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Heart, Lungs and Blood > Drug treatment for CVD > Flashcards

Drug treatment for CVD Flashcards

1
Q

What are the basic principles of hypertension management according to national guidelines?

A

The basic principles of hypertension management according to national guidelines include lifestyle changes, such as exercise and a healthy diet, and pharmacological treatment to lower blood pressure to the recommended level.

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2
Q

What is the recommended blood pressure level for hypertensive patients according to national guidelines?

A

The recommended blood pressure level for hypertensive patients according to national guidelines is < 140/90 mmHg, and for patients with diabetes or kidney disease, < 130/80 mmHg.

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3
Q

What lifestyle changes can help to manage hypertension?

A

Lifestyle changes that can help to manage hypertension include losing weight, eating a healthy diet, reducing salt intake, increasing physical activity, limiting alcohol consumption, and quitting smoki

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4
Q

What are some classes of antihypertensive drugs?

A

Some classes of antihypertensive drugs include diuretics, ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and aldosterone antagonists.

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5
Q

What are some potential side effects of antihypertensive drugs?

A

Potential side effects of antihypertensive drugs include dizziness, fatigue, headache, cough, nausea, electrolyte imbalances, and sexual dysfunction.

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6
Q

How is the choice of antihypertensive drug tailored to the individual patient?

A

The choice of antihypertensive drug is tailored to the individual patient based on their age, race, comorbidities, and other factors. For example, in African American patients, a thiazide diuretic or a calcium channel blocker may be preferred over an ACE inhibitor or an ARB.

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7
Q

what are factors you need to know about a drug

A
  • Molecular mechanism of action
  • What tissues/organs it acts on (
  • Physiological effect(s) on the body
  • Potential side-effects
  • Interactions
  • Pharmacokinetics
  • What it is used for clinically……….
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8
Q

What is the physiological effect of activation of a1 receptors?

A

Vasoconstriction, increased sweating, and bladder sphincter closure.

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9
Q

What is the physiological effect of activation of a2 receptors?

A

Decreased release of norepinephrine, acetylcholine, and insulin.

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10
Q

What is the physiological effect of activation of b1 receptors?

A

Increased heart rate, increased contractility, and increased renin release.

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11
Q

What is the physiological effect of activation of b2 receptors?

A

Vasodilation, bronchodilation, and increased gluconeogenesis.

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12
Q

What is the molecular action of beta-receptors?

A

Beta-receptors activate Adenylate Cyclase through Gs-protein-dependent activation. This results in increased cyclic AMP, which activates Protein Kinase A. Intracellular calcium levels may increase or decrease, leading to changes in contractility. In cardiac muscle, contractility increases, while it decreases in arterial smooth muscle and bronchial smooth muscle.

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13
Q

What is Propranolol?

A

Propranolol is a non-selective beta-blocker.

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14
Q

What are the conditions that Propranolol is effective for?

A

Propranolol is effective for angina, hypertension, arrhythmias, migraine, tremor, anxiety, and thyrotoxicosis.

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15
Q

What are the effects of beta-blockers on the heart?

A

Beta-blockers reduce the force and rate of contraction, and lower blood pressure.

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16
Q

What are the effects of beta-blockers on the lungs?

A

Beta-blockers can cause bronchoconstriction, which may lead to breathlessness and worsen asthma.

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17
Q

What are the effects of beta-blockers on the arterioles?

A

Beta-blockers can reduce blood supply to the muscles, skin, and penis, which can lead to fatigue, claudication, cold hands/feet, and erectile dysfunction.

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18
Q

What are the side effects of beta-blockers on the heart?

A

Beta-blockers can cause fatigue and bradycardia.

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19
Q

What are the side effects of beta-blockers on the lungs?

A

Beta-blockers can cause breathlessness and worsen asthma.

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20
Q

What are the side effects of beta-blockers on the arterioles?

A

Beta-blockers can cause fatigue, claudication, cold hands/feet, and erectile dysfunction.

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21
Q

What are b1 selective beta-blockers?

A

They are beta-blockers that have been developed to reduce side-effects.

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22
Q

Why are beta-blockers contraindicated in diabetic patients with recurrent hypoglycaemia?

A

Beta-blockers block the symptoms of hypoglycemia caused by the release of adrenaline in response to low blood glucose levels, which can make it difficult for patients to recognize the symptoms of hypoglycemia. This is dangerous, as it can lead to delayed treatment of hypoglycemia, which can result in serious complications.

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23
Q

What is the molecular action of thiazide diuretics?

A

Thiazide diuretics work by blocking the Na/Cl symporter in the Distal Convoluted Tubule of the kidney.

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24
Q

What is the molecular action of indapamide, a “thiazide-like” drug?

A

Indapamide works by inhibiting the Na/K/Cl transporter in the ascending limb of the Loop of Henle, leading to increased salt and water excretion.

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25
Q

What are the effects of thiazide diuretics?

A

Thiazide diuretics increase the loss of sodium and water in the kidney, leading to a decrease in blood pressure. They also cause vasodilation of arterioles.

26
Q

What are the side effects of thiazide diuretics?

A

Side effects of thiazide diuretics include hyponatremia (low sodium), hypokalemia (low potassium), alkalosis (high pH), hypercalcemia (high calcium), hypomagnesemia (low magnesium), and increased uric acid levels.

27
Q

What are other uses of thiazide diuretics?

A

Thiazide diuretics can be used for edema, urinary tract stones, and nephrogenic diabetes insipidus.

28
Q

What receptor do alpha blockers act on?

A

a1 receptor

29
Q

What protein does a1 receptor activate?

A

Gq protein

30
Q

What is the effect of alpha blockers on intracellular Ca2+ levels in arteriolar smooth muscle?

A

They decrease the intracellular Ca2+ levels in arteriolar smooth muscle

31
Q

What is the most common alpha blocker used in the UK?

A

Doxazosin

32
Q

What is another condition that alpha blockers are used to treat?

A

Prostatic hypertrophy

33
Q

What type of voltage-gated calcium channel do calcium channel blockers block?

A

L-type voltage-gated calcium channel

34
Q

What is the effect of calcium channel blockers on smooth muscle relaxation in arterioles?

A

They promote smooth muscle relaxation in arterioles

35
Q

What is the effect of calcium channel blockers on the force of contraction in cardiac muscle?

A

They decrease the force of contraction in cardiac muscle

36
Q

What is the effect of calcium channel blockers on heart rate?

A

They decrease heart rate

37
Q

Name three commonly used calcium channel blockers.

A

Amlodipine, diltiazem, verapamil.

38
Q

What is the molecular mechanism of calcium channel blockers?

A

Calcium channel blockers block the L-type voltage-gated calcium channel, which leads to a reduction in intracellular calcium. This causes smooth muscle relaxation in arterioles and a decrease in cardiac contractility, as well as a reduction in heart rate in the SA and AV nodes.

39
Q

What is the physiological effect of dihydropyridines?

A

Dihydropyridines, such as Amlodipine, cause vasodilation and have a strong effect on reducing blood pressure.

40
Q

What is the physiological effect of diltiazem?

A

Diltiazem has moderate vasodilatory effects and decreases cardiac contractility. It also has a moderate effect on heart rate.

41
Q

What is the physiological effect of verapamil?

A

Verapamil has a mild vasodilatory effect and decreases cardiac contractility. It also has a strong effect on reducing heart rate.

42
Q

What are some other uses of calcium channel blockers besides hypertension?

A

Calcium channel blockers are also used to treat angina, Raynaud’s syndrome, and certain arrhythmias.

43
Q

What is the molecular mechanism of action of ACE inhibitors?

A

ACE inhibitors like ramipril block the conversion of angiotensin I to angiotensin II by ACE, leading to decreased levels of angiotensin II and increased levels of bradykinin.

44
Q

What are some potential side effects of ACE inhibitors?

A

ACE inhibitors may cause a dry cough due to bradykinin accumulation in the lungs, renal impairment, and hyperkalemia. They are commonly given with a diuretic and are also used to treat heart failure.

45
Q

How do aldosterone antagonists like spironolactone work?

A

Aldosterone antagonists block the upregulation of epithelial sodium channels in the distal convoluted tubule by aldosterone, leading to decreased sodium reabsorption and increased sodium excretion. Spironolactone is used as an add-on in resistant hypertension and as a first-line treatment for hyperaldosteronism.

46
Q

What is the mechanism of ankle swelling as a side effect of calcium channel blockers?

A

Preferential dilation of pre-capillary arteriole, impaired function of the pre-capillary sphincter, increased hydrostatic pressure and net filtration.

47
Q

What are some other side effects of calcium channel blockers?

A

Palpitations (reflex tachycardia), constipation, flushing, headache, and exacerbation of heart failure.

48
Q

What is the mechanism of ACE inhibitors?

A

ACE converts AT-I to AT-II and breaks down bradykinin. ACE-I’s lower AT-II and increase bradykinin levels.

49
Q

What are the physiological effects of angiotensin II receptor antagonists?

A

They block the action of AT-II on the AT1 receptor, leading to similar effects as ACE inhibitors, but without the dry cough side effect.

50
Q

What is the mechanism of aldosterone antagonists?

A

They block the upregulation of epithelial sodium channels (ENaC) in the distal convoluted tubule by aldosterone.

51
Q

What are some common aldosterone antagonists?

A

Spironolactone, which is used as an ‘add-on’ in resistant hypertension, and as first-line treatment in hyperaldosteronism.

52
Q

What are the side effects of spironolactone?

A

The side effects of spironolactone include impaired renal function, hyperkalemia, and gynaecomastia (due to structural similarity to estrogen).

53
Q

What are some specific causes of hypertension?

A

Specific causes of hypertension include chronic kidney (renal) disease, structural causes (e.g. renal artery stenosis), endocrine (hormonal) causes (e.g. Conn’s syndrome), and pregnancy/pre-eclampsia.

54
Q

What are the blood pressure targets for patients younger than 80 years of age?

A

The blood pressure target for patients younger than 80 years of age is <140/90 mmHg.

55
Q

What are the blood pressure targets for patients with diabetes?

A

The blood pressure target for patients with diabetes is <135/85 mmHg.

56
Q

When should patients with a blood pressure reading of >140/90 mmHg be treated?

A

Patients with a blood pressure reading of >140/90 mmHg should be treated if they have end-organ damage or if they are diabetic.

57
Q

What is the blood pressure target for patients older than 80 years of age?

A

The blood pressure target for patients older than 80 years of age is <150/90 mmHg.

58
Q

At what stage should hypertension be treated immediately according to the NICE guidance?

A

Hypertension should be treated immediately at stage 3, where SBP (systolic blood pressure) is greater than 180 mmHg.

59
Q

At what stage should hypertension be treated once confirmed on 24-hour blood pressure measurement according to NICE guidance?

A

Hypertension should be treated at stage 2, where BP (blood pressure) is greater than 160/100 mmHg, once it has been confirmed on 24-hour blood pressure measurement.

60
Q

At what stage should hypertension be treated if there is end-organ damage or if the patient is diabetic, according to NICE guidance?

A

Hypertension should be treated at stage 1, where BP is greater than 140/90 mmHg, if there is end-organ damage or if the patient is diabetic.

Heart, Lungs and Blood (51 decks)

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