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Pharmocolgy > Hypertension and heart failure > Flashcards

Hypertension and heart failure Flashcards

1
Q

what is the equation for BP?

A

COTPR or HRSV*TPR

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2
Q

How does diabetes cause high blood pressure ?

A

endothelial dysfunction and increase in ROS = Medial hypertrophy of vessels

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3
Q

what is Nice definition of stage 1 hypertension ?
stage 2 ?
severe ?

A 
BP higher than 140/90
ABP = 135/85
stage 2 = 160/100
ABP = 150/95
severe = 180 / 110
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4
Q

What is the primary cause of hypertension ?

A

Idiopathic (Essential)

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5
Q

how do you take a BP ?

A

patient is sat down relaxed and arm supported

repeat on both arms if >20 difference repeat on higher arm

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6
Q

What is prehypertensions and how is it normally treated ?

A

elevated BP below stage 1 with no end organ damage.

Lifesyle changes

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7
Q

What are the 3 main types of anti-HT agents ?

A

ACE inhibitors /Ang Receptors (ARBs)
Calcium Channel blockers
Diuretics

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8
Q

where is ACE found ? where does ANG 2 work on ?

A

Luminal surface of capillary endothelial cells in the lungs

AT1 and AT2

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9
Q

What receptor is most potent for ANG2 and what are the effects?

A

AT1,

Vasoconstriction , Aldosterone release, ADH release and vascular muscle cell growth

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10
Q

Name 2 Ace inhibitors

A

Captopril, Ramipril , Enalapril and lasinopril

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11
Q

Why are ARBs used sometimes of ACE-i ?

A

ANG 2

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12
Q

what are the main side effects of ACE-i?

A

dry cough (BK build up), Angioedema , renal failure and Hyperkalaemia

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13
Q

What are the effects of Bradykinin on the body ?

A

Dry cough and vasodilation via NO and PGI2

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14
Q

what are the side effects of ARBs and what do they target ?

A

Renal failure and hyperkalaemia , no BK = no dry cough

AT1 receptors

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15
Q

what are the ways ANG2 is made ?

A

RAAS system

Chymase production

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16
Q

name 2 ARBs

A

Iosartan
Candesartan
eprosartan
irbesartan

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17
Q

what class of CCBs target VSMCs?

A

Dihydropyridines

18
Q

What class of CCBs target Cardiac myocytes ?

A

Phenylalkyamines and benzothazapines , non dihydropyridines

19
Q

what class of CCBs sits in the middle ?

A

benzothiazapines

20
Q

When would you use CCBs over ACE-i in first line treatment ?

A

low renin hypertensives

21
Q

name 2 dihyropryridines

A

Amlodipine , nifedipine and nicardipine

22
Q

what are properties of Dihydropyridines ?

A

Good oral absorption
protein bound
metabolised by liver

23
Q

what are the side effects of dihyropyridines ?

A 
Tachycardia - sympathetic activation 
palpitations 
Flushing, sweating , headaches
oedema
reaction with simvastatins
24
Q

what is the MOA of Phenylalkylamines ? what is the overall effect?

A

impeded calcium transport across myocardial membrane
prolongs the AP and refractory period
negative chronotrophic and inotropic
Used in angina and arrthymia

25
Q

side effects of phenylalkylamines

A

bradycarida , constipation and worsen HF

26
Q

name a phenylalklamine

A

verapamil

27
Q

Name a benzothiazapine ? what is a good for ?

A

diltiazem and angina

28
Q

why do afro-carbianen or >55 a years old patients go straight to CCBs or Diuretics?

A

low renin activity

29
Q

what is the MOA of Thiazides ?

A

Inhibit Na+ reabsorption in DCT

30
Q

What are the side effects of thiazides ?

A

Hypokalaemia , increased Urea levels, glucose intolerence , hyperlipidemia, activates RAAS

31
Q

Name 1 thiazide

A

bendroflumethiazide

indapamide

32
Q

what can be used in hypertensive emergencies ?

A

Nitriates e.g. SNP

Labetalol - beta blocker, Good in pregnancy

33
Q

name a A1 Blocker and its side effects

A

doxazosin
postural hypotension
headache and fatigue
oedema

34
Q

name a beta blocker and its side effects

A

bisoprolol
bronchoconstriction
mask tacycardia
Raynaud’s - cold hands

35
Q

what are the main causes of acute HF ?

A

Haemorrhagic shock, cariogenic shock (MI) or septic shock

36
Q

what do we mean by self perpetuating cycle of HF?

A

Decresed CO leads to more vasoconstriction via RAAS lead to increased afterload and preload = worsening HF

37
Q

What is the management of HF?

A

Diuretics- treat symptoms , treat underlying condition

ACEi and beta blockers . similar to HT.

38
Q

what is digoxin used for ?

A

an adjunct therapy of HF - only patients with Sinus rhythm

used in AF

39
Q

What is ivabradine ?

A

If current blocker = slows HR

40
Q

What is sacubitril ?

A

potentiates ANP and BNP = Loss in BP

Pharmocolgy (22 decks)

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