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Pharmacology 381 > Hypertension and Heart failure > Flashcards

Hypertension and Heart failure Flashcards

1
Q

How is peripheral vascular resistance controlled by calcium

A
  • Increased calcium> vasoconstriction> raises BP
  • Decreased calcium> vasodilation> Decreases BP
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2
Q

Hypertension increases the risk of

A
  • stroke
  • Myocardial infarction
  • Congestive heart failure
  • renal failure
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3
Q

Preeclampsia

A

Complications associated with hypertension during pregnancy

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4
Q

Eclampsia

A

Preeclampsia with seizures

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5
Q

RAAS

A

Hormone system that regulates blood pressure and fluid balance

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6
Q

Factors that initiate RAAS through renin release

A
  • Decrease renal perfusion
  • Sympathetic nerve stimulation(beta1 agonists)
  • Transmitters: catecholamine, prostaglandin I2 and E2
  • Reduced Na ad Cl conc at distal tubule
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7
Q

Factors that prevent activation of RAAS

A
  • neg feedback through angiotensin II and increased renal perfusion
  • Natriuretic peptide
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8
Q

Action of RAAS to increase BP

A
  • induced renin release in juxtaglomerular cells of kidney
  • Renin cleaves angiotensinogen> angiotensin I
  • ACE converts angiotensin I> angiotensin II
  • Angiotensin II activates AT1 receptors to increase BP
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9
Q

Effects Aldosterone and vasopressin

A
  • aldosterone increases salt retention> upregulates Na+ channels in collecting ducts
  • vasopressin increases water retention> increases Na+ reabsorption across ascending loop of Henle
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10
Q

Antihypertensives

A
  • Direct-acting: CCB, Hydralazine
  • Indirect-acting: Sympatholytics, ACE-I, ARB, centrally-acting drugs
  • diuretics
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11
Q

ACE-I drugs and their MOA

A
  • Captopril, enalapril, perindopril
  • Inhibits ACE mediated conversion of AngI to Ang II. Prevents RAAS activation and subsequent downstream effects
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12
Q

ACE-I side effects and contraindication

A
  • Angioedema, hypotension, photosensitivity, nephrotoxicity
  • pregnancy, renal stenosis
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13
Q

Angiotensin II receptor blocker drugs and their MOA

A
  • Candesartan, losartan, valsartan
  • Reversibly competitively bind to AR increases secretion of aldosterone and vasopressin leading water and sodium retention> vasodilation
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14
Q

ARB side effects and contraindications

A
  • coughing, hypotension, photosensitivity, nephrotoxicity
  • renal stenosis, pregnancy
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15
Q

CCB drugs and their MOA

A
  • Diltiazem, amlodipine, nifedipine, verapamil
  • Blocker bind to L-type Ca+ channels> inhibiting opening of channels> reduces Ca+ influx> vasodilation and neg inotropy of heart
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16
Q

CCB side effects and contraindications

A
  • Flushing, headache, tachycardia, hypotension, constipation
  • heart failure> worsening of cardiac function
17
Q

Adrenergic blocker drugs and their MOA

A
  • Atenolol(beta1), propranolol(beta), Carvedilol, labetalol(alpha/beta)
  • Beta blockers decreases renin secretion
18
Q

Centrally-acting vasodilator drugs and their MOA

A
  • alpha-Methyldopa
  • Potent agonist of presynaptic alph2-adrenergic receptors> prevents release of NA> inhibits synaptic outflow
19
Q

Direct-acting vasodilator drug and their MOA

A
  • hydralazine
  • Arteriolar vasodilation
20
Q

Indications and side effects of direct-acting vasodilators

A
  • Gestational hypertension
  • oedema, reflex tachycardia, thrombocytopaenia
21
Q

Dangerous interactions with antihypertensives

A
  • NSAID> increased BP> renal failure
22
Q

Treatment for hypertensive emergency

A
  • IV labetalol
  • IV nitroprusside
  • IV nitroglycerin
23
Q

Causes for heart failure

A

Hypertension, obesity, sleep apnoea, myocardial infarction

24
Q

Systolic heart failure

A

Myocardium too weak to pup blood due to large ventricles and thin myocardial walls

25
Q

Diastolic heart failure

A

Myocardial stiffness, and heart fill with blood due to thick myocardial walls

26
Q

Left-side heart failure

A

Blood cannot pump oxygenated blood to body
Decreased cardiac output

27
Q

Right-side heart failure

A

Blood cannot pump deoxygenated to lungs

28
Q

Cardiac remodeling

A

Heart changes in shape, size and functionality in response to stress

29
Q

Aims of pharmacotherapy for heart failure

A
  • Decrease RAAS activation
  • Decrease SNS stimulation
  • Prevent remodeling
  • Increase survival
30
Q

Drugs used to treat heart failure

A
  • ACE-I
  • ARB
  • Sympatholytics
  • Diuretics
  • Aldosterone antagonists
  • Positive inotropes
31
Q

Na/K/Ca role in heart contraction

A

Electrochem gradient drive ion influx> IC Na+ exchanged for EC K+ via Na+/K+ antiporter> EC Na+ exchanged for IC Ca2+ to maintain Na+ balance

32
Q

How does IC Ca2+ modulate myofibril contraction

A
  • High Ca conc> + inotropy
  • Low Ca conc> - inotropy
33
Q

Digoxin MOA

A
  • positive inotrope
  • Inhibits Na-K-ATPase antiporter binding to K site inhibiting Na extrusion> EC Na decreases Na electrochem gradient needed by Na-Ca antiporter> IC Ca increases> Increased Ca conc in cells increases force of myofibril contraction
34
Q

Digoxin Indications and side effects

A
  • Adjuvant heart failure
  • Dizziness, tachycardia, arrhythmias

Pharmacology 381 (7 decks)

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