Drug treatments for CVD Flashcards
Describe which meds you would prescribe for whom in hypertension
describe the roles of the vascular endothelium (5)
angiogenesis
metabolism
thrombosis
platelet activation
lymphocytes traffic
VSMC (vascular smooth muscle cells) proliferation
inflammation
vascular tone
name 4 main types of CVD
stroke and tia (mini stroke)
coronary heart disease
peripheral arterial disease
aortic disease
what is optimal and normal bp
O: <120, <80
N: <130, <85
first line hypertension pharmacotherapy <55 and not black pt
Ace inhibitor
first line hypertension pharmacotherapy >55 and/or black pt
calcium channel blocker
when would you use an Ace inhibitor for a black pt
other risks factors eg coronary ht disease or CKS
what is the first step of the RAAS pathway
activation of JG cells - prorenin turns to renin
what does renin do?
converts angiotensinogen (liver) to angiotensin I
how is angiotensin I turned to Angiotensin II
ACE
where do you find ACE
lungs and kidneys
what does A II do in teh proximal tubule
promotes Na+ reuptake
what does A II do in the adrenal cortex
promotes release of aldosterone
what does aldosterone do?
promotes Na+ reabsorption in distal tubule
what does A II bind to in teh vascular system
GPCR
which hormonw causes vasoconstriction in systemic vasculature
A II
in which vessels does most vasoconstriction happen
arterioles
what does A II stimulate in the brain?
ADH release
what is natriuresis
excretion of Na+ in the urine
what are the two angiotensin related antihypertensives
ACE inhibitors and angiotensin II receptor antagonists (losartan)
what do Ca2+ channel blockers do
decrease vasoconstriction
what are the 2 types of diuretics
loops and thiazide
what do thiazide diuretics do
inhibit NaCl cotransporter in distal CT therby causing naturesis
what to loop diuretics do
inhibit Na-K-Cl cotransporter in loop of Henle causing naturesis
what are some dangers of loop diuretics
loss of calcium, loss of K
what is the name of a dihydropyridine CCB and what are some side effects
amlodipine
flushing, oedema, headaches
name a non-dihydropyridine CCB
diltiazem
when should you not use diltiazem
heart failure
why is diltiazen contraindicated
in heart failure because is negative chrono and ionotrope
what is the first line treatment for angina
lower cholestrerol, dietary changes
what pharmacotherapy an you use for angina
GTN spray, B blockers, ACE inhibitors
what does GTN do?
ultimately venodilation - converts to NO,
increases cyclic GMP, diminished actin-myosin cross bridges
which medicine is absolutely contraindicated with GTN and why
viagra - severely low bp
what is decreased with low doses of GTN
preload
what receptors does adrenaline bind to
BETA 1!!!
what is a beta blocker
BETA 1 and2 receptor antagonist
what is angina
heart ischaemia caused by problems with coronary arteries
how do calcium channel blockers help angina
decrease afterload
decrease SVR
increase O2 supply to coronary arteries by dilating them (so more blood comes)
signs/symptoms of heart failure
oedema (peripheral and/or pulmonary)
dyspnoea
lack of energy
raised JVP
pulmonary crackles
what is the cardiac result of heart failure(2)
reduced CO
increased intracardiac pressure
what is the critical measurement in the diagnosis of types of heart failure
ejection fraction
what are the 3 EF versions
> 50 preserved
40-50 borderline
<40 reduced
with preserved ejection fraction HF what should you prescribe
diuretics
with reduced EF what should you prescribe
ACE- i and B blocker, then MRA (mineralocorticoid receptor antagonist)
what is an MRA
Mineralocorticoid receptor antagonist eg spiranolactone. Diuretic
how does GTN reduce preload
vasodilation - increases capacitance in the body so less blood goes back to the heart
what is the difference between low and high doses of gtn
low - decreased preload
high - decreased preload AND afterload bc arteries also dilated
