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103: Theme 3 - 304 - Cardiovascular > Hypertension and Pharmacology > Flashcards

Hypertension and Pharmacology Flashcards

1
Q

What are the receptors associated with the sympathetic regulation of blood pressure?

A
  • Preload alpha-1 receptor
  • afterload (arterio-constriction): Afterload alpha-1 receptor
  • Noradrenaline increases the frequency of and force of contractions by acting on Beta- receptors
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2
Q

What as the action of the sympathetic system on the ß1 receptors?

A
  • increase cAMP
  • increases Ca++ released through ion channels
  • increases heart rate and force of contractions
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3
Q

What receptors does the parasympathetic system act on in the heart and what is its response?

A
  • acts on M2 receptors and decrease the cAMP
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4
Q

What is the effect of sympathetic activity on the total peripheral resistance?

A

Increased sympathetic activity

  • increases peripheral resistances
  • reduces blood flow
  • boosts central blood volume
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5
Q

What is the sympathetic pathway and the receptor that causes smooth muscle constriction?

A
  • Noradrenaline is released, acts on alpha-1 receptors
  • stimulates the activation of IP3
  • increases Ca++
  • causes smooth muscle contraction
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6
Q

What is the sympathetic pathway and the receptor that causes smooth muscle relaxation?

A
  • Adrenaline binds to Beta 2 receptors
  • stimulates adenyl cyclase to form cAMP
  • cAMP causes smooth muscle relaxation and glycogen breakdown
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7
Q

What is the distribution of adrenergic receptor Alpha-1?

A
  • Arterioles: coronary, visceral, cutaneous
  • veins,
  • internal sphincters
  • iris dilator muscle
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8
Q

What is the distribution of adrenergic receptor Alpha-2?

A
  • presynaptic membrane
  • pancreas
  • veins
  • adipose tissue
  • GIT sphincters
  • salivary glands
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9
Q

What is the distribution of adrenergic receptor Beta-1?

A
  • Heart: SA node, atrial muscle, AV node, ventricles
  • Kidney
  • adipose tissue
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10
Q

What is the distribution of adrenergic receptor Beta-2?

A
  • muscular Arterioles
  • veins
  • bronchi muscles
  • liver pancreas
  • uterus
  • Iris constrictor muscle
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11
Q

What is the distribution of adrenergic receptor Beta-3?

A
  • Adipose tissue

- urinary bladder

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12
Q

What is the Renin- Angiotensin-aldosterone system?

A
  • hormone regulatory system that maintains the blood pressure and fluid balance in the body
  • regulation is controlled through the kidney
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13
Q

Explain how blood pressure is controlled through the RAAS

A
  • low blood pressure in the arterioles is identified by the kidney
  • kidney releases renin, which converts angiotensinogen produced in the liver into angiotensin I
  • ACE (angiotensin-converting enzyme) released by the lungs helps converts Ang I
    into Angiotensin II
  • Ang II acts on the adrenal gland causing it to release Aldosterone
  • Aldosterone causes increased Na+ retention and water retention in the kidneys, increasing blood volume therefore BP
  • Ang II also causes vasoconstriction by increased IP3 and decreases the GFR and urine output
  • Ang II stimulates the pituitary gland to release ADH
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14
Q

What three factors should be considered when choosing a course of treatment?

A
  • Age: < 55yrs, use ACE inhibitor or Angiotensin receptor blocker, ARB. > 55yrs calcium channel blocker
  • Race: ACE inhibitors/beta-blockers may not be as effective, use calcium ion channel blockers
  • Co-existing diseases
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15
Q

What are the different types of anti-hypertensive drugs?

A
  • ACE inhibitors and Angiotensin receptor blockers
  • Calcium channel antagonists
  • Diuretics
  • Beta-blockers
  • Vasodilators
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16
Q

What is the British Hypertension Society guideline flow chart for treatment?

A
  • flow chart
17
Q

Give an example of ACE inhibitors

A
  • Ramipril
  • perindopril
  • enalapril
18
Q

What are some side effects and contraindications of ACE inhibitors?

A
  • Dry cough in 10-30% of patients as a result of accumulation in the lungs of bradykinin: switch to ARB instead
  • first does hypotension: diuretics or severe hypertension or Na+ depletion
  • renal impairment: measure kreatinin output first
  • Contraindication in bilateral renal artery stenosis
  • Hypoperfusion in the efferent arteriole in the kidney could be exacerbated
  • Hyperkalaemia
19
Q

What are ARBs, give an example?

A
  • Angiotensin receptor blockers
  • Block the action of Ang II on AT1-Receptor
  • Losartan
  • Spironolactone: add on for resistant hypertension, primary aldosteronism
20
Q

Give examples of Ca++ channel

antagonists?

A
  • Amlodipine: target L-type Ca++ channels on the smooth muscle of arterioles
  • Phenylalkylamines (e.g. verapamil) and benzothiazepines (e.g. diltiazem) target L-type channels in the heart and decrease the frequency and force of contraction, less used to treat hypertension.
21
Q

What are the side effects and contraindications of Ca++ channel antagonists

A
  • peripheral oedema
  • flushing and headaches ( meninges of the brain)
  • grapefruit juice enhances the action
22
Q

Explain peripheral oedema caused by Ca2+ channel antagonists

A

increases the hydrostatic pressure across the capillary and reducing fluid reabsorption due to dilation of the precapillary arteriole. The tissue fluid thing

23
Q

Give examples of thiazide diuretics

A
  • hydrochlorothiazide (HCT)
  • bendroflumethiazide
  • indapamide.
24
Q

Give examples of thiazide-like diuretics

A
  • Chlorthalidone

- metolazone

25
Q

What is the mechanism of thiazide diuretics?

A
  • act on the DCT and the collecting duct
  • inhibit the sodium/chloride co-transporter
  • slow to act, less effective than loop diuretics but longer-acting
  • cause vasodilation over time
26
Q

What are the side effects and contraindications for thiazide diuretics?

A
  • Hypokalemia
  • increase in urate: wouldn’t give to gout patients
  • increase in blood glucose: (-like) not good for diabetes patients
  • Increase in blood lipids
27
Q

What is the action of Indapamide

A
  • a thiazide diuretic
  • hyperpolarises smooth muscle cells: causes K+ to move out of the cells
  • causing relaxation/dilation of the arteriole: more Ca++ moves
  • and a decrease in total peripheral resistance
28
Q

Explain Hypoglycaemia

A
  • low blood glucose: activates the release of adrenaline, mobilises glucose release from the liver
  • leads to tremor, palpitation and sweats
  • blocked by Beta-blockers
  • beta-blockers and thiazides are contraindications to diabetics
29
Q

Give examples of types of beta-blockers

A
  • Non-selective ß1 and ß2: propranolol

- selective ß1 antagonist: bisoprolol

30
Q

Explain vasodilators, including an example

A
  • alpha-1 antagonists (IP3)
  • used to treat hypertension in patients with benign prostatic hypertrophy
  • e.g Doxazosin,
  • minoxidil open K+ channels

103: Theme 3 - 304 - Cardiovascular (12 decks)

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