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Drugs and Disease > Drugs affecting blood pressure > Flashcards

Drugs affecting blood pressure Flashcards

1
Q

What are the factors causing primary hypertension?

A 
Smoking
Obesity
Diet (e.g. salt)
Exercise (lack of)
Genetic
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2
Q

How many of the cases are primary hypertension?

A

Roughly 90%

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3
Q

How many of the cases are secondary hypertension?

A

<10%

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4
Q

What is an example of secondary hypertension?

A

Renal hypertension or pheochromocytoma

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5
Q

What does chronic hypertension lead to?

A 
Further cardiovascular disease
E.g. 
Atherosclerosis
Stroke
Myocardial infarction 
Heart failure
Renal failure
Retinopathy
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6
Q

What are the benefits of antihypertensive therapy?

A

40% reduction of stroke
25% reduction in myocardial infarction
>50% reduction in heart failure

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7
Q

What is the equation to calculate blood pressure?

A

BP= Total peripheral resistance x Cardiac output

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8
Q

How do you calculate cardiac output?

A

CO= Heart rate x Stroke volume

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9
Q

What are the ways of lowering blood pressure by drug action via the block of sympathetic nervous system

A

Reduce effects on heart (beta1-blockers)
Reduce effects on blood vessels (alpha1-blockers
Reduce renin release from kidney (beta1-blockers)

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10
Q

What are the ways of lowering blood pressure by drug action via the kidney?

A

Reduce blood volume (diuretics)

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11
Q

What are the ways of lowering blood pressure by drug action via hormones?

A

Inhibit renin-angiotensin-aldosterone system (angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers)

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12
Q

What are used to lower blood pressure by drug action?

A 
Via:
Block of sympathetic nervous system
Kidney
Hormones
Vasodilation of peripheral resistance arterioles (Ca2+ channel blockers)
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13
Q

What are examples of beta-adrenoceptors?

A

Propranolol (beta1 and beta2) and atenolol (beta1 selective)

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14
Q

What do competitive reversible antagonists do?

A

Decreases pressure via blockade of beta1 sympathetic tone on heart and reduction in renin release from kidney
Decrease in heart rate and stroke volume
Decrease in cardiac output

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15
Q

What are the adverse effects of beta-adrenoceptor blockers?

A

Exacerbate asthma (block of beta2- abslute contraindication)
Intolerance to exercise
Hypoglycaemia
Vivid dreams

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16
Q

What are some examples of alpha-adrenoceptor blockers?

A

Phentolamine (alpha1 and alpha2)

Doxazosin, prazosin (alpha1 selective)

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17
Q

What are alpha-adrenoceptor blockers?

A

Competitive reversible antagonists

Decreases blood pressure via decreases in sympathetic tone in arterioles (alpha1 (decreases peripheral resistance)

18
Q

What are the adverse effects of alpha-adrenoceptors?

A 
Postural hypotension (loss of sympathetic venoconstriction)
Reflex tachycardia (via baroreceptors)
19
Q

What are some examples of ACE inhibitors?

A

Captopril and enalapril

20
Q

What do ACE inhibitors do?

A

Angiotensin Converting Enzyme on vascular endothelial surface converts angiotensin I to the active angiotensin II

21
Q

What effects do ACE inhibitors have?

A

Lower blood pressure

22
Q

How do ACE inhibitors lower blood pressure?

A

Reduced formation of the vasoconstrictor angiotensin II (decrease in peripheral resistance)
Reduced blood volume (loss of angiotensin II- stimulated release of aldosterone, thus reduction of renal reabsorption of Na+ and water)

23
Q

What are the adverse effects of ACE inhibitors?

A

Sudden fall in BP on 1st dose
Persistent irritant cough- due to reduced breakdown of bradykinin, a peptide that activates sensory nerves in lung tissue

24
Q

What are the two receptor subtypes of angiotensin II receptor blockers?

A

AT1

AT2

25
Q

What does AT1 receptor mediate?

A

Vasoconstrictor and aldosterone-releasing actions of angiotensin II

26
Q

What are some examples of AT1 blockers?

A

Losartan and candesartan

27
Q

What are AT1 blockers useful for?

A

Antihypertensive agents

28
Q

Are side effects seen with AT1 blockers?

A

No

No irritant cough as seen with ACE inhibitors

29
Q

What are some examples of diuretics?

A

Bendroflumethiazide (a thiazide)

30
Q

What do diuretics do?

A

Lower blood pressure by reducing blood volume

31
Q

What is the mechanism of diuretics?

A

Mechanism is through reduced renal reabsorption of Na+ and water
(additional vasodilator action may also contribute: decrease peripheral resistance)

32
Q

What are the adverse effects of diuretics?

A

Decrease in plasma K+

33
Q

What are examples of calcium channel blockers?

A

Verapamil, dlitiazem and nifedipine

34
Q

What do L-type voltage operated calcium channel do?

A

Open upon membrane depolarisation

Calcium entry into cardiac and vascular smooth muscle

35
Q

What do L-type voltage operated calcium channels reduce?

A

Ca2+ entry into vascular smooth muscle and cardiac muscle by blocking L-type voltage-operated calcium channels

36
Q

What are the 3 mechanism of L-type channel blockers?

A

Open channel block
Allosteric modulation
Tissue selectivity

37
Q

What drugs use open channel block mechanism?

A

Verapamil and diltiazem

38
Q

What do allosteric modulation bind to?

A

Allosteric site and reduce channel opening

Nifedipine works this way

39
Q

What is tissue selectivty in smooth muscle?

A

nifedipine > diltiazem > verapamil

40
Q

What is tissue selectivity in cardiac muscle?

A

verapamil > diltiazem > nifedipine

41
Q

How do calcium channel blockers lower blood pressure?

A

Reducing peripheral resistance (block of Ca2+ entry into vascular smooth muscle → vasodilation)
Reducing cardiac output (block of Ca2+ entry into cardiac muscle- heart rate and stroke volume both reduced)
1»2

42
Q

What are the adverse effects of calcium channel blockers?

A

Headache
Constipation
Cardiac dysrhythmias (negative chronotropic effect and slowed conduction)

Drugs and Disease (25 decks)

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