Hypertension

Question 1

what is the first line treatment for hypertension

Answer 1

lifestyle changes

Question 2

in which cases do drug treatment start straight away

Answer 2

organ damage, cardiovascular disease, renal disease and diabetes

Question 3

where do antihypertensive drugs work?

Answer 3

sympathetic nervous system and cerebral acting blood vessels AND the kidney (RAAS)

Question 4

what does RAAS stand for?

Answer 4

Renin-angiotensin-aldosterone-system

Question 5

what does RAAS do?

Answer 5

regulate blood pressure

Question 6

what triggers RAAS

Answer 6

low blood pressure or certain nerve impulses (e.g. in stressful situations), the kidneys release an enzyme called renin.

Question 7

end result of RAAS activation

Answer 7

increased blood pressure

Question 8

what does Renin do?

Answer 8

converts angiotensinogen –> angiotensin 1

Question 9

what does ACE do

Answer 9

convert angiotensin 1 –> angiotensin 2

Question 10

what can angiotensin 2 do?

Answer 10

activate AT1 receptors

Question 11

4 ways AT1 receptors increase BP

Answer 11

heart, hypertrophy/fibrosis
vascular growth, hyperplasia/hypertrophy
vasoconstriction, direct on the blood vessels due to sympathetic NA release
Salt retention, increases aldosterone, increasing bp

Question 12

primary effect of aldosterone

Answer 12

increased reabsorption of sodium, sodium loss in urine is decreased under aldosterone stimulation.

Question 13

3 targets in RAAS for drugs

Answer 13

renin inhibitors
ACE inhibitors
AT1 receptor antagonists/blocker

Question 14

renin inhibitor

Answer 14

aliskiren

Question 15

ACE inhibitor

Answer 15

captopril and enalapril

Question 16

adverse effects of ACE inhibitors

Answer 16

hypotension, palpitations, skin rush, hyperkalaemia, dry cough

Question 17

AT1 receptor blockers

Answer 17

losartan and candesartan

Question 18

what is the normal effect of bradykinin

Answer 18

potent endothelium-dependent vasodilator and mild diuretic, which may cause a lowering of the blood pressure

Question 19

what effect does ACE have on bradykinin

Answer 19

decreases it, therefore decreasing the vasodilation effect and increasing blood pressure

Question 20

side effect of ACE inhibitors

Answer 20

dry cough, ACE inhibited = more bradykinin, increased B2 activation and increased vasodilation

Question 21

what symptom do you get with ACE inhibitors but not with AT1 receptor blockers

Answer 21

dry cough

Question 22

2 main effects of activating AT1 receptors

Answer 22

increased aldosterone and increased vasoconstriction

Question 23

with AT1 receptor blockers, what is there a reduced risk of

Answer 23

angioedema

Question 24

what are ACE inhibitors usually used with

Answer 24

diuretics

Question 25

what is the triple whammy

Answer 25

ACEI (dilate efferent arteriole, reducing glomerular filtration rate) diuretic (reduce plasma volume and reduce glomerular filtration rate) NSAID (restrict blood flow into glomerulus via afferent arteriole, reducing glomerular filtration rate)

Question 26

what does the triple whammy often lead to

Answer 26

kidney failure

Question 27

normally, how is the GFR monitored

Answer 27

when it is reduced, due to lower blood volume, the RAAS is activated, causing angiotensin 2 to constrict the efferent arteriole, causing blood to flow out of the glomerulus, increasing the pressure in the glomerulus and increasing the GFR.

Question 28

when can drugs acting on the RAAS not be used

Answer 28

pregnancy

Question 29

drugs acting on the RAAS can be used for...

Answer 29

systemic hypertension, ischaemic heart disease, myocardial infarction, heart failure

Question 30

when are drugs acting on the RAAS not first choice therapy

Answer 30

over 55 year olds | African-American or Caribean origin

Question 31

name 2 direct-acting vasodilators

Answer 31

Calcium channel blockers | K channel activators

Question 32

what are the preferred 1st line treatment in elderly and patients of African-American or Caribbean family origin and severe hypertension in pregnancy

Answer 32

Ca channel blockers

Question 33

name 2 vascular calcium channel blockers

Answer 33

nifedipine and amlodipine

Question 34

are diltiazem and verapamil used for hypertension?

Answer 34

no, (but they are Ca channel blockers)

Question 35

verapamil is selective for where?

Answer 35

heart

Question 36

adverse effects of Ca channel blockers

Answer 36

hypotension, postural hypotension, reflex tachycardia, peripheral oedema

Question 37

how do K+ channel activators work as a vasodilator

Answer 37

membrane hyperpolarised, L-type VACCs close, vasodilation

Question 38

example of a K+ channel activator

Answer 38

minoxidil

Question 39

adverse effects of K channel activators

Answer 39

``` reflex tachycardia (which can be treated with beta blockers) fluid retention (can be treated with diuretics) diabetes mellites ```

Question 40

name another vasodilator (not Ca channel blocker or K channel activator)

Answer 40

hydralazine

Question 41

what is hydralazine usually taken with

Answer 41

beta blocker and a diuretic

Question 42

Calcium channel blockers and K channel activators work where?

Answer 42

directly on smooth muscle cells

Question 43

there are antihypertensive drugs that work...

Answer 43

sympathetic nervous system

Question 44

what kind of drugs can help with hypertension that act on the SNS

Answer 44

beta blockers, alpha1 adrenoreceptor antagonist, alpha2 agonists

Question 45

how do beta blockers work as an antihypertensive

Answer 45

block beta1 on the heart and kidneys, thus reducing reflex tachycardia, reducing renin release and less activation of RAAS. some beta blockers can release NO (a vasodilator)

Question 46

what beta blocker can release NO

Answer 46

nebivolol

Question 47

non-selective beta blockers can also act as ...

Answer 47

alpha1 adrenoreceptor antagonist

Question 48

name 2 non-selective beta blockers that can also act as an alpha1 antagonist

Answer 48

carvedilol and labetalol

Question 49

how would alpha 1 antagonists work as an antihypertensive drug

Answer 49

antagonist, so inhibit postsynaptic alpha1 adrenoreceptors on vascular SMC causing arterial dilation

Question 50

name 2 alpha1 adrenoreceptor antagonists

Answer 50

doxazosin and prazosin

Question 51

another category of antihypertensive drugs that work on the sympathetic nervous system

Answer 51

alpha2 adrenoreceptor agonist

Question 52

2 examples of alpha2 agonists

Answer 52

clonidine and methyldopa

Question 53

how to alpha2 agonists help in hypertension

Answer 53

increase parasympathetic output/effect, and decrease sympathetic output

Question 54

name 1 imidazoline 1 receptor agonist and what it does

Answer 54

moxonidine, decrease sympathetic output

Question 55

name 1 ganglionic blocking drug and how it works

Answer 55

trimetaphan, competitive nAChR antagonist at the autonomic ganglia (this is not used very much as an antihypertensive)

Question 56

where else can antihypertensives work?

Answer 56

``` autonomic ganglia (nAChR) adrenergic neurone ```

Question 57

name 2 adrenergic blocking drug

Answer 57

guanethidine (only used in hypertensive emergency) and reserpine (not used much at all)