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Semester 5 - Farmocology > Session 9 - Hypertension and Heart Failure > Flashcards

Session 9 - Hypertension and Heart Failure Flashcards

1
Q

Is blood pressure a disease?

A

No, it’s a risk factor for future vascular disease

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2
Q

How does higher blood pressure cause organ damage?

A

Higher Blood Pressure -> Increased arterial thickening -> Smooth muscle cell hypertrophy and accumulation of vascular matrix -> Loss of arterial compliance -> end organ damage

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3
Q

What are the five organ systems affected by sustained hypertension?

A 
Brain
Heart
Arterial System
Kidney
Eye
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4
Q

What two conditions is blood pressure a good indicator of?

A

Ischaemic heart disease and stroke

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5
Q

What are the two types of hypertension and which is more common?

A

Primary and secondary
Primary high BP with unkown cause - 90% pop
Secondary - Known cause
10% pop

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6
Q

What two factors determine whether drug therapy is offered to a patient or not?

A

The sustained level of blood pressure

The overall cardiovascular risk profile

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7
Q

What is hypertension defined as?

A

BP over 140/90

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8
Q

What is the effect of lowering diastolic BP by 10mmHg?

A

58% reduction in strokes

37% reduction in coronary artery disease

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9
Q

What level of hypertension justifies drug treatment

A

 ≥ 160mmHg Systolic and ≥100mmHg diastolic justifies drug treatment

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10
Q

What is the overall cardiovasc risk profile?

A

 Is there > 15% risk of a cardiovascular event in the next 10 years?
 Presence of end organ damage?
 In the presence of diabetes the treatment threshold is 140/90mmHg

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11
Q

What are the four non-pharmocological factors that will modify decision to insitute a drug regime

A

o Optimum body weight (BMI 20-25 kg/m2)
o Regular physical activity (>30 mins a day)
o Moderation of alcohol and salt. (< 2 units for women. < 6g salt)
o Smoking cessation should be strongly advised, and supported as necessary (e.g. nicotine replacement therapy)

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12
Q

What is severe hypertension?

A

> 180/>110

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13
Q

What is mild hypertension?

A

140-159/90-99

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14
Q

Name three ace inhibitors

A

 Ramipril
 Lisinopril
 Captopril

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15
Q

What is the mech of action of ACE inhibitors in lowering blood pressure

A

 ACE inhibitors cause inhibition of Angiotensin Converting Enzyme, consequently reducing Angiotensin II and Aldosterone levels. This causes vasodilation and consequent reduction in peripheral resistance and reduced sodium retention.
 Reduce breakdown of the vasodilator Bradykinin

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16
Q

Give three indications for ACE inhibitors?

A

 Hypertension
 Heart failure
 Renal dysfunction

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17
Q

Give three contraindications for ACE inhibitors

A

 Pregnancy, renovascular disease, aortic stenosis

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18
Q

Give five adverse drug reactions of ACE inhibitors

A

 Characteristic dry cough
 Angio-oedema (rare, but more common in black population)
 Renal Failure
 Hyperkalaemia
 Hypotension, dizziness and headache, diarrhoea and muscle cramps

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19
Q

Give two angiotensin blockers

A

 Losartan

 Valsartan

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20
Q

Give an indication for an angiotensin blocker

A

 Hypertension

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21
Q

When would you not use an angiotensin blocker?

A

 Pregnancy, breastfeeding

 Caution in renal artery stenosis and aortic stenosis

22
Q

Give a mechanism of action of an angiotensin blocker?

A

 Bind to and antagonise the receptor for Angiotensin II – Angiotensin 1 Receptor (AT1 R).
 Inhibits vasoconstriction and aldosterone stimulation by angiotensin II.

23
Q

Give the main diuretic used in control of BP

A

Thiazide diuretics

24
Q

Give a short list of drugs involved in BP management

A

ACE inhibitors
Angiotensin blocker
Beta blocker
Calcium Channel Blockers

25
Q

Give four beta blockers

A

 Propranolol
 Atenolol
 Bisoprolol
 Metoprolol

26
Q

Give the mechanism of action of beta blockers

A

 Antagonise β-adrenoreceptors. β1-receptors are found in the heart, when they are activated they cause increased Chronotropy and Inotropy.
 Inhibit renin release

27
Q

Give four indications for beta blockers

A

 Angina
 Post myocardial infarction
 Hypertension
 Arrhythmias

28
Q

Give a couple of contraindications for beta blockers

A

 Non-selective β-blockers (e.g. Propranolol) must not be given to asthmatic patients.
 Bradycardia, hypotension, AV block, Congestive Cardiac Failure

29
Q

Give some adverse drug reactions to B blockes

A

 Bronchospasm, fatigue and insomnia, dizziness, cold extremities, hypotension, bradycardia and decreased glucose tolerance in diabetic patients

30
Q

Give two drug-drug interactions of beta blockers

A

 Prevents Salbutamol working (β2-adrenoagonist)

 Verapamil – Both have –‘ve inotropic action

31
Q

Give three types of calcium channel blockers

A

Dihydropyridine
Phenylalkylamine
Benzothiazepine

32
Q

What is the mechanism of action of calcium channel blockers?

A

o Calcium channel blockers bind to specific alpha subunit of L-type calcium channel, reducing cellular calcium entry
o Vasodilates peripheral, coronary and pulmonary arteries
o No significant effect on veins
o Verapamil depresses SA node and slows A-V conduction

33
Q

Give two examples of dihydropyridine calcium channel blockers

A

Nifedipine

Amlodipine

34
Q

Give three properties of 1. Dihydropyridine Ca2+ blockers

A

 Good oral absorption
 Protein bound > 90%
 Metabolised by the liver

35
Q

Give three adverse effects of dihydropyridine

A

 Sympathetic nervous system activation – tachycardia and palpitations
 Flushing, sweating, throbbing headache
 Oedema

36
Q

What is a phenylalkylamine calcium channl blocker?

A

Verapamil

37
Q

Give three properties of verapamil (phelyalkylamine calcium channel blocker)

A

 Impedes calcium transport across myocardial and vascular smooth muscle cell membrane
 Class IV anti-arrhythmic agent (prolongs action potential/effective refractory period)
 Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility

38
Q

Give three adverse effects of verapamil

A

 Impedes calcium transport across myocardial and vascular smooth muscle cell membrane
 Class IV anti-arrhythmic agent (prolongs action potential/effective refractory period)
 Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility

39
Q

Give an example of a benzothazepine calcium channel bloceker

A

 Diltiazem

40
Q

Give three properties of a benzothazepine calcium channel bloceker

A

 Impedes Calcium transport across the myocardial and vascular smooth muscle cell membrane
 Prolongs the action potential/effective refractory period
 Peripheral vasodilation and reduction in cardiac preload and myocardial contractility

41
Q

Give two adverse effects of 3. Benzothiazepine Calcium Channel Blockers

A

 Risk of bradycardia

 Negative inotropic effect (less than Verapamil) can worsen heart failure

42
Q

Name a direct renin inhibitor

A

Aliskiren

43
Q

Give an indication for a direct renin inhibitor

A

Hyperension

44
Q

Give to contraindicator

A

 Pregnancy
 Caution in patients at risk of hyperkalaemia, Na+ and volume depleted patients, severe renal impairment and renal stenosis

45
Q

Give a mechanism of action a direct renin inhibitor

A

 Antagonises Renin, preventing the conversion of Angiotensinogen  Angiotensin I.
 Reduces plasma renin activity by 50-80%

46
Q

Give an adverse drug reaction of angio-oedema

A

 Angio-oedema, hyperkalaemia, hypotension, GI disturbances

47
Q

Give a therapeutic note for direct renin inhibitors

A

 t½ of ~40 hours, supporting once daily doses
 Mainly eliminated as an unchanged compound in faeces (78%)
 Not metabolised via CYP450

48
Q

What are two common combinations of blood pressure control?

A

o Diuretic and ACE inhibitor

o Diuretic and Beta Blocker

49
Q

What is treatment patter in people under 55?

A

Primary is Ace inhibitor (A)
Secondary A+C or A+D
Third is A+C_D
Four is more diuretic, alpha blocker or beta blocker

50
Q

What treatment pattern in people over 55 or black patients?

A

Primary is C or D
Secondary A+C or A+D
Third is A+C_D
Four is more diuretic, alpha blocker or beta blocker

Semester 5 - Farmocology (27 decks)

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