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OD2 (S1&2) > PHARM - Introduction to Cardiovascular Pharmacology - Week 4 > Flashcards

PHARM - Introduction to Cardiovascular Pharmacology - Week 4 Flashcards

1
Q

What forms the high and low pressure components of the cardiovascular system? What percentage volume of blood can be found in each?

A

High pressure - arteries/arterioles, has ~17% of blood
Low pressure - veins/venules, has ~70% of blood

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2
Q

Do capillaries have smooth muscle?

A

No

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3
Q

What is the formula for blood pressure?

A

BP = cardiac output x total peripheral resistance

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4
Q

What is the formula for cardiac output?

A

CO = heart rate x stroke volume

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5
Q

What three components control total peripheral resistance?

A

Humoral control
Sympathetic control
Local control

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6
Q

Define preload.

A

Filling pressure of the right atrium/ventricle

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7
Q

What is defined as the resistance to outflow from the left ventricle?

A

Afterload - total peripheral resistance

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8
Q

Do the sympathetic and parasympathetic systems control both heart rate and contractility?

A

Sympathetic - controls heart rate and contractility
Parasympathetic - controls heart rate only

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9
Q

Define total peripheral resistance.

A

It is the sum of all vascular resistances in the systemic circulation

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10
Q

In what manner do arteries supply tissue/organs?

A

Parallel circuits

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11
Q

Describe Poiseuille’s Law, the equation, and what it means.

A

TPR ∝ 1 / ri^4
TPR = total peripheral resistance
ri = vessel radius
Arteriolar diameter determines resistance to local blood flow in a particular vascular bed

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12
Q

Are arteriolar walls thicker in relation to lumen diameter? How does this affect the effect of contraction on resistance?

A

Arteriolar walls are thicker than lumen diameter, and so changing contraction affects resistance significantly.

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13
Q

Name an example of a sympathetic factor that controls arteriolar diameter.

A

Noradrenaline

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14
Q

Name two passive factors that control arteriolar diameter.

A

Pressure
Architecture

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15
Q

Consider elevated blood pressure. What 2 structural changes happen to blood vessels.
Why do these changes occur?

A

Hypertrophy of smooth muscle
Decreased vessel lumen
This decreases wall stress with increasing pressure

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16
Q

Keeping Poiseuille’s Law in mind, describe the impact on blood pressure a constrictor stimulus will have on blood pressure.

A

If TPR ∝ 1 / ri^4, and BP = CO x TPR, then as ri increases, BP will increase more for hypertensive patients for any given constrictor stimulus.

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17
Q

Describe the optimal, normal, and normal high values for blood pressure (systolic and diastolic).

A

Optimal
Systolic - <120
Diastolic - <80
Normal
Systolic - 120 - 129
Diastolic - 80 - 84
Normal High
Systolic - 130 - 139
Diastolic - 85 - 89

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18
Q

Describe the grade 1, 2, and 3 values for hypertension (systolic and diastolic).

A

Grade 1
Systolic - 140 - 159
Diastolic - 90 - 99
Grade 2
Systolic - 160 - 179
Diastolic - 100 - 109
Grade 3
Systolic - ≥180
Diastolic - ≥110

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19
Q

Describe the value for isolated systolic hypertension (systolic and diastolic).

A

Systolic - ≥140
Diastolic - <90

20
Q

Describe primary/essential hypertension, the percentage of patients that fall under this category, and the cause (7). What age group typically falls under this category?

A

Primary/essential hypertension has no apparent cause. 90-95% fall under this category.
Typically occurs in patients >40 years
Possible causes are:
-genetic predisposition
-diet (high Na+)
-Obesity
-EtOH
-physical inactivity
-psychological factors

21
Q

Describe secondary hypertension, the percentage of patients that fall under this category, and 3 possible causes.

A

Secondary hypertension has an identifiable cause. 5-10% fall under this category.
Possible causes are:
-renal disease
-endocrine disorders
-pre-eclampsia in pregnancy

22
Q

What is the first choice therapy for hypertension treatment, what mmHg goal, and 5 factors that can lower pressure?

A

Lifestyle modifications, with a goal of diastolic blood pressure ≤80mmHg
Choices include weight loss, healthy diet, exercise, no smoking, and no coffee.

23
Q

Do all antihypertensives have adverse effects?

A

Yes

24
Q

Keeping in mind the formula for blood pressure, how can it be lowered (4)?

A

BP = CO x TPR
Reducing CO involves:
-decreasing sympathetic effects on the heart
Reducing TPR involves:
-decreasing plasma volume
-decreasing sympathetic effects on arteries
-deother mechanisms

25
Q

Do a1 adrenoceptors increase or decrease TPR?

A

Increase

26
Q

Do catecholamines increase or decrease TPR?

A

Increase

27
Q

Does angiotensin II increase or decrease TPR?

A

Increase

28
Q

Does NO increase or decrease TPR?

A

Decrease

29
Q

What does angiotensin II act as an antagonist to?

A

B1 adrenoceptors

30
Q

Name the three things that control heart rate, their effector molecule, the receptor it acts on, and where in the heart. Note the effect on heart rate.

A

Sympathetic system - using noradrenaline, acting on B1 receptors, increasing heart rate.
Adrenal gland - releases circulating adrenaline, acting on B1 receptors, increasing heart rate.
Parasympathetic system - using acetylcholine, acting on M2 recetors, decreasing heart rate.
They affect the SA node of the heart.

31
Q

What two thing control stroke volume, their effector molecule, the receptor, the effect on stroke volume, and where in the heart.
Why is stroke volume affected?

A

Sympathetic system - using noradrenaline, acting on B1 receptors, increasing stroke volume.
Adrenal gland - releases circulating adrenaline, acting on B1 receptors, increasing stroke volume.
The receptors are on cardiac muscles.
These two systems increase force and contractility, thus increasing stroke volume.

32
Q

Describe inotropic effect.

A

A change in the force of contraction.

33
Q

Describe chronotropic effect.

A

A change in the rate of contraction.

34
Q

Keeping in mind the formula for BP, describe the mechanisms of B1 antagonism.

A

BP = CO x TPR and CO = HR x SV
Antagonising B1 will decrease HR at the SA node, and decrease SV at cardiac muscles, decreasing cardiac output, and thus BP.

35
Q

Describe the effects of B1 inhibition at the kidney, and the effect on blood volume, and thus BP.

A

Decreases renin secretion, decreasing volume, and therefore BP.

36
Q

Give two examples of non selective B antagonists.

A

Propranolol
Oxprenolol

37
Q

Give two examples of B1 selective antagonists.

A

Atenolol
Metoprolol

38
Q

Are B antagonists typically lipid soluble?

A

Yes

39
Q

Name 6 common adverse effects of B antagonists, and the mechanism if possible.

A

Cold extremities - peripheral vasoconstriction/loss of B mediated dilation
Fatigue - decreased cardiac output
Dreams and insomnia - CNS effects due to lipid solubility
Cardiac depression - elderly
Bradychardia
Bronchoconstriction - B2 inhibiton

40
Q

Why are B antagonists contraindicated for patients with bronchoconstriction?

A

Its life threatening to them

41
Q

What molecule is released in response to adrenaline, and how does this relate to the use of B blockers in diabetics? What does it increase the likelihood of, and why?

A

Glucose is released.
In diabetics, the use of B blockers increases the likelihood of hypoglycaemia as adrenaline-induced release of glucose from the liver is diminished.

42
Q

Is diabetes a contraindication for B blockers?

A

Only poorly controlled diabetus.

43
Q

Name 5 contraindications for B antagonists.

A

Athsma
Sinoatrial or atrioventricular dysfunction
Hypertensives with heart failure
Peripheral vascular disease
Patients with poorly controlled diabetus

44
Q

Describe B antagonist drug withdrawal syndrome, and what can happen as a result. What is done to avoid this?

A

An upregulation of B receptors occurs during the blockade, resulting in increased sensitivity to endogenous catecholamines.
It can result in a rebound hypertension to higher levels.
Dosage must be tapered over eeks to months.

45
Q

What is the drug of choice for B antagonism (which receptor, not drug name), hydrophilic or lipophilic, and why.

A

B1 is preferred, and hydrophilic.
This limits side effects.

OD2 (S1&2) (174 decks)

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