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CVS > Hypertension, hypotension and therapeutic interventions > Flashcards

Hypertension, hypotension and therapeutic interventions Flashcards

1
Q

What is the equation for aterial blood pressure

A

ABP = CO x TPR

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2
Q

How can we lower blood pressure

A

well if we look at the equation
drugs that can lower CO, and lowerTPR can reduce blood pressure

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3
Q

How do we physiologically maintain our blood pressure

A

Baroreceptor reflex

  • Autonomic nervous system
    • this is very fast response
      • could target and
  • Heart
  • Vessels

Renin-angiotensin-aldosterone system

  • Kidneys → alter blood volume → slower
  • Vessels → this is faster

this means there’s lots of places we can target drug wise

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4
Q

How do we determine drug choice

what factors do we look at

A
  • Age
  • Genetics (Black African/Caribbean)
  • they also take comorbidities/health status
    • includes pregnancy
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5
Q

What are the classes of drugs

A

Class A, C, D, B

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6
Q

What are class A drugs

A

Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin (AT1) receptor antagonists

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7
Q

Name a class A drug (ACE)

A

Eg lisinopril, enalapril… end with pril

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8
Q

How do class A drugs wotk

A
  • lower angiotensin 2
  • ACE enzyme is inhibited to stop the conversion of angiotensin 1 to 2
  • we use ACE to degrade vasodilator kinins e.g bradykinin
  • which reduces TPR and CO
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9
Q

What are the side effects of class A drugs

A
  • Dry cough( can disrupt sleep)
    • may be due to kinins in the lungs not as great degradation which can act as irritants
    • may be due to demographics (some evidence evidence→ women more than men, older age, and having an east asian origin may be your more likely t have a cough)
      -may cause severe sudden hypotension is taken with diuretics
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10
Q

What is the first line of drugs given to patients that have mild uncomplciated, younger patinets

A

ACE inhibtors

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11
Q

What other class A drug do we have

A

Angiotensin (AT1) receptor antagonists

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12
Q

Name some AT1 receptor antagonists

A

Eg Losartan, irbesartan…. (sartan ending)

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13
Q

How do AT1 receptor antagonists work

A

Mechanism

  • decrease vasoconstriction by decreasing angiotensin 2
  • indirect effect
  • have antagonist action at AT1 receptor
  • this decreases TPR and CO
  • they have no major side effects as yet (not associated with cough) → maybe because they don’t affect ACE itself, which affects the kinins

we may use this if ACE doesnt work

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14
Q

What are class C drugs

A

Calcium channel blockers

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15
Q

Name a class C drug

A

Eg amlodipine (pine ending)

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16
Q

How do class c drugs work on hypertension

the whole mechanism is not there, but you should know it

A

reduces TPR which reduces blood pressure

17
Q

What are the side effects of class c drugs

A
  • impact on heart function
  • have effect in smooth muscle in GI tract for example
18
Q

What is the first line of treatment for uncomplicated, mild hypertension

A

Class C drugs

19
Q

What are class D drugs

A

Diuretics (D for diuretics)
Drugs act at various sites in the kidney nephron

Clinically - First line treatment for uncomplicated, mild hypertension

20
Q

How does Class D drugs

A

-Has a biphasic mechanism (2 stage mechanism)
- Initially
- it increases water/Na+ excretion from kidneys → which impacts blood volume
- which reduces CO

To compensate 
-Thiazide/thiazide-like are better than loop diuretics

They may be better because
- Longer-term effects = which causes arterial dilation which causes decrease TPR?
- maybe due to: sodium depletion can decrease intracellular calcium in smooth muscle cells

21
Q

What are the side effects of Class D drugs

A

hypokalemia

its a diuretic

22
Q

What types od drugs act on the peripheral symathteic nervous system

A

Beta adrenoreceptor antagonists (beta blockers)

23
Q

Name same beta blockers

A

Eg propranolol ( beta 1&2), atenolol ( beta 1)→ aka the olols

24
Q

How do beta blockers help with hypertension

A
  • decreases heart rate/contractility which decreases cardiac output
  • decreases renin secretion which decreases angiotensin 2 which decreases TPR and CO
25
Q

What are the side effects of beta blockers

A
  • Beta 2 action can cause bronchospasm
  • there may be an exercise intolerance
26
Q

What does it say clinically now about beta blockers

A

to avoid them

27
Q

What other receptor can you effect in the peripheral sns

A

Alpha1 adrenoceptor antagonists

28
Q

Name some alpha1 adrenoceptor antagonists

A

Eg prazosin, doxazosin

29
Q

How do alpha 1 adrenorecpetors work

A
  • target alpha one which causes vasoconstriction
  • Block vasoconstriction
  • primarily on arteriole side
  • decreases TPR and CO
30
Q

What are the side effects of alpha 1 adrenoreceptors antagonists

A

postural hypotension

31
Q

What are alpha 1 adrenorecpeor antagonists used for

A

Clinically used for

  • people with severe hypertension
  • or for patients with other cardiac/renal problems
32
Q

How are drugs that treat hypertension and hypotension catagorised into

there;s two

A
  • ones that directly reducd RAAS (A+B)
    • ACE inhibitors, A2 receptor antagonists and beta blockers
  • Ones that have no direct effect on RAAS (C+D)
    • calcium channel blockers and diuretics
33
Q

If someone has worsening hypertension what do we do

A
  • we can increase the dose of the drug
    • increasing the dose means increasing the side effects
34
Q

How do we combot the side effects of increading drug doses

A
  • we use combination therapy
    • this can decrease toxic effects
    • and increase the chance of successful therapy
35
Q
A
35
Q

How do we combine the drugs

A
  • A+C
  • or A+d
  • but we try to avoid C+D (but it can be done)
36
Q

What are the possible causes of hypotension

A

bleeding, burns, shock

37
Q

If someone has shock what drugs can we use

A
  • adrenaline (aka a Sympathomimetics)
  • which increases cardiac output, and increase blood pressure
38
Q

How do we help people with chronic hypotension

A

they are often told to increase salt intake, but not much is done clinically

CVS (4 decks)

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