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Pharmacology Y2 > High Blood Pressure > Flashcards

High Blood Pressure Flashcards

1
Q

Above what blood pressure is it clinically classified as high blood pressure?

A

140/90 mmHg or higher

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2
Q

What is a normal blood pressure?

A

160/95 mmHg

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3
Q

What is the equation linking blood pressure, peripheral resistance and cardiac output?

A

BP = CO x TPR

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4
Q

What is the equation linking blood pressure, peripheral resistance and cardiac output?

A

BP = CO x TPR

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5
Q

Cardiac output is heart rate x _____ ______

A

Stroke volume

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6
Q

What is the main characteristic of high blood pressure?

A

Increase in peripheral resistance

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6
Q

What is the main characteristic of high blood pressure?

A

Increase in peripheral resistance

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7
Q

Which adrenoreceptor targets the level of sympathetic resistance?

A

Alpha 1 receptors

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8
Q

Why do patients usually have to take multiple drugs to target high blood pressure?

A

Some drugs may only target either heart of vasculature, meaning the baroreceptor reflex may still have a reactive effect to try return the blood pressure to “normal”, which is not desirable

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9
Q

Name 4 areas that can be targeted to reduce the peripheral resistance

A

1- Reduce mean arterial blood pressure
2- Reduce stroke volume
3- Reduce heart rate
4- Increase vasodilation

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10
Q

Define primary hypertension

A

Hypertension with no known mechanism/cause

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11
Q

Define secondary hypertension

A

Hypertension caused by an existing condition

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12
Q

Name 4 conditions that can cause high blood pressure

A

Phaechromocytoma
Primary aldosteronism
Cushings syndrome
Renal glomerulonephritis

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13
Q

Name 2 smooth muscle vasodilators

A

Bendroflumethiazide
Hydralazine

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13
Q

Name 2 smooth muscle vasodilators

A

Bendroflumethiazide
Hydralazine

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14
Q

Is the mechanism of smooth muscle vasodilators known?

A

Unknown how they work, they do not work via diuresis

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15
Q

How does the baroreceptor reflex react to vasodilation?

A

Baroreceptor reflex -> activate beta 1 receptors to increase heart rate and stroke volume -> reversing the effects of low blood pressure

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16
Q

What kind of smooth muscle does hydralazine act on?

A

Arteriolar smooth muscle only

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17
Q

How does RAAS react to vasodilators?

A

Activation of beta 1 -> increases renin release form the kidneys, -> increased angiotensin 2 -> activation of aldosterone -> increases salt and water retention

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18
Q

What may happen to the patient if RAAS is activated in response to a vasodilator?

A

Oedema due to water retention

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19
Q

What type of drug is minoxidil?

A

K+ channel opener

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20
Q

On which cells are K+ channel openers used?

A

Arteriolar smooth muscle cells

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20
Q

On which cells are K+ channel openers used?

A

Arteriolar smooth muscle cells

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21
Q

How does minoxidil act to open K+ channels?

A

Minoxidil blocks ATP from binding to K+ channels, by making the K+ channels bind to sulphonic urea receptors instead - this forces the K+ channels to be open

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22
Q

What is the effect of K+ channel openers?

A

Causes an efflux of K+ -> which hyperpolarises the membrane -> calcium channels will be closed if the membrane is not depolarised -> prevents smooth muscle contraction from occurring

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23
Q

What is another use of K+ openers other than treating high blood pressure?

A

For treatment of hypertrichosis (baldness)

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24
Q

Name 2 Ca2+ channel blockers

A

Amlodipine
Nifedipine

24
Q

Name 2 Ca2+ channel blockers

A

Amlodipine
Nifedipine

25
Q

What is the mechanism of Ca2+ channel blockers preventing vascular smooth muscle contraction?

A

Calcium channels being blocked prevents calcium influx -> so no muscular contraction occurs -> leading to vasodilation

26
Q

Are nitrovasodilators used for chronic hypertension?

A

No

27
Q

Give an example of a nitrovasodilator

A

Sodium nitroprusside

28
Q

What is the mechanism of nitrovasodilators?

A

NO diffuses into smooth muscles -> increased conversions of GTP to cGMP through guanylate cyclase -> muscular relaxation

29
Q

How is sodium nitroprusside administered?

A

Through an IV drip

30
Q

What group of drugs is known for being an indirect vasodilator?

A

Alpha 1 antagonists

31
Q

Name 2 indirect vasodilators that prevent noradrenaline from activating alpha 1 receptors

A

Prazosin
Doxazosin

32
Q

Name a vasodilator that prevents noradrenaline being released form the nerve terminal

A

Guanethidine

33
Q

What is the mechanism of action of hexamethonium?

A

Prevents nervous impulse passing from the preganglionic neurones to the post ganglionic neurones -> by binding to nicotinic ACh receptors

34
Q

Why is hexamethonium not used anymore?

A

Because it affects the sympathetic and parasympathetic pathways so causes adverse effects as well as its desired effect

35
Q

What group of drugs acts by causing diuresis?

A

K+ sparing diuretics

36
Q

Give an example of a K+ sparing diuretic

A

Spironolactone

37
Q

What is the mechanism of spironolactone?

A

Changes expression of Na+/K+ ATPases -> blocks the receptor for aldosterone -> decreases number of ENaC on the cell membrane -> less sodium and water reabsorption -> circulation volume decreases -> blood pressure decreases

38
Q

What group of drugs can act on the central parts of the sympathetic nervous system?

A

Alpha 2 agonists

39
Q

How do alpha 2 agonists reduce sympathetic outflow?

A

Alpha 2 receptors causes the reuptake of noradrenaline -> agonists will increase the reuptake of noradrenaline -> prevents nervous impulse form being transmitted -> also inhibits the sympathetic outflow from the RVLM and NTS

40
Q

Where do alpha 2 agonists act to prevent sympathetic outflow to preganglionic neurones?

A

RostraVentroLateral Medulla
Nucleus of Solitary Tract

41
Q

Give an example of an alpha 2 agonist

A

Clonidine

42
Q

What is one counter action of alpha 2 agonists?

A

They can also activate the alpha 2 receptors of the post synaptic membrane -> contributes to vasoconstriction

43
Q

Is the amount of vasoconstriction from alpha 2 agonists significant?

A

No, there is a bigger effect of reducing noradrenaline release and reducing sympathetic stimulation than the small amount fo vasoconstriction

44
Q

Name a false transmitter that reduces sympathetic outflow

A

Alpha methyl DOPA

45
Q

What is the mechanism of alpha methyl DOPA?

A

Synthesised through same pathway as noradrenaline -> less noradrenaline packaged into vesicles -> alpha methyl noradrenaline has lower affinity to alpha 1 -> alpha 1 antagonist and alpha 2 agonist -> vasodilation

46
Q

What are side effects of alpha methyl DOPA?

A

Postural hypotension (blood pressure too low that sympathetic outflow does not increase enough when standing up)
Dry mouth (saliva production is inhibited)

47
Q

List the 4 functions of beta adrenoreceptor antagonists

A

Reduces cardiac output
Reduces renin release
Reduces sympathetic tone
Resets the baroreceptor reflex

48
Q

Is the baroreceptor reflex activated by beta adrenoreceptor antagonists?

A

No, beta blockers do not cause a reactive mechanism from the baroreceptor reflex

49
Q

Name 3 contraindications of beta receptor antagonists

A

Asthma
Diabetes
Peripheral vascular disease

50
Q

How do beta receptor antagonists cause an contraindication to diabetes?

A

Prevents action of adrenaline -> adrenaline helps indicate whether blood glucose levels are high or low

51
Q

How do beta receptors cause a contraindication to asthma?

A

Blockage of beta 2 receptors -> cannot activate relaxation of airway smooth muscle

52
Q

How would the RAAS system of the kidneys react to a lower blood pressure?

A

Reduced perfusion of kidneys -> release of renin into the blood -> angiotensinogen from liver cleaved to angiotensin 1 -> ACE from pulmonary endothelium cleaves angiotensin 1 to angiotensin 2

53
Q

List the effects of angiotensin 2

A

Increased sympathetic activity
Vasoconstriction
Reabsorption of ions
Releases aldosterone which increases salt and water retention
ADH release from pituitary gland

54
Q

Which drugs action prevents renin cleaving angiotensinogen?

A

Aliskiren

55
Q

Name 3 ACE inhibitors

A

Ramipril
Captopril
Enalapril

56
Q

What type of drug is Losartan?

A

Angiotensin 2 receptor antagonist -> prevent angiotensin 2 from acting on its various receptors

57
Q

What are mineralocorticoid antagonists?

A

Prevents aldosterone from having its effects on sodium and water retention -> decreases circulating volume -> lowers blood pressure

58
Q

Give an example of a mineralocorticoid antagonist

A

Amiloride triamterene

59
Q

Do nitrovasodilators cause an increase or decrease in cardiac work/output?

A

Decreases

60
Q

Do calcium channel blockers affect cardiac muscle and other smooth muscle tissues as well as vascular smooth muscle?

A

Yes

61
Q

Do calcium channel blockers cause tachycardia?

A

No

62
Q

What do ACE inhibitors so to the concentration of bradykinin?

A

Inhibits breakdown of bradykinin so concentration increases

Pharmacology Y2 (9 decks)

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