Acts on IP receptors relaxes smooth muscle and inhibits platlet aggregation by acting on adenlyl cycaseexamplesprostaglandins, thromboxanes, and prostacyclins

EDRFactivates guanylyl cyclase which is released continoisly in reistance blood vesselsthis leads to vasodilator tone and physiolgical control of BP and decreases it

more potent than angiotensin II no clinical uses ET antagonists only licened for rare disease primary pulomonary hypertrension

smooth muscle rapid acting usually produce refelx tachcardia whihc verpamil & diltiazem do not

SEM 2__BM322 Pharmacology__BLOCK A Cardiovascular AR Flashcards by John Duthie

Class of mediators

prostanoids, NO, peptides, EDHF

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The two types of vasoactive drugs

vasoconstritors and vasodilators

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Clinical uses of vasoactive drugs

systemic hypertension, HR, shock and hypotensice states, Periphera vascuar disease, Raynauds disease and pulmonary hypertension.

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Prostanoids

Acts on IP receptors relaxes smooth muscle and inhibits platlet aggregation by acting on adenlyl cycase examples prostaglandins, thromboxanes, and prostacyclins

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Nitric Oxide (NO)

EDRF activates guanylyl cyclase which is released continoisly in reistance blood vessels this leads to vasodilator tone and physiolgical control of BP and decreases it

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vasodilator tone

the degree in which the vessel can relax, widen or dilate

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peptides

vasodilators working respectively through cGMP and cAMP

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NO inhibits

vasucalr smooth muslce cell proflifration platlet adhesion and aggregation <div> </div><div>NO activates soluble guanylyl cyclase (sGC), leading to an increase in cyclic GMP (cGMP) levels. Elevated cGMP can activate protein kinase G (PKG), which can phosphorylate and inhibit phospholipase C (PLC), the enzyme responsible for hydrolysing phosphatidylinositol 4,5-bisphosphate (PIP₂) to produce IP₃ and diacylglycerol (DAG). This inhibition reduces IP₃ formation, thereby decreasing intracellular calcium release from the endoplasmic reticulum. </div>

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Edonthelium Derived hyperisation factor (EDHF)

causes hyperpolarisation of endotheila and smooth muscle cells

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list of vasoacitve drugs that are vasconstritors and natural vasoconstritors

Eicosanoids, Angiotenisn II, ADH, Endothelins Epinephrine: A vasopressor used in emergency situations Phenylephrine: A vasoconstrictor found in Sudafed PE that can be applied topically to the eyes or nasal passages

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Types of Eicosanoids

Prostacyclin, Thromboxane A2, ADH, endothelin angiotnein, angitoensin II, Endothelin

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angiotensin II

40 times more potent than noradrelanine in raisng BP No routine clinical use since drugs like captopril and losartan affect cardio system by reduing its production

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Anti Diurteic Hormone (ADH)

also known as vasopressin importatn for its antidurtetic action on the kidney powerful vasoconstrictor in skin and some other vasucar beds initated by receptors V1 and V2

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activation of V1 and V2 leads to

V1 - vasoconstricion and promotes platlet aggregation V2 - water rentention and vasodilation

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Vasucalr beds

network of small blood vessels

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Endothelins

more potent than angiotensin II no clinical uses ET antagonists only licened for rare disease primary pulomonary hypertrension

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list of vasoactive drugs that are vasodilators

Calcium antagonoists - Nifedipine, Verapamil, Diltiazem, Amlodipine Drugs that act on potassium channels - minoxidil, Nicorandil, levosimedan

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examples of calium antagonists

nifedprine, verapanil, Diltizaem

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nifedprine acts on

smooth muscle rapid acting usually produce refelx tachcardia whihc verpamil & diltiazem do not

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verapanil acts on the

heart

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Drugs that act on potassium channles

minoxidil, diazoxide

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minoxidil and diazoxide allow

smooth muscles to relax by opening KATP channle which leds to hyperporising the cell, switching off voltage-dependent calcium channels

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minoxidil is especially

potent long acting vasdilator last resort in treating serve hypertension when patient is not repsonseive to other drugs can cause severe relfex Tachycardia

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Levosimendan

combines KATP channel activation of the cardiac contaticle mechanism to ca2+ by binding troponic C and is used in decompensated HR

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decompaenrsated HR is when

HR symptoms worsen

systemic hypertenison, if not effectibvely treated can lead to increase risk of

cononary thrombosis, strokes, Myocardial infarction and renal failure

treatment for systemic hypertenison

anti-hypertenive drugs

list of correctable cuases of hypertension

Phaeochromoctyoma, steroid secreting tuours, narrwoing of the aorta

phaeochromocytoma

rare tunmours that start in the inner part of the adrenla gland

steroid secreting tumours of

adrenal cortex are one of the correcitve causes of hypertension

narrowing of the aorta in medica terms is known as

coarctation of the aorta

Heart failure is characterised by

breathlesseness and/ or fatigue usally with signs of fluid overload

fluid overload is known as

oedmea

oedmea refers to

abnormal accumulation of fluid in the tissues of the body

oedma can be heard in making

crackles when listening to chest with a stephoscope

what is the underlying physioligcal abnormality of Heart failure

CO that is inadequate to meet the metabolic demands of the body, intially during exercise but as the syndrome progresses, stuggles also at rest

Drug treatments for Heart failure

Metoprolol, carvediol and bisoprolol

3 targets for treating Heart failure

Block B adrenoceptors, antagonise ADH and relax vasucalr smooth muscle

shock and hypotenisce states is the

inadequate perfusion to vital organs usually due to low BP
this leads to anaerobic metabolism and hence increased lactate prodcution

Hypotrnsive state - blood pressure is lower than normal

causes of shock

haemorrhage, burns, bactarial infections, anaphylaxis and mycocaridal infarction

Haemorrhage

accutae loss of blood from damaged blood vessels

Treatments for shock and hypotensice states

vasopressin, adrenaline, dobutamine

Peripheral vasucalr diease is when

blood vessels narrow or become blocked, reducing blood flow to the body. blocked by atheroma in peripheral arteries
atheroma being fatty deposits that build up in the walls of arteries

Atheroma refers to

fatty deposits that build up in the walls of arteries

difference between atheroma and atherosclerosis

atheroma refers to the fatty substance
atherosclerosis is the disease that results from this build up

treatment for peripheral vasucalr disease

Antiplatlet drugs that include
asprin, clopidepgrel, statin (sinvastin), ACEI ike ranipril

Raynauds disease is the

inapproriate vascoconstrition of small arteries and arteroiles
most commonly in the fingers and toes

what is meant by the Raynauds phenomen

caused by inapproariate vasoconstriotion of small arteries and aterioles leads to
blacnching of fingers
follwed by blueness owing to deoxygenation of the static blood and redness from reactive hyperamia (follwing return of blood flow)

Raynauds disease can lead to mild or severe

ulceration and gangrene

Rayndauds disease can occur in isoaltion or in asscoatiaion with

a number of other diseaes inclucing so called conncective tissue diseases
eg - systemic sclerosis

systemic sclertosis

chronic AI disease that causes skin and internal organs to harden and tighten

Pulmonary hypertesnion refers to

high BP in the blood vessels that supply the lungs

Where are the nephrons located in the kidney

the renal cortex and medulla of the kidney

Nephron, structural order

Glomerulus, Bowmans capsule
Proximal convoulted tubule
Decending limb of loop of henle
accending limb of loop of henle
distal convouluted tubule
collecting duct system

what is Bowaman's capsule

part of the nephron that forms a cup-like sack surrounding the gloerulus
located before proximal convoluted tubule

what does the glomerulus do

a cluster of tiny blood vessel in the kidney that filters blood

where does RAAS in the kidney occur

in the juxtaglomerular cells of the afferent arterioles

What is the juxtaglomerular apparatus

a specialised structure located in the kidney near the glomerulus, composed of cells called the macula densa and juxtaglomerular cells.
plays a crucial role in regulating blood pressure by monitoring sodium levels and releasing the enzyme renin to control blood volume and filtration rate within the nephron.

Macula densa

Macula densa cells are specialized cells in the kidney that detect changes in sodium chloride levels

Vascular smooth muscle cell (VSMC) proliferation is

the process by which VSMCs multiply in response to injury or disease.

A hypertensive emergency is defined by severe hypertension with evidence of:

Organ damage

Which diuretic is most effective in cases of acute pulmonary oedema?

Furosemide

A patient is prescribed spironolactone for resistant hypertension. What is the primary risk associated with this medication?

Hyperkalaemia

describe the mechanism of action of aldosterone?

Increases sodium reabsorption and potassium excretion in the distal tubule

A patient with hypertension and chronic kidney disease (CKD) is prescribed an ACE inhibitor. What is the main renal concern associated with this medication?

Acute worsening of kidney function

In advanced atherosclerosis, the necrotic core of the plaque is composed primarily of:

foam cells and extracellular lipids

What triggers the release of renin from the juxtaglomerular apparatus?

Sympathetic nervous system activation

Why do loop diuretics cause hypokalaemia?
A) They block potassium reabsorption in the proximal tubule
B) They cause excessive sodium reabsorption in the distal tubule
C) They increase sodium delivery to the collecting duct, leading to potassium excretion
D) They directly block sodium-potassium pumps in the kidney

Answer: C) They increase sodium delivery to the collecting duct, leading to potassium excretion

Which of the following events is most likely to trigger a myocardial infarction in a patient with atherosclerosis?
A) Plaque calcification
B) Plaque rupture with thrombosis formation
C) Increased HDL levels
D) Progressive but stable plaque enlargeme

Answer: B) Plaque rupture with thrombosis formation

A patient with chronic kidney disease and hypertension is prescribed an ACE inhibitor. What major electrolyte abnormality should be monitored?
A) Hypokalaemia
B) Hyperkalaemia
C) Hyponatraemia
D) Hypocalcaemia

Answer: B) Hyperkalaemia

Which of the following is a key feature of malignant hypertension?
A) Blood pressure >140/90 mmHg
B) Papilloedema and retinal haemorrhages
C) Increased nitric oxide production
D) Bradycardia

B) Papilloedema and retinal haemorrhages

malignant hypertension

a medical emergency that occurs when blood pressure increases suddenly and severely, causing organ damage. More severe than hypertenive emergency