Hypertension drugs Flashcards
What are the factors influencing hypertension
cardiac output (contractility, heart rate, filling pressure- venous tone and blood volume)* peripheral resistance (made of arteriolar tone)
What are the main classes of drugs used in hypertension
- Angiotensin antagonist: ACE inhibitor, AT1-R inhibitor
- Sympathoplegics: Betablockers, Prozasin
- Calcium channel blockers
4, Diuretics
5, Vasodilators : nitrates
How is blood pressure maintained short term and long term
Short term: sympathetic system–> beta 1 receptors in heart increase CO, alpha 1 receptors smooth muscle of arterioles, constriction and hence higher blood pressure
Long term: RAAS–> renal blood flow mediated
- increased peripheral resistance
- increased blood volume
Give an overview of how smooth muscle tone is controlled
Calcium–> causes activation of myosin light chain kinase through binding calmodulin
Beta agonist–>Adenylyl cyclase action–> will cause conversion to ATP to cAMP–> activation of PKA and then back to calcium pathway
In smooth muscle of the bronchioles, can cause inactivation of the myosin light chain kinase
Nitrates cause the increase in guanylyl cyclase, GTP–>cGMP and cause the deactivation of MLC
What are examples of ACE inhibitors
“pril” , captopril, enalipril, ramipril
WHat is ACE inhibitor MOA
Inhibition of Angiotensin converting enzyme, reduced agII
- decreased RAAS, blood vol
Inhibition of the bradykinin activation, production of Pg and nitrates that cause vasodilation
WHat is the clinical indication of ACE inhibitors
- hypertension
- heart failure
AMI - renal dysfunction
What is the adverse side effects of ACEI
Hypotension
Angioedema
Hyperkaelemia
COntraindicated in pregnancy
- Teratogenic
- last trimesters cause alot of issues: anuria, hypotension
ANg II type 1 receptor blockers examples, MOA
“sartan” , losartan, valsartan
inhibits AG II receptors
Contraindications of AGII receptor blocker
pregnacy, dry cough
SHould AGII type 1 blockers be used with ACEI
no, same pathway so not synergistic, can worse hyperkaelemia side effects
What is the MOA of beta blockers
- Block beta 1 adrenoreceptors
- antagonist to beta receptors of the heart, prevent epinephrine from causing PKA activation, calcium influx
- reduce calcium induced calcium release
- Bind calmodulin and activation of MLCK
- decreased heart rate/contractility
- Lower CO, TPR
WHat are some examplesof beta blockers
nonselective: propanolol, carvedilol
beta 1 selective: metoprolol, Bisoprolol
What are some adverse effects of betablockers
Hypotension
Can worsen heart failure
Can exacerbate asthma
What is the MOA of calcium channel blockers
CICR inhibitions, reduction of activation of the myosin light chain
