Drug treatments for Cardiovascular disease

Question 1

Define hypertension

Answer 1

Persistently higher than normal blood pressure

Question 2

When should treatment for hypertension begin?

Answer 2

When mean blood pressure increases above 150/95 mmHg

Question 3

What regulates stroke volume?

Answer 3

Regulated by the ventricles

Question 4

What regulates heart rate?

Answer 4

SA node

Question 5

What is total peripheral resistance?

Answer 5

A measure of the degree of constriction of the arterioles

Question 6

Give the equation of blood pressure

Answer 6

BP = CO X TPR

Question 7

Describe how the autonomic nervous system regulates blood pressure

Answer 7

Sympathetic system increases frequency and force via Beta 1 receptors, increases cAMP, increases Ca2+ and increases rate and force
Parasympathetic system decreases the frequency by decreasing cAMP via M2 receptors

Question 8

Describe the molecular pathway of regulating total peripheral resistance by the sympathetic nervous system

Answer 8

SNS - NA - alpha1 - Ip3 - Ca2+ - Constriction

Question 9

What does angiotensin 2 do?

Answer 9

Increases reabsorption of Na+ and Cl-, so increases H2O retention
Aldosterone secretion
Increased sympathetic activity
Causes ADH secretion
Causes vasoconstriction

Question 10

Name drug classes which can be used to treat hypertension by targeting the renin-angiotensin- aldosterone system

Answer 10

ACE inhibitors

AT1 receptor blockers

Question 11

Why can the aldosterone receptor be found in the cytoplasm floating freely?

Answer 11

Aldosterone is lipid soluble

Question 12

What is the choice of hypertension drug dependent on?

Answer 12

Age, race and coexisting diseases

Question 13

Which class of drug is most likely to be given to black african americans?

Answer 13

Calcium channel blockers

Question 14

Which class of drug is more likely to be given to people under the age of 55 who are suffering with hypertension?

Answer 14

ACE inhibitors

Angiotensin receptor blockers

Question 15

List some classes of anti-hypertensives

Answer 15

ACE inhibitors and Angiotensin receptor blockers; Renin Antagonists.
Calcium channel antagonists
Diuretics (no longer frontline)
Beta Blockers (no longer frontline).
Vasodilators

Question 16

What is the most common symptom of ACE inhibitors?

Answer 16

A dry cough

Question 17

Why do patients get a dry cough when on anti-hypertensives

Answer 17

Prevents peptides being broken down so accumulation occurs and gives the sensation there is something in the airway

Question 18

What is 1st dose hypotension?

Answer 18

When the blood pressure drops too much when given because all the mechanisms are prevented when taking an ACE inhibitor

Question 19

What advice can be given so 1st dose hypotension effects can be avoided?

Answer 19

Take the ACE inhibitor at night

Question 20

Which conditions must ACE inhibitors be avoided in? Explain why

Answer 20

Bilateral renal artery stenosis. Efferent arteriole restricts so blood pressure increases and filtration carries on in a normal person however with ACE inhibitors, the ability of the blood vessel to constrict decreases so the efferent vessel can dialate. pressure in bowman’s capsule therefore decreases

Question 21

What is hyperkalemia?

Answer 21

High potassium

> 5mmol/L

Question 22

What do angiotensin receptor antagonists do?

Answer 22

Block the actions of angiotensin 2 on AT1R

Question 23

What do the names of angiotensin receptor antagonists usually end with?

Answer 23

-artan

Question 24

Which aldosterone antagonist is used to treat hypertension in patients with primary aldosteronism?

Answer 24

Spironolactone

Question 25

What is the name of the main class of calcium channel antagonists?

Answer 25

Dihydropyridines

Question 26

What do calcium channel antagonists do?

Answer 26

Target L-type Ca2+ channels on smooth muscle of blood vessel

Question 27

What side effects are caused by calcium channel blockers?

Answer 27

Flushing Headaches Peripheral oedema

Question 28

Why is peripheral oedema caused when a patient is given calcium channel blockers?

Answer 28

Sphincters have L-type receptors on them so contraction does not occur properly and fluid is able to leak out

Question 29

What do thiazide and thiazide-like diuretics do?

Answer 29

Prevent the reabsorption of sodium ions. Some diuretic action but also acts via activation of KATP in smooth muscle of blood vessel to dilate arterioles and decrease BP

Question 30

What type of diuretic is Indapamide?

Answer 30

Thiazide like diuretic

Question 31

How does indapamide work?

Answer 31

Indapamide hyperpolarises smooth muscle cells causing a relaxation/dilation of the arteriole and a decrease in total peripheral resistance

Question 32

List the side effects of thiazide diuretics

Answer 32

Hypokalaemia Increase in urate Increase in glucose Increase in blood lipids

Question 33

List the side effects of beta blockers

Answer 33

``` Potential bronchoconstriction Vasoconstriction via blockade of 2-R Fatigue Increase blood lipids Hypoglycaemia CNS side effects (nightmares, impotence) Potentially not as efficacious in black Afri-can/Americans ```

Question 34

How do beta blockers affect the vasculature

Answer 34

Cause Vaso and broncho constriction

Question 35

What is hyperglycemia?

Answer 35

Low blood glucose activates the release of adrenaline, mobilises glucose release from liver.

Question 36

How is hyperglycemia affected by beta blockers?

Answer 36

Blocked by beta blockers

Question 37

State the 2 types of beta blocker

Answer 37

Selective and non selective

Question 38

When are vasodilators used to treat hypertension?

Answer 38

In patients with benign prostatic hypertrophy

Question 39

What are vasodilators?

Answer 39

Alpha 1 receptor antagonists