Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 3 > Drug treatment of hypertension > Flashcards

Drug treatment of hypertension Flashcards

1
Q

What is advised before taking antihypertensive drugs

A

oModify diet
oIncrease exercise
oReduce alcohol consumption
oReduce coffee and other caffeine-rich products
oReduce sodium (salt) intake
oStop smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What controls BP

A

-nerves (ANS/baroreceptors)
-RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is angiotensin released

A

Renin is released from the kidneys
Renin (enzyme) converts angiotensinogen to angiotensin I (inactive)
Angiotensin converting enzyme (ACE) converts angiotensin I to angiotensin II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What regulates renin release

A

Beta adrenergic receptor agonists
Renal sympathetic nerve activity
Prostaglandin I2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does angiotensin II act

A

AT1 receptors
(increases BP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the action of angiotensin II

A
  1. Vasoconstriction ↑total
    peripheral resistance
  2. Stimulates release of
    aldosterone (from adrenal gland) - salt retention
    which ↑blood volume
  3. Stimulates thirst and release of ADH which ↑blood volume, cardiac output and MAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the action of ACE

A

on extracellular surface of endothelial cells
AT1 receptors on SMC
Gq - IP3 - Ca2+ release - contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the first ACEi

A

captopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the effect of higher renin levels in patients

A

more angiotensin produced
greater effect of ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Examples of ACEi

A

Ramipril
Lisinopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Uses of ACEi

A

Hypertension
Heart failure
After MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adverse effects of ACEi

A

Cough
Hypotension
Reversible renal impairment
Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Elimination of ACEi

A

Mainly renal excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Examples of angiotensin receptor blockers (ARBs)

A

losartan
candesartan
irbesartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Uses of ARBs

A

Hypertension
Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adverse effects of ARBs

A

Hypotension
Reversible renal impairment
Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Elimination of ARBs

A

Mainly hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is coughing an adverse effect of ACEi

A

ACE breaks down bradykinin
inhibiting ACE increases bradykinin levels
Bradykinin acts on itch channels causing coughs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do ACEi and ARBs cause hyperkalemia (high potassium)

A

Angiotensin II releases aldosterone
Aldosterone increases sodium reabsorption
from urine to blood and subsequent potassium loss into urine
Reduced angiotensin II = reduce aldosterone

20
Q

2 types of L-type calcium channel blockers

A

Cardiac selective - arrythmias
verapamil/diltiazem
vascular selective (SMC)
amlodipine/nifedipine

21
Q

Mechansim of vascular selective calcium channel blockers

A

In vascular smooth muscle,
influx of calcium through
calcium channels in the
cell membrane leads to
contraction and thus
vasoconstriction.
Vasodilation
 ↓ arterial resistance
 ↓ blood pressure
 ↓ cardiac afterload

22
Q

Adverse effects of vascular selective calcium channel blockers

A
  • Headache
  • Flushing
  • Dizziness
  • Peripheral oedema
  • ↑ gastro-oesophageal reflux
23
Q

What is the functional unit of the kidney

A

nephron

24
Q

Renal system

A

Blood is filtered at the glomerulus and fluid (filtrate)
containing small molecules moves into the Bowman’s
capsule.
* The filtrate proceeds through the tubule where
absorption and secretion occur. Many small molecules
and ions are returned to the blood. Some molecules
are secreted from the blood to urine (e.g. uric acid).
* The reabsorption of water from urine to blood is
regulated by hormones.
* The collecting duct collects the urine from many
nephrons.

25
Q

Why do loop and thiazide diuretics increase urine output

A

Inhibit ion transporters ↓ sodium reabsorption in nephron which leads to greater urine volume.

26
Q

How do diuretics treat hypertension

A

unclear
Initial decrease in BP due to ↓ blood volume, cardiac output & peripheral
resistance -RAAS system activated

27
Q

Examples of loop diuretics

A

Furosemide/frusemide

28
Q

Action of loop diuretics

A

Inhibit Na+/K+/2Cl-
transporter in ascending loop of Henle
* Increase Na+ in urine
* Increased volume of urine
* Very powerful “torrential”

29
Q

Examples of thiazide diuretics

A

indapamide, bendroflumethiazide

30
Q

Action of thiazide diuretics

A
  • Bind to Cl- site of the Na+/Cl- transporter in the distal tubule
    Prevent Na+ movement into cell
    Increase sodium in urine
    Increased volume of urine.
  • Less powerful than loop diuretics
31
Q

Adverse effects of loop diuretics

A

↑ loss of H+ = metabolic alkalosis
↑ loss of K + Use with K+ -sparing diuretics
↑ loss of Ca +
↑ loss of Mg +
↓ loss of uric acid = gout

32
Q

Adverse effects of thiazide diuretics

A

↑ loss of H+ = metabolic alkalosis
↑ loss of K + Use with K+ -sparing diuretics
↑ loss of Mg +
↓ loss of uric acid = gout
erectile dysfunction

33
Q

Types of potassium sparing diuretics

A
  • Epithelial sodium channel blockers e.g. amiloride, triamterene
  • Mineralocorticoid antagonists (a.k.a. aldosterone antagonists ) e.g. spironolactone, eplerenone
34
Q

Mechanism of potassium sparing diuretics

A

High Na+ arriving at collecting tubule enters cell via epithelial sodium
channel (ENaC).
K+ moves out through leak channel
* Amiloride blocks ENaC
* Spironolactone reduces expression of ENaC and Na + /K+ ATPase.

35
Q

Spironolactone adverse effects

A

-Hyperkalemia
-GI upset
-Gynecomastia, menstrual disorders, testicular
atrophy (via action on progesterone/androgen
receptors outside kidney)

36
Q

Amiloride adverse effects

A

-Hyperkalemia
-GI upset

37
Q

Action of beta blockers on hypertension

A

e.g. propranolol
block action of NA
B1 - reduces contractility/HR (heart)/inhibits renin release (kidney)
a1/b2 - blood vessels
a1 stimulation = vasoconstriction
B2 stimulation = vasodilation

38
Q

Bisoprolol

A

B1 selective beta blocker

39
Q

pindolol/celiprolol

A

partial agonists at B2 adrenoceptors in skeletal muscle

40
Q

carvedilol/labetalol

A

B adrenoceptor& vasodilator a1 antagonist

41
Q

Beta blocker adverse effects

A

B1 - cardiac depression/bradycardia
B2 - Cold hands and feet/Bronchoconstriction/impaired glycogenolysis/gluconeogenesis
Propranolol still prescribed for peripheral symptoms of anxiety – performers and exams.

42
Q

Examples of a1 antagonists

A

doxazosin
prazosin

43
Q

Mechanism of a1 antagonists

A

Block effects of NA/adrenaline causing vasodilation
-decreased peripheral resistance/BP
Blocks:
activation of Gq,
Activation of PLC (phospholipase C)
↑IP3
↑Ca2+
contraction

44
Q

What does blockage of a2 adrenergic receptors cause

A

reflex tachycardia

45
Q

Uses of a1 antagonists

A
  • hypertension (occassionally)
  • congestive heart failure
  • benign prostatic hyperplasia (common use)
46
Q

adverse effects of a1 antagonists

A

first dose - postural hypotension (fainting) and syncope
limit initial dose/monitor BP both standing and recumbent BP

47
Q

What drug is taken by over 55s/Black African/Caribbeans

A

CCB

Module 3 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions