Hypertension pharmacology Flashcards
What is hypertension
raised blood pressure above certain value normally above 160/100mmHg
hypertension can cause what
stroke left ventricular hypertrophy heart failure ( rEF and pEF) angina end-orang damage ( kidneys and eyes)
why are people hypertensive
stress shift-work diet family history alcohol age sedentary lifestyle obesity built-envrionment
angina
heart attacks of chest pain caused by reduced blood flow to the heart
Sx - tight, dull or heavy pain in chest
normally due to coronary arteries become blocked or occluded due to fatty build up( atherosclerosis)
NNT
number needed to treat to prevent 1 thing
what is the difference between primary and secondary hypertension
primary docent have a known cause and is also called essential hypertension. Secondary hypertension has a know cause.
primary is 90-95% of all cases
features of secondary HTN
young difficult to treat rapid onset normally under 3 months abnormal biochemistry abnormal urine dip headache abdo pain
what lifestyle changes can you do to treat HTN
Weight loss mediterranean diet low salt diet exercise smoking alcohol reduction
Amlodipine works by blocking
L-type voltage gated calcium channels inhibiting vascular smooth muscle contraction
what are the treatments available for hypertension
ACE inhibitors ARBS - angiotensin receptor blockers CCBS - calcium channel lockers thiazide like diuretics potassium sparing diuretics beta blockers
side effects of CCbs such as amlodipine
ankle oedema and reflex tachycardia
change in pressure is proportional to what
Q(flow) x resistance (R)
what stimulates renin production
reduced stretch in the juxtaglomerular apparatus
for a drug to reduce the action of the RAAS system should it enhance or inhibit angiotensin converting enzymes
inhibit
these are called ACE inhibitors
ACE also breaks down bradykinin. Bradkinin excess is correlated with cough and angioedema. What side effects might you expect with ACEi
cough and angioedema
angioedema
rapid edema or swelling beneath the skin - allergic reaction - fluid accumulates - limbs, genitals and face and throat
two examples of ACE inhibitors
ramipril
lisinophil
work by causing relaxation of blood vessels as well as decreasing blood volume which leads to lower blood pressure and decrease oxygen demand from he heart
what is ACE - angiotensin covering enzyme
central components. of the renin-angiotensin system which controls the blood pressure by regulating the volume of fluids in the body - converts hormone angiotensin I to the active vasoconstrictor angiotensin II
what are the effects of angiotensin II
increases blood pressure by causing vasoconstriction and in the nerves increases the sensation of thirst , the desire for salt and encrouags the release of other hormones involved in fluid retention
side effects of ACEi
cough
angioedma
hepotoxicity
what is bradykinin
vasodilator and mild diuretic causing lowering of the BP
what also might be a target for RAAS blockade
AT1 angiotensin II receptor
if aldosterone is impaired, what might happen to serum potassium
it will rise - worsening kidney function
losartan and candesartan are examples of what
angiotensin II receptor blockers - this decease in effects of angiotensin II
what are the side effects of ARBs
hyperkalaemia
Cl: pregnancy
no rise In bradykinin
what effect do aldosterone antagonists cause
loss of sodium and water
hyperkalemia
some risk of acidosis
spironolactone , an aldosterone antagonist , is also a weak antagonist of the androgen receptor. What effect might be seen in males who take this drug
gynecomastia - enlargement or swelling of breast tissue in males - male eostogen levels that are too high or out of balance testosterone levels
potassium sparing diuretics are aldosterone receptor antagonists that inhibit reabsorption of sodium from distal DCT can cause what side effects
hyperkalaemia
metabolic acidosis
gynaecomastia
thiazide like diuretics cause water
loss of sodium and water
hypokalaemic metabolic alkalosis
increased calcium reabsorption
how much sodium is nomally reabsorbed in the DCT
10%
what is the site of action of thiazide like diuretics
proximal to glomerulus than aldosterone site of action . By inhibiting sodium reasbsoption , they leave a saltier filtrate which means there is more sodium available for aldosterone to swap for potassium later on - so thiazide like diuretics can cause hypokalaemia
what sympathetic receptors will you find in the heat and vasculature
alpha 1 and beta 2
alpha blockers such as doxazosin and prazosin antagonise smooth muscle a1 receptors ( NA receptor ) dilate the veins and arteries but have what side effects
arthostatic hypotension
headache and nasal congestion
beta blockers such as bisoprolol and atenolol antagonise beta1 receptors resulting in negative chronotrophy and ionotrphy
these are cardioslective some can be B2 cause what side effects
bradycardia bronchoconstriction ( non-cardio selective B blockers)
is blood pressure proportional to CO and inversely proportional to material vascular radius ?
yes
so we can reduce blood pressure by reducing CO and dilating blood vessels
True or false
CBBS dilate blood vessels by relaxing vascular smooth muscle. ARBs and ACEi both interrupt the RAAS pathway and stop the effects of angiotensin II
true
thiazide Ike and potassium sparing diruretic work , in part, by reducing blood volume which impacts CO true or false
true
alpha and beta blockers antagonise sympathetic stimulation , reducing CO and dilating BV true or false ?
true
what is an example of a cardiovascular risk assessment
QRISK score
62 year old man recently diagnosed with hypertension ( 139/88) and suffers from T2D and CKD. Which of the following would be the best drug of choice? CCB ACEi ARBs Thiazide diuretics
ACEi
slender 60yr female diagnosed with stage 1 hypertension. BP is 135/85. No other comorbid conditions otherwise in excellent health. What initial therapy would be most appropriate ARB Thiazide diuretics lifestyle changes Alpha 1 receptor blockers
lifestyle changes
then if stage 2 would be ACEi and thiazide diuretics using the NICE pathway
Some jobs also have legal requirements and standards that need to be met, such as the national standards for Commercial and Heavy Vehicle driving, Rail Safety Workers medical, and Queensland Coal Board medical to name just a few.
what is this normally called
work medical or a fitness to work
what are the normal ranges of blood pressure
normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg.
high blood pressure is considered to be 140/90mmHg or higher. Unless over 80 and 150 and above
low blood pressure is considered to be 90/60mmHg or lower.
