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CVS > Hypertension > Flashcards

Hypertension Flashcards

1
Q

list classes of antihypertensive drugs

A

ABCDV:

  • Angiotensin antagonist (ACEI, AT1 blocker)
  • Beta blockers
  • Ca channel blocker (DHP)
  • Diuretics
  • Vasodilators
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2
Q

determinants of CO

A

CO = SV x HR

- SV: contractility, filling pressure (BV, venous tone)

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3
Q

Effective drug combinations

A

any 2 of:

  • Ca channel blocker
  • angiotensin antagonist
  • diuretics
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4
Q

Not well supported drug combinations

A

Ca channel blocker and B blocker

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5
Q

Drugs contraindicated in diabetic patients

A

B blocker: masks symptoms of hypoglycemia

Diuretics: worsens diabetes

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6
Q

Ca channel blocker MOA

A
  1. Smooth muscle:
    - normal effect of Ca –> increase formation of Ca:calmodulin complex –> activate MLCK
    - phosphorylation of MLC –> causes contraction with actin
  2. Heart:
    - normal effect of Ca –> increase contractility
    - also has CICR

Blocking of L type voltage sensitive Ca channel:
=> (1) block vascular smooth muscle tone –> reduce TPR, reduce BP
=> (2) reduce contractility –> reduce CO, reduce BP

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7
Q

Ca channel blocker uses

A
  1. Hypertension
  2. stable angina (amlodipine)
  3. MI and stroke prevention (amlodipine)
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8
Q

Name 2 DHP Ca channel blockers

A

Nifedipine

Amlodipine

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9
Q

Ca channel blockers adverse effects

A
  1. hypotension
  2. MI (esp first time or increasing dose for first time)
  3. bradycardia, AV block
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10
Q

Ca channel blocker contraindication

A

CHF, reduced contractility worsens LV output

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11
Q

Name 2 peripheral adrenergic blockers

A

a blocker: prazosin

B blocker: propranolol

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12
Q

B blocker MOA

A
  1. B1 adrenoceptors
    - activate adenylyl cyclase –> convert ATP to cAMP –> activate PKA –> activate Ca channels
    - Ca influx + CICR –> increase contractility of heart
  2. B2 adrenoceptors
    - activate adenylyl cyclase –> convert ATP to cAMP –> inactivate MLCK (becomes MLC-bisphosphate) –> dephosphorylation of MLC –> loss of smooth muscle contraction –> vasodilation (for arterioles supplying skeletal muscle)
    - bronchodilation

Blocking B adrenoceptors
=> (1) reduce contractility –> reduce CO, reduce BP
=> (2) vasoconstriction, but not significant as reduced contractility outweighs this effect + bronchoconstriction

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13
Q

B blocker clinical uses

A
  1. hypertension
  2. cardiac failure
  3. following MI
  4. arrhythmias
  5. anxiety disorders (second line)
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14
Q

B blocker adverse effects

A
  1. hypotension
  2. bradycardia, AV block
  3. reduced exercise capacity
  4. bronchoconstriction (esp in asthmatics)
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15
Q

B blocker contraindications

A

asthma, diabetics

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16
Q

Nitrates MOA

A

donate NO –> NO activates guanylyl cyclase –> converts GTP to cGMP –> directly dephosphorylates MLC –> relaxation of vascular smooth muscle. vasodilation

17
Q

Why are angiotensin antagonists not used together

A
  1. Efficacy not additive

2. additive adverse effects

18
Q

Name 4 ACE inhibitors

A

captopril, enalapril, ramipril, lisinopril

19
Q

ACE inhibitors MOA

A
  1. Inhibit actions of angiotensin II such as:
    - vasoconstriction –> vasodilation
    - aldosterone secretion –> reduced NaCl reabsorption, reducing water retention
  2. angiotensin I accumulates –> feedback inhibition on renin
  3. activates bradykinin
    - increases production of NO, PGs –> vasodilation
20
Q

ACE inhibitors clinical uses

A
  1. hypertension
  2. HF
  3. following MI
  4. renal insufficiency
21
Q

ACE inhibitors adverse effects

A
  1. hypotension
  2. acute renal failure
  3. hyperkalemia
  4. angioedema (bradykinin and substance P induce “inflammation like” response
  5. dry cough (bradykinin and prostaglandin increase sensitivity of bradykinin-dependent airway sensory neurons)
22
Q

ACE inhibitors contraindication

A

pregnancy (esp late), affects renal function of fetus

23
Q

Name AT1 blockers

A

losartan, valsartan, candesartan, eprosartan, irbesartan, telmisartan

24
Q

AT1 blocker MOA

A

prevents angiotensin II from binding to angiotensin II type 1 receptors

25
Q

AT1 blocker adverse effects

A

same as ACE inhibitors, but less/no dry cough

26
Q

Diuretics MOA

A

reduce water retention –> reduce blood volume –> reduce CO, reduce BP

CVS (6 decks)

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