripheral resistance, activate sympathetic nervous system. Increase HR and BP. Stimulates kidneys to retain Na which raises BP

Question 9

What is the aim of hypertension management?

Answer 9

Prevent myocardial infarction and stroke (reduce risk of heart failure)

Question 10

How is hypertension managed?

Answer 10

Lifestyle advice and drug treatment

Question 11

What is ABPM?

Answer 11

Ambulatory blood pressure monitoring

Question 12

What is HBPM?

Answer 12

Home blood pressure monitoring

Question 13

How can hypertension be classified?

Answer 13

Stage 1
Stage 2
Severe

Question 14

If a patient is diagnosed with stage 1 hypertension what is the course of action?

Answer 14

Monitor lifestyle modification and arrange 24 hour monitoring

Question 15

What is the course of action for stage 2 hypertension?

Answer 15

Lifestyle modification fairly urgent 24hours monitoring

Question 16

What is the course of action for severe hypertension?

Answer 16

Treat immediately - emergency

Question 17

What lifestyle changes can be used to manage hypertension?

Answer 17

Lose weight
Exercise
Smoking
Diet - salt
Manage other vascular risk factors e.g. cholesterol, diabetes

Question 18

Function of ACE inhibitors?

Answer 18

Inhibit ACE - inhibits formation of angiotensin II. Inhibits aldosterone secretion = no increase in BP

Question 19

What is the bets choice of drug for a patient under 55 with hypertenison?

Answer 19

ACE inhibitors

Question 20

What is the choice of drug fro patient over age 55 with hypertension?

Answer 20

Calcium-channel blocker

Question 21

Describe the mechanism of action of thiazide like diuretics?

Answer 21

Increase excretion of Na and water
More Na reaches the distal tubule
BP lowering related to decreased peripheral reisstance

Question 22

Mechanism of beta blockers?

Answer 22

Decrease HR, decrease myocardial contractility, inhibit renin-angiotensin system (reduce peripheral resistance)

Question 23

Adverse effects of beta blockers?

Answer 23

Heart failure
fatigue
Blunting recognition of hypoglycaemia in diabetes
Withdrawal
tooth demineralisation

Question 24

Calcium channel blockers mechanism of action?

Answer 24

Block Ca entry into smooth muscle cells, inhibit Ca current in sinus and AV node
Decrease peripheral resistance, decrease HR, decrease coronary vascular resistance

Question 25

Adverse effects of calcium channel blockers?

Answer 25

Flushing, headaches, oedema, bradycardia, heart failure

Question 26

Adverse effects of ACE inhibits

Answer 26

Renal failure Cough Burning mouth syndrome

Question 27

Describe angiotensin receptor blockers mechanism of action?

Answer 27

Inhibit action of angiotensin II at receptor

Question 28

Effect of angiotensin receptor blockers?

Answer 28

Decrease sympathetic nervous system, vasodilation

Question 29

Mehcanism of action of alpha blockers?

Answer 29

Alpha - adrenoreceptor antagonist. Vasodilation = fall in BP Increase HR

Question 30

What is the aim of management of angina?

Answer 30

Reduce symptoms and reduce risk of MI stroke

Question 31

What risk factors need to be managed for treatment of angina?

Answer 31

Vascular risk factors e.g. smoking, cholesterol, diabetes

Question 32

What is the effect of anti-platelet therapy for angina treatment?

Answer 32

Reduces risk of NI and stroke

Question 33

Mechanism of action of nitrates for angina teatment?

Answer 33

Relax arterial and venous smooth muscle. Venodilation = reduced BP Redistribution of blood flow to ischaemic myocardium

Question 34

Disadvantages of nitrate therapy to treat angina?

Answer 34

Tolerance - decreased effect at given concentration. after repeated doses

Question 35

Effect of catecholamines like adrenaline and noradrenaline on oxygen demand?

Answer 35

Increase myocardial oxygen demand during exercise by effecting HR and contractility

Question 36

Effect of B blockers on oxygen demand?

Answer 36

Decrease myocardial oxygen demand by decreasing the effects of noradrenaline and adrenaline

Question 37

Effect of B blockers on angina?

Answer 37

Reduces effects of adrenaline = reduce oxygen demand during exercise = angina tolerance improved

Question 38

Effect of If channel blockers (in the sinus node)?

Answer 38

lowers HR without any other action on cardiac function