phys pharm - Circulation & Peripheral CV Flashcards

1
Q

Function of vascular system:

A

to supply oxygenated blood and nutrients to tissues and remove waste products

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2
Q

Circulation:

A

Consists of a pump (heart) and tubes (the vessels and capillaries)

Blood flow to each tissue is regulated by local chemical and general neuronal and humoral mechanisms

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3
Q

Blood vessels have 3 layers:

A
  1. connective tissue adventitia
  2. smooth muscle layer
  3. endothelium
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4
Q

Capillaries:

A

Capillaries made from endothelial cells (single cell thick)

oxygen and nutrients enter the interstitial fluid and carbon dioxide and waste products enter the bloodstream

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5
Q

transport across capillaries:

A
  • diffusion of lipid soluble substances through plasma membranes
  • diffusion of lipid insoluble substances through endothelial pores
  • bulk flow of water and dissolved substances
  • exocytosis / endocytosis
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6
Q

the blood brain barrier:

A

Acidic dyes e.g. trypan blue injected into bloodstream all tissues except brain and spinal cord were stained.

Barrier is the endothelium of the cerebral capillaries and the choroids plexus epithelium

Only water, CO2 and O2 enter the brain with ease with the exchange of other substances between blood and brain is slow.

Helps to maintain a constant environment around the neurons.

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7
Q

Lymphatics:

A

Lymphatics drain into subclavian and jugular veins

Lymphatics act as a filter at the lymph nodes (packed with lymphocytes and phagocytes) and remove foreign particles such as bacteria

= an important component of body’s defences.

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8
Q

Oedema =

A

block of lymph flow, so protein from capillaries builds up in interstitial spaces, and promotes water retention
- may result from injury, inflamation, parasitic infection or surgery.

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9
Q

Blood pressure:

A

systolic – force of the heart

diastolic – basal BP in the system

normal young adult at rest 120 systolic /70 mm Hg diastolic

rises slowly with age and with 50-70 yr. old expected 130/80

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10
Q

hypertension:

A

high blood pressure

diastolic arterial BP > 90 mmHg

increased risk of other diseases, e.g. heart attack and stroke

primary hypertension = no apparent cause but associated with genetics, obesity, alcohol, lack of exercise and smoking

secondary hypertension = caused by renovascular disease or endocrine disease (e.g. tumour of adrenal - secretes excessive adrenaline)

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11
Q

factors regulating blood pressure:

A

1) Changes in cardiac output

2) Peripheral mechanisms involved in control of blood flow

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12
Q

Main classes of regulation (non-cardiac)…

A

1) Drugs that affect the sympathetic nervous system/muscle contraction
2) Endothelium/local regulation
3) The renin-angiotensin system
4) Changes in blood volume

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13
Q

Neuronal control of blood pressure:

A

Detection of blood pressure by baroreceptors in aortic arch and carotid sinus

=Increase in pressure = increases in baroreceptor output

Changes in baroreceptor activity produce RECIPROCAL changes sympathetic activity

Increased baroreceptor activity – decreased sympathetic activity

Decreased baroreceptor activity – increased sympathetic activity

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14
Q

3 sites of action to block artery contraction:

A

(i) block NA release from sympathetic nerve varicosities
(ii) adrenoceptor antagonists that act on α1-adrenoceptor (Gαq) receptors
(iii) effects on calcium = no contraction

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15
Q

Adrenergic neuron blockers: Reserpine…

A

Reserpine an alkaloid extract of the roots of a climbing shrub

Reserpine is taken into nerve by uptake 1 and binds to storage
vesicles and stops them concentrating NA so less NA for release

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16
Q

Adrenergic neuron blockers: Guanethidine…

A

anti-hypertensive

Mechanism of action – taken up by uptake 1, competes with NA to be taken up into storage vesicles (higher affinity at pump than NA) – so decrease in NA stored

can also block action potential propagation

17
Q

Adrenergic neuron blockers side effects =

A

hypotension

depression

18
Q

α1-adrenoceptors agonists…

A

treatment of hypotension and shock (caused by hypovolemia)

e.g. methoxamine and phenylephrine - lead to an increase in BP through activation of smooth muscle α1-adrenoceptors

19
Q

α1-adrenoceptors antagonists…

A

treatment of hypertension

e.g. prazosin - blocks noradrenaline induced artery constriction

20
Q

α2-adrenoceptors agonists…

A

act pre-synaptically to inhibit transmitter release

e.g. clonidine and methyldopa

21
Q

α2-adrenoceptors antagonists…

A

e.g. yohimbine - blocks prejunctional α2-adrenoceptors and so will potentiate transmitter release from sympathetic nerves.

22
Q

Calcium and artery contraction:

A
  • sympathetic nerve stimulation leads to depolarisation of smooth muscle and activation of voltage dependent calcium channels
  • α-adrenoceptor activation couples through Gq to stimulate PLC-β and generate IP3 which releases calcium from calcium stores
  • calcium reacts with calmodulin = stimulation of myosin light chain kinase = phosphorylates myosin = contraction
23
Q

Calcium channel antagonists act on different voltage dependent calcium channels…
:

A

N-type – act on Neurons involved with transmitter release

T-type – act in brain and heart, Transient opening

L-type – act on smooth muscle, Long lasting

24
Q

Role of the endothelium:

A

endothelium is also able to exert control over the vascular system by the production of vasoactive substances

e.g.
vasoconstrictors (endothelins)

or

vasodilators

25
Q

nitrovasodilators =

A

mostly used in treatment of heart failure

e.g. Sodium nitroprusside is given to reduce BP during hypertensive emergency = breaks down to produce NO inside smooth muscle cells

26
Q

Role of the kidney in controlling blood pressure:

A

Rein-angiotensin system

Regulation of blood volume

27
Q

Actions of Angiotensin II…

A

Vasoconstriction

Increase in blood pressure

Aldosterone release from adrenal cortex = Na+ and water retention = Release of vasopressin ADH = increases fluid retention in kidney

Stimulates thirst centre in brain

Facilities norepinephrine release = stimulates cardiac hypertrophy

28
Q

Diuretics:

A

= drugs that increase the rate of urine flow

  • increase the rate of excretion of salt, increased water loss
  • decrease the reabsorption of sodium and chloride from the filtrate
  • reduce the volume of extracellular fluid by decreasing total body NaCl content
29
Q

Kidney Function:

A
  • excretion of waste products such as urea

- regulation of salt, electrolytes and volume of extracellular fluid

30
Q

2 functional parts of the nephron of the kidney…

A
  • filtering apparatus (the glomerulus)

- tubular portion that reabsorbs from the filtrate

31
Q

different type of diuretics:

A
  • loop diuretics (Na+, Cl- out)
  • early distal tube diuretics (Na+ out)
  • potassium sparing diuretics (Na+ out, K+ in)
  • osmotic diuretics
32
Q

Regulation of volume and blood pressure: loop diuretics…

A

e.g. frusemide

cause 15-25% of the sodium in the filtrate to be excreted

inhhibit transport of NaCl out of tubule

33
Q

Regulation of volume and blood pressure: early distal tube diuretics…

A

e.g. bendrofluazide

drugs acting on the distal convoluted tubule

inhibit Na+/Cl- co-transporter

treats hypertension

34
Q

Regulation of volume and blood pressure: Potassium sparing diuretics…

A

e.g. amiloride

Block excretion of potassium into urine

treat hypokalemia (low potassium leading to tachycardia)

35
Q

Regulation of volume and blood pressure: Osmotic diuretics…

A

e.g. mannitol

are incompletely reabsorbed, and increases osmolarity in the tubule

= increase amount of water excreted