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Cardiovascular, Renal and Peripheral Pharmacology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is the first line treatment for hypertension

A

lifestyle changes

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2
Q

in which cases do drug treatment start straight away

A

organ damage, cardiovascular disease, renal disease and diabetes

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3
Q

where do antihypertensive drugs work?

A

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

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4
Q

what does RAAS stand for?

A

Renin-angiotensin-aldosterone-system

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5
Q

what does RAAS do?

A

regulate blood pressure

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6
Q

what triggers RAAS

A

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

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7
Q

end result of RAAS activation

A

increased blood pressure

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8
Q

what does Renin do?

A

converts angiotensinogen –> angiotensin 1

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9
Q

what does ACE do

A

convert angiotensin 1 –> angiotensin 2

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10
Q

what can angiotensin 2 do?

A

activate AT1 receptors

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11
Q

4 ways AT1 receptors increase BP

A

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

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12
Q

primary effect of aldosterone

A

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

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13
Q

3 targets in RAAS for drugs

A

renin inhibitors
ACE inhibitors
AT1 receptor antagonists/blocker

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14
Q

renin inhibitor

A

aliskiren

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15
Q

ACE inhibitor

A

captopril and enalapril

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16
Q

adverse effects of ACE inhibitors

A

hypotension, palpitations, skin rush, hyperkalaemia, dry cough

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17
Q

AT1 receptor blockers

A

losartan and candesartan

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18
Q

what is the normal effect of bradykinin

A

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

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19
Q

what effect does ACE have on bradykinin

A

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

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20
Q

side effect of ACE inhibitors

A

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

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21
Q

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

A

dry cough

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22
Q

2 main effects of activating AT1 receptors

A

increased aldosterone and increased vasoconstriction

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23
Q

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

A

angioedema

24
Q

what are ACE inhibitors usually used with

A

diuretics

25
Q

what is the triple whammy

A

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)

26
Q

what does the triple whammy often lead to

A

kidney failure

27
Q

normally, how is the GFR monitored

A

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.

28
Q

when can drugs acting on the RAAS not be used

A

pregnancy

29
Q

drugs acting on the RAAS can be used for…

A

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

30
Q

when are drugs acting on the RAAS not first choice therapy

A

over 55 year olds

African-American or Caribean origin

31
Q

name 2 direct-acting vasodilators

A

Calcium channel blockers

K channel activators

32
Q

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

A

Ca channel blockers

33
Q

name 2 vascular calcium channel blockers

A

nifedipine and amlodipine

34
Q

are diltiazem and verapamil used for hypertension?

A

no, (but they are Ca channel blockers)

35
Q

verapamil is selective for where?

A

heart

36
Q

adverse effects of Ca channel blockers

A

hypotension, postural hypotension, reflex tachycardia, peripheral oedema

37
Q

how do K+ channel activators work as a vasodilator

A

membrane hyperpolarised, L-type VACCs close, vasodilation

38
Q

example of a K+ channel activator

A

minoxidil

39
Q

adverse effects of K channel activators

A 
reflex tachycardia (which can be treated with beta blockers)
fluid retention (can be treated with diuretics)
diabetes mellites
40
Q

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

A

hydralazine

41
Q

what is hydralazine usually taken with

A

beta blocker and a diuretic

42
Q

Calcium channel blockers and K channel activators work where?

A

directly on smooth muscle cells

43
Q

there are antihypertensive drugs that work…

A

sympathetic nervous system

44
Q

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

A

beta blockers, alpha1 adrenoreceptor antagonist, alpha2 agonists

45
Q

how do beta blockers work as an antihypertensive

A

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)

46
Q

what beta blocker can release NO

A

nebivolol

47
Q

non-selective beta blockers can also act as …

A

alpha1 adrenoreceptor antagonist

48
Q

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

A

carvedilol and labetalol

49
Q

how would alpha 1 antagonists work as an antihypertensive drug

A

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

50
Q

name 2 alpha1 adrenoreceptor antagonists

A

doxazosin and prazosin

51
Q

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

A

alpha2 adrenoreceptor agonist

52
Q

2 examples of alpha2 agonists

A

clonidine and methyldopa

53
Q

how to alpha2 agonists help in hypertension

A

increase parasympathetic output/effect, and decrease sympathetic output

54
Q

name 1 imidazoline 1 receptor agonist and what it does

A

moxonidine, decrease sympathetic output

55
Q

name 1 ganglionic blocking drug and how it works

A

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

56
Q

where else can antihypertensives work?

A 
autonomic ganglia (nAChR)
adrenergic neurone
57
Q

name 2 adrenergic blocking drug

A

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

Cardiovascular, Renal and Peripheral Pharmacology (13 decks)

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