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Pharmacology Test #3 > Targets for Antihypertensive Drugs > Flashcards

Targets for Antihypertensive Drugs Flashcards

1
Q

What does renin do?

A

cleaves angiotensinogen to angiotensin I

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2
Q

What does kallikrein do?

A

cleaves kininogen to bradykinin

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3
Q

What does angiotensin-converting enzyme do?

A

converts angiotensin I to angiotensin II and inactives bradykinin

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4
Q

What does bradykinin do in the body?

A

vasodilation, decreased peripheral vascular resistance, decreased blood pressure

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5
Q

What does angiotensin II do in the body?

A

vasoconstriction -> increased peripheral vascular resistance
aldosterone secretion -> increased sodium and water retension
INCREASES BLOOD PRESSURE

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6
Q

What does aminopeptidase do?

A

converts angiotensin II to angiotensin III

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7
Q

What does angiotensinases do?

A

breaks down angiotensin III

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8
Q

What does prorenin do besides act as a precursor for renin?

A

prorenin has a receptor itself and its activity regulates the renin-angiotensin system and plays a role in other stuff

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9
Q

Primary biologically active molecule in the renin-angiotensin system?

A

angiotensin II

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10
Q

Name the three pathways that control renin release.

A
  1. NaCl reabsorption at macula dense
  2. blood pressure in pre-glomerular vessels
  3. activation of beta1 adrenergic receptors on JGCs
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11
Q

Angiotensin II Type 1 (AT1) receptors

A

G-protein coupled; Gi and Gq

also couples to phospholipase A2

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12
Q

Where are AT1 receptors located?

A

blood vessels, brain, adrenals, kidney, and heart

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13
Q

Activation of AT1 receptors works to

A

increase BP through vasoconstriction and Na+/water reabsorption

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14
Q

Name three things that angiotensin II alters

A
  1. altered peripheral resistance
  2. altered renal function
  3. altered cardiovascular structure
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15
Q

How does angiotensin II alter peripheral resistance?

A
  1. direct vasoconstriction
  2. enhancement of peripheral noradrenergic neurotransmission (increased NE release, decreased NE reuptake, increased vascular response)
  3. increased sympathetic discharge
  4. release of catecholamines from adrenal medulla
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16
Q

Result of altered peripheral resistance from angiotensin II

A

rapid pressor reponse (increased bp)

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17
Q

How does angiotensin II alter renal function?

A
  1. direct effect to increase Na+ reabsorption in proximal tubule
  2. release of aldosterone from adrenal cortex
  3. altered renal hemodynamics (direct renal vasoconstrictoin, enhanced noradrenergic neurotransmission in kidney, increased renal sympathetic tone)
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18
Q

Result of altered renal function from angiotensin II?

A

slow pressor response (Na+ and water retention)

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19
Q

How does angiotensin II alter cardiovascular structure?

A

I. non-hemodynamically mediated effects (increased expression of proto-oncogenes, increased GFs, increased synthesis of extracellular matrix proteins)
II. Hemodynamically mediated effects (increased afterload, increased wall tension)

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20
Q

Result of altered cardiovascular structure from angiotensin II?

A

vascular and cardiac hypertrophy and remodeling

21
Q

Three classes of drugs that inhibit the renin-angiotensin system

A
  1. direct renin inhibitors
  2. ACE inhibitors
  3. Angiotensin receptor blockers
22
Q

Sulfhydryl-containing ACE inhibitor

A

captopril (capoten)

23
Q

Dicarboxyl-containing ACE inhibitor

A

enalopril (vasotec)

24
Q

Phosphorous-containing ACE inhibitor

A

fosinopril sodium (monopril)

25
Q

What class of drugs would interfere with bradykinin-mediated vasodilation?

A

NSAIDs

26
Q

What is the effect of ACE inhibitors on bradykinin?

A

bradykinin is not inactivated, so more is available to promote vasodilation and decrease blood pressure

27
Q

What is the effect of ACE inhibitors on angiotension II?

A

decreased angiotensin II, so blood pressure is decreased

28
Q

Side effects of sulfhydryl-containing ACE inhibitors (captopril)

A

altered taste (metallic) and rash

29
Q

What is significant about Moexipril?

A

only ACE inhibitor cleared through hepatic metabolism (dose doesn’t have to be adjusted in patients with compromised renal function)

30
Q

Dicarboxyl-containing ACE inhibitor (Enalopril) requires

A

requires hydrolysis of ethyl ester to form active diacid form, enalaprilat (soluble form); enalopril is a pro-drug

31
Q

Parenteral dosage forms of ACE inhibitors end in which suffix?

A

-PRILAT

32
Q

Lysine-derivative of enalaprilat

A

Lisinopril (dicarboxyl-containing ACE inhibitor)

33
Q

Clinical uses of ACE inhibitors

A

hypertension, left ventricular systolic dysfunction, myocardial infarction, diabetic nephropathy (prevention)

34
Q

Adverse effects of ACE inhibitors

A

hypotension, dry cough, hyperkalemia, acute renal failure, skin rash (captopril), angioedema (contraindication)

35
Q

Drug-drug interactions of ACE inhibitors

A

antacids (reduce bioavailability), NSAIDs may reduce effectiveness, K+ supplements, may increase plasma levels of digoxin and lithium

36
Q

Contraindications of ACE inhibitors

A

pregnancy, high doses in patients with renal insufficiency may lead to neutrpenia

37
Q

Angiotensin II type 1 receptor antgaonists

A

“the sartans”

losartan potassium; valsartan; irbesartan; candesartan cilexetil; temisartan; eprosartan mesylate

38
Q

Actions of angiotensin II type 1 receptor (AT1) antagonists

A

selective blocks effects of angiotensin II: pressor effects, stimulation of NE system, secretion of aldosterone, effects on renal vasculature, growth-promoting effects on cardiac and vascular tissue
uricosuric effect

39
Q

What system does AT1 antagonists NOT effect

A

no effect on bradykinin system

40
Q

What do angiotensin II receptor antagonists provide more complete inhibition of the action of angiotensin II as compared to ACE inhibitors?

A

Angiotensin III also works on these receptors

41
Q

Clinical uses of AT1 receptor antagonists

A

hypertension, CHF, diabetic nephropathy, stroke prophylaxis

42
Q

Adverse effects of AT1 receptor antagonists

A

hypotension, hyperkalemia, teratogenic potential

43
Q

Renin inhibitor

A

Aliskiren (Tekturna)

44
Q

How does Aliskirin work?

A

direct renin inhibition; dipeptide like mimetic

45
Q

Aliskiren used to treat

A

used alone or in combination to treat hypertension

46
Q

What decreases the absorption of Aliskirin

A

high-fat meals

47
Q

Side effects of Aliskirin

A

diarrhea

48
Q

Contraindications for Aliskirin

A

contraindicated in pregnancy and nursing mothers

Pharmacology Test #3 (13 decks)

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