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Year 2 Pharmacology > Hypertension Drugs > Flashcards

Hypertension Drugs Flashcards

1
Q

Name some of the risks assosiated with hypertension…

A

Increased Stroke Risk
Increased Risk of Ischemic heart disease (angina, MI)
Other cardiovascular problems

morbidity/mortality

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2
Q

What level of blood pressure is considered high enough to treat?

A

Sustained Systolic about 160mm
Sustained Diastolic above 100mm

But if know cardiovascular disease:
sustained systolic 140-159 mm Hg and/or
diastolic BP 90-99 mm Hg

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3
Q

What things do you need to reduce in order to treat blood pressure?

A

Reduce cardiac output by reducing:
heart rate stroke volume plasma volume

Reduce total peripheral resistance by dilating arterioles

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4
Q

Name some antihypertensives and their basic mode of action

A

Diuretics- Reduce plasma volume then gradually TPR

vasodilators- Directly lower TPR

b-blockers- Reduce cardiac output & kidney renin secretion

ACE inhibitors- Inhibit endogenous vasoconstrictor production

a-blockers - Reduce TPR by inhibiting noradrenaline action

angiotensin antag -Reduce TPR by inhibiting angiotensin action

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5
Q

Where do diuretics act?

And what is there action?

A

They act on the kidney to increase urine output.

They method of action is to:
Increase Na+ excretion
reduce salt re-absorption from glomerular filtrate 
water loss follows 
reduce plasma volume
reduce cardiac output
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6
Q

Name some types of diuretics…

A

Thiazides
Loop diuretics
Potassium Sparing Diuretics

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7
Q

What is the most POTENT type of diuretic?

A

Loop Diuretics

They can make you go ‘loopy’ they’re so strong

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8
Q

What’s the most widley used diuretic?

A

Thiazide Diuretics.

ie
– chlorothiazide
– hydrochlorothiazide
– bendrofluazide

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9
Q

Where is the sight of action for Thiazide Diuretics?

A

The Distal Tubule

They inhibit Na and Cl co-transport in the distal tubule. Also have vasodilation properties which have an unknown mechanism.

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10
Q

True or false:

Thiazides Increase Renin release.

A

True
Thiazide diuretics do increase renin release.
Which may conteract BP as it can increase BP.

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11
Q

What potency are Thiazide Diuretics?

A

They are moderate potency, so suitable for most patients.

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12
Q

Name some Thiazides:

Derived from Benzothiadiazine:

And Thiazide like structures:

A

Derived from bensothiadiazine:
– chlorothiazide
– hydrochlorothiazide
– bendrofluazide

Thiazide Like structures:

  • Chlorthalidone
  • metolazone
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13
Q

Name some Thiazide Side effects…

A
  • More frequent urination
  • Hypokalemia
  • Diuretic properties reduce over time but vasodilation propeties remain
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14
Q

In what situation would you give loop diuretics over thiazides

A
  • If an emergency
  • Patients with renal insufficiency
  • Patients with resistant hypertension or heart failure
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15
Q

True or false:

Loop diuretics are more effective at lowering BP than thiazides

A

FALSE

Loop diuretics are no more effective than thiazides at reducing BP

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16
Q

Name some Vasodilator Drugs in the treatment of BP

A
  • Calcuim Antagonists (Calcium Channel Blockers) MAIN ONE
  • Alfa-blockers

Special Circumstances:

  • Angiotensin Agonists
  • Potassium Channel Activators
  • Sodium Notroprusside
  • Hydralazine
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17
Q

What is the sight for vasodilator action?

And how do they work?

A

The sight of action is the Smooth Muscle Cells surrounding the artery.

Action:
Lower intracellular calcium concentration. Cause muscle cell relaxation= vasodilation

18
Q

How do Calcium Antagonists work?

A

They block Calcium from entering voltage operated calcium channels in arterial smooth muscle cells.

19
Q

What categories are there within Calcium Channel Blockers (Calcium Antagonist)? And Name some…

A

Dihydrophyridines:

  • Nifedipine
  • amlodipine
  • nicardipine

Benzothiazepine
-Diltiazem

20
Q

Which Calcium Antagonist also blocks calcium channels in conducting tissue of the Heart?

A

Benzothiazepine
(Diltiazem)

Which can slow the heart down and also potentiate Beta Blocker action

21
Q

Which Calcium Antagonise is a once daily dose?

A

Amlodipine

As it’s longer acting

22
Q

What are some advers effects of Calcium Channel Blockers (Calcium Antagonists)

A

All:

  • Flushing (due to dilation of facial vessles)
  • Ankle Oedema

Diltiazem

  • Cardiac Depression
  • Interaction with Beta Blockers
23
Q

What is the mechanism of action of Diltiazem?

A

Blocks voltage-operated calcium channels in cardiac muscle

24
Q

Oedema (swollen ankles) is a common side-effect of which of the following classes of anti-hypertensive drug?

A

Calcium channel blockers

25
Q

True or false…

Alfa 2 receptors are in the Smooth muscle and are a target for Antihyperintensives…

A

FALSE!!!

Alfa 2 receptors are in nerve endings.

Alfa1 receptors are targets for BP lowering drugs as they are in smooth muscle cells

26
Q

What are the targets and mode of action for Alfa 1 blocker antihyperintensives?

A

They act on G proteins within the smooth muscle cells.
They are selective blockers for alfa 1 adrenoceptors

Prevent Vasoconstrictor action of endogenous noradrenaline

27
Q

Examples of Alfa Blockers

hint SIN

A

Doxazosin 1xdaily
Terazosin 1xdaily
Prazosin 3xdaily

28
Q

Name some SE of Alfa Blockers

A

-Postural Hypotension
(dizzyness/lightheaded)
-Possible severe lowBP after first dose

but generally well tolerated

29
Q

Name some Beta Blockers

A

Atenolol

Metoprolol

30
Q

True or False:

Beta Blockers bind to B1 adrenoceptors in the heart?

A

TRUE- they bind to sino atrial node + Ventricular muscle in the heart.

B2 receptors are for the airways

31
Q

How do B1 Blockers Treat high BP?

A

They block action of Noradrenaline release from the sympathetic Nerves and circulating adrenaline. Do this by binding and blocking B1 adrenoceptors in the heart.

32
Q

Inital and long term affects of BBlockers….

A

Initial:
reduces rate&force of heart beat.

After Continued Treatment:
Cardiac output returns to normal but BP remains low.
(Total Periferal resistance resets at lower level)

33
Q

SE of BBlockers

A
  • Cold Hands
  • Fatigue & Difficulty excercisng

Less common

  • can provoke asthma attack
  • heart failure
  • conduction block in heart
  • Could affect blood lipids
34
Q

TRUE or FALSE

Can BB provoke asthma attacks ?

A

Yes, but only if the patient is asthmatic to begin with

35
Q

Name some ACE Inhibitors

A

Catopril 2xdaily
Enalapril 1xdaily
Lisinopril (lysine analogue of enalapril)
Ramipril

36
Q

Action of ACE Inhibitors

A

-prevent Conversion of Angiotensin 1 -> Angiotensin 11
(which is a potent vasoconstrictor and inhibits H20 excretion)
-Causes Vasodilation
-Reduces Plasma volume

37
Q

Name some effects of Angiotensin 11 (the thing that ACE inhibitors block)

A

Angiotensin 11 is a potent vasoconstrictor and it also stimulates aldosterone secretion (which inhibits salt and H20 excretion)

38
Q

Some SE of ACE Inhibitors

A
  • Dry Cough
  • Hypotension initially, especially if given with diuretic

These effects wear off with time

39
Q

Losartan is often preferred to enalapril in the treatment of hypertension because it…

A

Because it …
does not cause a dry cough

Like ACE Inhibitors do!

40
Q

Name some Angiotensin 11 receptor antagonists

Tan

A

Losartan
Candesartan
Eprosartan
Valsartan

41
Q

What do Angiotensin 11 antagonists do?

A

Block Action of Angiotensin 11 at it’s receptors, therefore blocking the effects of it
(Vasoconstriction + Aldosterone secrion)

42
Q

When are Angiotensin 11 receptor antagonists used?

A
  • They’re used in combo with ACE inhibitors as they improve the mortality and morbidity compared to ACE inhibitors alone
  • They provide an alternative to ACE inhibitors when patients are intolerant (or have SE ie dry cough)

Year 2 Pharmacology (11 decks)

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