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Heart > Pharmacology of Hypertension > Flashcards

Pharmacology of Hypertension Flashcards

1
Q

Main factors affecting BP(3)

A

Blood volume
Cardiac output
Peripheral Vascular Resistance

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2
Q

Main MoA of HTN drugs

A

Vasodilators
Diuretics
Centrally acting drugs

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3
Q

Management of HTN

A

A/CD rule
DM or <55years

A -ace inhibitors/ angiotensin 2 receptor blocker ARB

Aged >55years/ african descent any age - CCB

A+C
A+C+D  Step 3
ACD +
low dose spironolactone if blood Potassium <4.5mmol/l
a/b-blocker if potassium >4.5mmol/L
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4
Q

Vasodilators target sites(7)

A 
Ltype CCB
Potassium channel openers - minoxidil
alpha blockers
Endothelin antagonist
angiontensin receptor blocker
Nitrodilators - GTN
Direct acting vasodilators
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5
Q

VAsodilators SE (8)

A
  1. Systemic vasodilation and pressure reduction - baroreceptor - mediated reflex stimulation of the heart >HR and Inotropy
  2. Impair baroreceptor function when person stands - othorstatic hypotension and syncope on standing
  3. Na and H2O retention >BV + CO
  4. GI distress
  5. Headaches
  6. Non productive cough (> bradykinin)
  7. Angioedema
  8. Hyperkalaemia (
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6
Q

Types of Vasodilators

A 
ACE inhibitors
ATN2R antagonists
CCN
a/b blockers 
Hydralazine
Minoxidil
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7
Q

ACE inhibitor MoA

A

Reduction of activity of ACE ?( angiotensin I prevented from being Angiotensin II)

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8
Q

RAAS

A

Na + Cl re-absorption > water retention
• ADH from posterior pituitary > H2O re absorption in collecting duct
• constriction of blood vessels via AT1 receptors on smooth muscles
• increased sympathetic activity on heart and blood vessels > release of NA and inhibits its re uptake

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9
Q

Therapeutic use of ACE inhibitors

A

HTN (In conj with a diuretic)
HF by systolic dysfunction (In conj with a diuretic)
MI - post. reduce deleterious remodelling

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10
Q

ACE inhibitor medications

A

Ramipril
Lisinopril
Enalapril
Captopril

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11
Q

ACEI contraindications

A

Pregnancy

Bilateral renal artery stenosis

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12
Q

ARBs MoA

A

Block AT1 receptors on blood vessels and heart > coupled to signal pathway that stimulates vascular smooth muscle contraction

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13
Q

Therapeutic uses of ARBs

A

HTN

HF

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14
Q

ARB medications

A 
Candesartan 
Irbesartan
Losartan
Telmisartan
Valsartan
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15
Q

Uses of diuretics

A

HTN
CHF
Congenital Heart Defects

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16
Q

Classes of diuretics(3)

A

Thiazides and Thiazide like
Loop Diuretics
Potassium-sparing diuretics

17
Q 
Diuretic site of action 
Acetazolamide
Osmotic diuretics - mannitol
Loop diuretics - furosemide
Thiazides -HCZ
Potassium-sparing - Spironolactone
A 
Proximal convoluted tubule
Descending limb of loop of Henle
Ascending limb of loop of Henle
Distal convoluted tubule
Distal convoluted tubule
18
Q

Thiazide

A

1st line of treatment when CCB are unsuitable due to oedema/heart failure
add on treatment for ACE/ARBs and CCB

19
Q

Thiazide medications

A

Bendroflumetiazide

Hydrochlorothiazide

20
Q

Thiazide-like medications

A

Indapamide
Metalozone
Chlorthaliodone

21
Q

Thiazide MoA

A

Inhibiting Na/Cl co-transporter in DCT. prevents reabsorption of Na

22
Q

Thizide SE

A

Hyponatraemia//kalaemia
Increased plasma glucose
Impotence

23
Q

Thiazide contraindications

A

Severe dehydration/hypovolaemia
Pre existing hyponatraemia/kalaemia
long term use of loop diuretiucs - inhuibit exretion of uric acid - worsen gout

24
Q

Thiazide Interactions

A

reduced by nsaids
drugs that lower potassium - loop duiuretics
monitor electrolytes for hyperkalaemia

25
Q

a blockers used in prostate gland and bladder management

A

Tamulosin
Akfuzosin
Silodosine

26
Q

A1-blockers for HTN

A

Doxazosin
Indoramin
Prazosin
Terazosin

27
Q

A1 blockers SE

A 
First dose effect
Postural hypotension
Tachycardia
Headache
Nasal congestion
Decreased ejaculation
28
Q

Uses of Sprinolactone

A

Treat HTN and HF
Oedema
low potassium
potassium sparing diuretic

29
Q

Spironolactone Pharmocological activity (4)

A

Mineralocorticoid receptor antagonist -aldosterone
Androgen receptor Antagonist - treat hirsutism
Glucocorticoid receptor antagonist
Progesterone receptor agonist

30
Q

Uses of Minoxidil

A 
Vasodilator
Antihypertensive
Alopecia
Rerely indicarted in HTN due to SE
Topical 2-5%lotion/gel
31
Q

Uses of Hydralazine

A

Directly acting vasodilator
Moderate hypertension when 1st line fails - with beta blockers and diuretics
in pregnancy 25-50mg OD

32
Q

When stimulated, the alpha 1 receptors are largely responsible for

A

Vasoconstriction: Stimulation of alpha 1 receptors helps to constrict the blood vessels. As a result of this, blood pressure will rise.
Mydriasis: dilation of the pupil.
The contraction of the internal sphincter of the bladder, preventing the flow of urine.

33
Q

alpha 1 receptors respond to

A

adrenaline and noradrenaline. They are divided into alpha 1 ( vascular smooth muscle) and alpha 2 (presynaptic nerve terminals).

34
Q

Alpha blockers can be subdivided

A 
non-selective (1&2) 
*Phentolamine, Phenoxybenzamine
and     selective  (1 - vascular smooth muscle, bladder neck and prostate gland)
*Tamulosin, Alfuzosin, Silodosin

Heart (9 decks)

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