Systemic hypertension 2

Question 1

What are chronotrophic drugs?

Answer 1

Change the heart rate and rhythm by impacting the electrical conduction system eg the rhythm produced by the SA node

Question 2

What are Inotrophic drugs?

Answer 2

Impact the force of muscular contractions

Question 3

Ca2+ channel blockers - main clinical indicators, where do they act?

Answer 3

First line of treatment for hypertension
Angina, hypertension and arrhythmias
Act on L-type calcium channels

Question 4

Ca2+ channel blockers&raquo_space; Dihydropyridines - name and target?

Answer 4

NEFIDIPINE

Mainly target vascular smooth muscle – cause peripheral vasodilation

Question 5

Ca2+ channel blockers&raquo_space; Phenylalkalamines - name and target?

Answer 5

VERAPAMIL
-vely chronotrophic, decrease heart rate, decrease force of contraction and target
CAN CAUSE CONSTIPATION

Question 6

Ca2+ channel blockers&raquo_space; Benzotriazopines - effects?

Answer 6

Effects half way between verapamil and dihyropyridines.

Treatment of intermediate heart and vascular defects

Question 7

Ca2+ channel blocker adverse effects?

Answer 7

FLushing, headaches, oedema, palpitations (due to peripheral vasodilation),
decreased Heart rate leading to bradycardia, AV heart blocks (-ve chronotrophic effects)
negative inotrophic effects causing worsening of HF and LVD

Question 8

Alpha blockers - how do they work and what is their impact on peripheral vessels?

Answer 8

Sympathetic nervous system keeps peripheral vessels under a degree of sympathetic tone (causing vasoconstriction)
Alpha blockers prevents this effect of noradrenaline!! Decreases peripheral resistance and constriction of peropheral vessels

Question 9

How can a blockers be used in treatment of benign prostatic hypertrophy

Answer 9

Results from an increase in muscle mass surrounding the prostate.
A blockers relax prostatic bladder and smooth muscle

Question 10

Adverse impacts of alpha blockers?

Answer 10

Postural hypotension (heart rate decreases when you stand up which is why you feel light headed causing peripheral vessels to temporarily shut down)
Also blocks the response to a fall in blood pressure seen which could have adverse effects

Question 11

RENIN INHIBITOR - used to treat?

Answer 11

Used in treatment of hypertension

Question 12

RENIN INHIBITOR - adverse effects? -

Answer 12

Hyperkalaemia 
Dizziness
Arthralgia
Diarrhoea
Don't use with another inhib of the renin angiotensin (eg ACE inhibitor) as could cause renal failure

Question 13

Centrally acting drugs - methyldopa - how does it work?

Answer 13

Activates pre-synaptic alpha 2 receptors to decrease noradrenaline release preventing vasoconstriction
Competitive inhibitor of DOPA decarboxylase.
Can be used in pregnancy!!!

Question 14

Centrally acting drugs - Monoxidine - how does it work?

Answer 14

Imidazoline type 1 receptor agonist (found at medulla)

causes a decrease in sympathetic nervous system activity and, therefore, a decrease in blood pressure.

Question 15

How do centrally acting drugs work?

Answer 15

Block sympathetic drive from the brainstem to the peripheral tissues (prevents centrally acting hypertensives)

Question 16

step 1 and 2 of NICE treatment steps

Answer 16

Are they under 55?
Give ace –|, AT1r blocker
Over 55/afro caribbean?
Ca2+ channel blocker

If neither of these work, step 2 –> thiazide like diuretic
!! Will leach out the Na+ from the system

Question 17

step 3 of NICE treatment steps

Answer 17

If steps 1 and 2 don’t work, patient is Hypertensive resistant.
Step 3 - give them spironolactone, high doses of the diuretic and alpha blockers!!!