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Cardiovascular > Hypertension pharmacology > Flashcards

Hypertension pharmacology Flashcards

1
Q

What is hypertension

A

raised blood pressure above certain value normally above 160/100mmHg

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2
Q

hypertension can cause what

A 
stroke 
left ventricular hypertrophy 
heart failure ( rEF and pEF) 
angina 
end-orang damage ( kidneys and eyes)
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3
Q

why are people hypertensive

A 
stress
shift-work 
diet
family history 
alcohol 
age 
sedentary lifestyle 
obesity 
built-envrionment
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4
Q

angina

A

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)

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5
Q

NNT

A

number needed to treat to prevent 1 thing

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6
Q

what is the difference between primary and secondary hypertension

A

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

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7
Q

features of secondary HTN

A 
young 
difficult to treat 
rapid onset normally under 3 months 
abnormal biochemistry 
abnormal urine dip 
headache 
abdo pain
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8
Q

what lifestyle changes can you do to treat HTN

A 
Weight loss 
mediterranean diet 
low salt diet 
exercise 
smoking 
alcohol reduction
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9
Q

Amlodipine works by blocking

A

L-type voltage gated calcium channels inhibiting vascular smooth muscle contraction

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10
Q

what are the treatments available for hypertension

A 
ACE inhibitors 
ARBS - angiotensin receptor blockers 
CCBS - calcium channel lockers 
thiazide like diuretics 
potassium sparing diuretics 
beta blockers
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11
Q

side effects of CCbs such as amlodipine

A

ankle oedema and reflex tachycardia

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12
Q

change in pressure is proportional to what

A

Q(flow) x resistance (R)

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13
Q

what stimulates renin production

A

reduced stretch in the juxtaglomerular apparatus

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14
Q

for a drug to reduce the action of the RAAS system should it enhance or inhibit angiotensin converting enzymes

A

inhibit

these are called ACE inhibitors

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15
Q

ACE also breaks down bradykinin. Bradkinin excess is correlated with cough and angioedema. What side effects might you expect with ACEi

A

cough and angioedema

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16
Q

angioedema

A

rapid edema or swelling beneath the skin - allergic reaction - fluid accumulates - limbs, genitals and face and throat

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17
Q

two examples of ACE inhibitors

A

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

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18
Q

what is ACE - angiotensin covering enzyme

A

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

19
Q

what are the effects of angiotensin II

A

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

20
Q

side effects of ACEi

A

cough
angioedma
hepotoxicity

21
Q

what is bradykinin

A

vasodilator and mild diuretic causing lowering of the BP

22
Q

what also might be a target for RAAS blockade

A

AT1 angiotensin II receptor

23
Q

if aldosterone is impaired, what might happen to serum potassium

A

it will rise - worsening kidney function

24
Q

losartan and candesartan are examples of what

A

angiotensin II receptor blockers - this decease in effects of angiotensin II

25
Q

what are the side effects of ARBs

A

hyperkalaemia
Cl: pregnancy
no rise In bradykinin

26
Q

what effect do aldosterone antagonists cause

A

loss of sodium and water
hyperkalemia
some risk of acidosis

27
Q

spironolactone , an aldosterone antagonist , is also a weak antagonist of the androgen receptor. What effect might be seen in males who take this drug

A

gynecomastia - enlargement or swelling of breast tissue in males - male eostogen levels that are too high or out of balance testosterone levels

28
Q

potassium sparing diuretics are aldosterone receptor antagonists that inhibit reabsorption of sodium from distal DCT can cause what side effects

A

hyperkalaemia
metabolic acidosis
gynaecomastia

29
Q

thiazide like diuretics cause water

A

loss of sodium and water
hypokalaemic metabolic alkalosis
increased calcium reabsorption

30
Q

how much sodium is nomally reabsorbed in the DCT

A

10%

31
Q

what is the site of action of thiazide like diuretics

A

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

32
Q

what sympathetic receptors will you find in the heat and vasculature

A

alpha 1 and beta 2

33
Q

alpha blockers such as doxazosin and prazosin antagonise smooth muscle a1 receptors ( NA receptor ) dilate the veins and arteries but have what side effects

A

arthostatic hypotension

headache and nasal congestion

34
Q

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

A 
bradycardia 
bronchoconstriction ( non-cardio selective B blockers)
35
Q

is blood pressure proportional to CO and inversely proportional to material vascular radius ?

A

yes

so we can reduce blood pressure by reducing CO and dilating blood vessels

36
Q

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

A

true

37
Q

thiazide Ike and potassium sparing diruretic work , in part, by reducing blood volume which impacts CO true or false

A

true

38
Q

alpha and beta blockers antagonise sympathetic stimulation , reducing CO and dilating BV true or false ?

A

true

39
Q

what is an example of a cardiovascular risk assessment

A

QRISK score

40
Q 
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
A

ACEi

41
Q 
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
A

lifestyle changes

then if stage 2 would be ACEi and thiazide diuretics using the NICE pathway

42
Q

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

A

work medical or a fitness to work

43
Q

what are the normal ranges of blood pressure

A

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.

Cardiovascular (20 decks)

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