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Pharmocology > Drugs and the cardiovascular system: the vasculature > Flashcards

Drugs and the cardiovascular system: the vasculature Flashcards

1
Q

List examples of vasoconstictors

A
  • angiotensin II
  • noradrenaline
  • ATP
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2
Q

List examples of vasodilators

A
  • NO
  • PGI2
  • C-type natriuretic peptide
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3
Q

What happens to pressure with increased sympathetic discharge to arterioles?

A
  • increased arteriolar constriction

- increased peripheral resistance

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4
Q

What happens if arterioles contract?

A
  • reduced radius, increased resistance, decreased blood flow
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5
Q

What happens if arterioles relax?

A
  • increased radius, decreased resistance, increased blood flow
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6
Q

What defines hypertension?

A
  • constant BP above 140/90 mmHg
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7
Q

What is the most important risk factor for stroke?

A

hypertension

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8
Q

What diseases is hypertension a major risk factor for?

A
  • myocardial infarction

- chronic kidney disease

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9
Q

What is the first step of hypertension treatment?

A
  • ACE inhibitor or angiotensin receptor blocker (ARB) for under 55s
  • calcium channel blocker (CCB) or thiazide-type diuretic for over 55s or AfroCaribbeans
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10
Q

What is the second step of hypertension treatment?

A
  • ACE inhibitor and calcium channel blocker
  • ACE inhibitor and thiazide type diuretic

ARB preferred to ACE for AfroCaribbean

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11
Q

What is the third step of hypertension treatment?

A

-combination of ACE inhibitor/ARB with CCB and thiazide-like diuretic

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12
Q

What is the fourth step of hypertension treatment?

A

-diagnosed as resistant hypertension

  • consider low dose spironolactone
  • consider beta-blocker or alpha blocker
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13
Q

Outline how the renin angiotensin-system works

A
  • Angiotensinogen is produced by the liver
  • reduced renal Na+ reabsorption, reduced renal perfusion pressure and increase sympathetic activation leads to the release of renin
  • renin converts angiotensinogen into angiotensin I
  • ACE converts angiotensin I into angiotensin II and bradykinin into inactive metabolites

-angiotensin II stimulates: thirst/SNS activation, vasoconstriction, salt and water retention and aldosterone secretion

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14
Q

How does ACEi work?

A

-inhibit ACE from converting angiotensin I to angiotensin II

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15
Q

What are the uses of ACEi?

A
  • hypertension
  • heart failure
  • post- MI
  • diabetic neuropathy
  • progressive renal insufficiency
  • patients at high risk of cardiovascular disease
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16
Q

Give an example of an ACEi

A

enalapril

17
Q

How does ACEi help hypertension?

A

inhibits vasoconstriction of vessels, reducing TPR directly leading to reduced BP
-it also contributes to decreased venous return and hence CO

18
Q

How does ACEi help heart failure?

A
  • inhibits vasoconstriction, meaning there is a decrease in afterload and hence cardiac work
  • this also reduces the chance of oedema due to long term venous return
19
Q

How do ARB work?

A

They prevent the renal and vascular actions of ANG II

-inhibits vasoconstriction, salt and water retention and aldosterone secretion

20
Q

Give an example of ARB

A

losartan

21
Q

What are the main side effects of ACEi and ARB

A
  • cough (ACEi)
  • hypotension
  • hyperkalaemia (less sodium reuptake and potassium excretion) - care with K supplements
  • renal failure in patients with renal artery stenosis
22
Q

What is the mechanism for smooth muscle contraction?

A
  • membrane depolarisation opens voltage-gated calcium channels
  • Ca++ enters and binds to calmodulin (CaM)
  • Ca++ CaM complex binds to and activates myosin light chain kinase
  • MLCK mediated phosphorylation leads to smooth muscle contraction
23
Q

What are the two types of CCB?

A

-dihydropyridines
more selective for blood vessels

-non-DHPs (non-rate limiting)

24
Q

Give examples of each type of CCB

A

-dihydropyridine- amlodipine (doesn’t cause any negative inotropy)
licensed for prophylaxis of angina

-non- DHPs - verapamil (large inotropic effect)

25
Q

Which calcium channel blocker would you use to inhibit hypertension?

A
  • dihydropyridines, they inhibit Ca++ entry into vascular smooth muscle cells
  • decreased TPR leads to decreased BP
26
Q

What can occur with powerful vasodilators?

A
  • reflex tachycardia
  • increased inotropy
  • increased myocardial oxygen demand
27
Q

Why might a- blockers be used as anti-hypertensives?

A

-block alpha 1 receptors, blocks vasoconstriction, decreases TPR and BP

Pharmocology (16 decks)

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