Hypertension and Heart failure

Question 1

How is peripheral vascular resistance controlled by calcium

Answer 1

• Increased calcium> vasoconstriction> raises BP
• Decreased calcium> vasodilation> Decreases BP

Question 2

Hypertension increases the risk of

Answer 2

• stroke
• Myocardial infarction
• Congestive heart failure
• renal failure

Question 3

Preeclampsia

Answer 3

Complications associated with hypertension during pregnancy

Question 4

Eclampsia

Answer 4

Preeclampsia with seizures

Question 5

RAAS

Answer 5

Hormone system that regulates blood pressure and fluid balance

Question 6

Factors that initiate RAAS through renin release

Answer 6

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

Question 7

Factors that prevent activation of RAAS

Answer 7

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

Question 8

Action of RAAS to increase BP

Answer 8

• 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

Question 9

Effects Aldosterone and vasopressin

Answer 9

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

Question 10

Antihypertensives

Answer 10

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

Question 11

ACE-I drugs and their MOA

Answer 11

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

Question 12

ACE-I side effects and contraindication

Answer 12

• Angioedema, hypotension, photosensitivity, nephrotoxicity
• pregnancy, renal stenosis

Question 13

Angiotensin II receptor blocker drugs and their MOA

Answer 13

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

Question 14

ARB side effects and contraindications

Answer 14

• coughing, hypotension, photosensitivity, nephrotoxicity
• renal stenosis, pregnancy

Question 15

CCB drugs and their MOA

Answer 15

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

Question 16

CCB side effects and contraindications

Answer 16

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

Question 17

Adrenergic blocker drugs and their MOA

Answer 17

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

Question 18

Centrally-acting vasodilator drugs and their MOA

Answer 18

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

Question 19

Direct-acting vasodilator drug and their MOA

Answer 19

• hydralazine
• Arteriolar vasodilation

Question 20

Indications and side effects of direct-acting vasodilators

Answer 20

• Gestational hypertension
• oedema, reflex tachycardia, thrombocytopaenia

Question 21

Dangerous interactions with antihypertensives

Answer 21

• NSAID> increased BP> renal failure

Question 22

Treatment for hypertensive emergency

Answer 22

• IV labetalol
• IV nitroprusside
• IV nitroglycerin

Question 23

Causes for heart failure

Answer 23

Hypertension, obesity, sleep apnoea, myocardial infarction

Question 24

Systolic heart failure

Answer 24

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

Question 25

Diastolic heart failure

Answer 25

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

Question 26

Left-side heart failure

Answer 26

Blood cannot pump oxygenated blood to body
Decreased cardiac output

Question 27

Right-side heart failure

Answer 27

Blood cannot pump deoxygenated to lungs

Question 28

Cardiac remodeling

Answer 28

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

Question 29

Aims of pharmacotherapy for heart failure

Answer 29

• Decrease RAAS activation
• Decrease SNS stimulation
• Prevent remodeling
• Increase survival

Question 30

Drugs used to treat heart failure

Answer 30

• ACE-I
• ARB
• Sympatholytics
• Diuretics
• Aldosterone antagonists
• Positive inotropes

Question 31

Na/K/Ca role in heart contraction

Answer 31

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

Question 32

How does IC Ca2+ modulate myofibril contraction

Answer 32

• High Ca conc> + inotropy
• Low Ca conc> - inotropy

Question 33

Digoxin MOA

Answer 33

• 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

Question 34

Digoxin Indications and side effects

Answer 34

• Adjuvant heart failure
• Dizziness, tachycardia, arrhythmias