Pharmacology and CVD

Question 1

Define Hypertension

Answer 1

a condition where arterial BP is elevated above normal levels

Question 2

in what unit is BP measured?

Answer 2

mmHg

Question 3

what are the classification levels of hypertension?

Answer 3

Normal= <120/80
Prehypertensive= 120-139/80-89
Stage 1= 140-159/90-99
Stage 2=160/100+
Stage 3= 180/110+

Question 4

what are the two types of hypertension?

Answer 4

primary hypertension- hypertension with no know cause

secondary hypertension- hypertension with a secondary cause

Question 5

how prevalent is secondary hypertension?

Answer 5

affects 10-15% of all cases.

Question 6

what are the causes of secondary hypertension?

Answer 6

Renal artery stenosis
Chronic renal disease
Hyperaldosteronism
Cushing’s disease
Hyperthyroidism
Phaeochromocytoma
Pre-eclampsia
Aortic coarctation
Sleep apnoea
Antidepressant drugs

Question 7

What are the risk factors of primary hypertension?

Answer 7

you should know this any way
age
race
familial history
gender
obesity
alcohol/tobacco use
sedentary life style
salt etc etc etc...
(vitamin D)

Question 8

what are the 5 classes of hypertensive drugs?

Answer 8

Diuretics 
Sympatholytics
Directly-acting vasodilators
Calcium antagonists
Drugs acting on Renin-angiotensin system

Question 9

What areas are tageted by antihypertensive drugs?

Answer 9

Sympathetic NS
Heart (Cardiac output)
Kidney (Blood volume)
Arterioles (Peripheral resistance)
Endothelial cells (NO)
Renin-angiotensin system (AII)
CNS (Medulla oblongata)-CNS actions to reduce sympathetic tone

Question 10

what are the 3 types of diuretics?

Answer 10

thiazides
loop diuretics
potassium-sparing

Question 11

give an example of a thiazide and briefly describe how it works

Answer 11

hydrochlorothiazide
inhibits Na+/CL- co-transporter on luminal membrane of early distal convoluted tubule
activation of ATP-regulated K+ channels in resistance vessels

Question 12

what are the 3 types of sympatholytics?

Answer 12

centrally acting
ganglion blockers
NA store depletion
adrenergic neurone blockers
Alpha-blockers
Beta-blockers

Question 13

give an example of an alpha blocker and briefly describe how it works

Answer 13

prazosin

Competitively antagonises alpha-1 adrenoceptors on arterioles to cause vasodilation in resistance vessels

Question 14

give an example of an beta blocker and briefly describe how it works

Answer 14

pindolol (partial antagonist)
binds at cardiac beta-1 adrenoceptors to reduce Cadiac output

other examples of beta blockers are:
Propranolol (non-selective)
Atenolol (beta-1 selective, water soluble)
Labetalol (alpha and beta blocker)

Question 15

give an example of a direclty-acting vasodilatore and briefly describe how it works

Answer 15

Minoxidil
Activates ATP-sensitive K+ channels in arterial resistance vessels
Activation of NO release
Reduction of Ca2+ influx (L- type)

other examples are:
Hydralazine
Sodium nitroprusside
Diazoxide

Question 16

give an example of a calcium channel blocker and briefly describe how it works

Answer 16

Verapamil

Interfere with inward displacement of Ca2+
Through slow channels of arterial muscle (L-type channels)

Question 17

give an example of an ACE inhibitor and briefly describe how it works

Answer 17

Captopril (an ACE inhibitor) a drug which acts on the renin-angiotensin system

Angiotensin converting enzyme (ACE) is a carboxypeptidase which cleaves off 2 amino acids at the leucine terminal of Angiotensin 1 (Active site has a Zn atom)
ACE inhibitors have a sulphydryl group which attaches to the Zn atom

Inhibition of Kininase II which breaks down bradykinin

Question 18

what are the 3 types of drugs which act on the renin-angiotensin system?

Answer 18

ACE inhibitor
AT1 antagonist
Renin inhhibitor

Question 19

give an example of an AT1 antagonist and briefly describe how it works

Answer 19

Losartan

Antagonist at AT1 receptors

Question 20

give an example of a renin inhibitor and briefly describe how it works

Answer 20

Aliskiren

Orally active non-peptide inhibitor of Renin