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Pharmacology year 2 > UMP2006 pharmacological basis of the treatment of high blood pressure > Flashcards

UMP2006 pharmacological basis of the treatment of high blood pressure Flashcards

1
Q

what is hypertension defined as?

A
  • systolic BP above 140mmHg and diastolic BP above 90mmHg
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2
Q

what are the 2 different types of causes of hypertension?

A
  • essential/primary = no known cause/ many factors like environmental/genetics?
  • secondary = hypertension with identifiable mechanism e.g. pheochromocytoma, primary aldosteronism, Cushing’s syndrome
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3
Q

what is the equation for blood pressure?

A

blood pressure = cardiac output x total peripheral resistance
cardiac output = stroke volume x heart rate

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4
Q

what is the equation for cardiac output?

A
  • cardiac output = stroke volume x heart volume
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5
Q

give all the different drug classes used to treat hypertension

A
  • alpha adrenoreceptor antagonist
  • adrenergic neurone blockers
  • beta blockers
  • sympathetic ganglion blockers
  • ACE inhibitors
  • angiotensin receptor blockers
  • diuretics
  • nitrates
  • Ca channel blockers
  • K channel activators
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6
Q

how do Ca channel blockers treat hypertension?

A
  • prevent Ca entry into cells which is needed for contraction, thus blood vessels relax and open more and for the heart muscle to contract less and less strongly
    = decreasing total peripheral resistance and cardiac output
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7
Q

give some examples of Ca channel blockers (hypertension)

A

dihydropyridines (such as nifedipine and amlodipine) (bp only)
and the nondihydropyridines (diltiazem and verapamil) (bp and heart)

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8
Q

how do K channel openers treat hypertension?

A
  • they let more K out of the cell
  • this blocks the action of ATP on Katp channels which causes hyperpolarisation, preventing Ca channels from opening
  • so low Ca = less contraction = relaxation
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9
Q

give some examples of K channel openers (hypertension)

A

minoxidil and diazoxide ( not used commonly)

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10
Q

how do nitrovasodilators treat hypertension?

A
  • they cause the release of NO (nitric oxide) which activates guanylate cyclase which increases cGMP causing relaxation and vasodilation locally in endothelial and muscle tissue
    (short term fix)
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11
Q

give some example of nitrovasodilators (hypertension)

A

Glyceryl trinitrate (nitroglycerin), sodium nitroprusside
(not used for chronic hypertension)

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12
Q

give some example of a smooth muscle vasodilator and how they lowers blood pressure

A
  • thiazide diuretics e.g. bendroflumethiazide
  • lowers bp but not through diuresis
  • thought to cause vasodilation but mechanism unknown
  • (might be due to reduced Ca entry caused by Na depletion or by synthesis of prostaglandins, or by opening K channels)
  • hydralazine ( unknown - maybe activation of guanylate cyclase)
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13
Q

give examples of drug classes that effect the sympathetic nervous system that reduce blood pressure

A
  • a1 antagonists
  • a2 agonists
  • beta blockers
  • ganglion blockers
  • drugs that block catecholmine synthesis
  • drugs that block storage and release of NA from presynaptic terminal
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14
Q

how do alpha 1 adrenoreceptor antagonists lower blood pressure?

A
  • block effect of noradrenaline on blood vessels which constricts them, causing relaxation and vasodilation
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15
Q

give some examples of alpha 1 antagonists (hypertension)

A

Doxazosin. Prazosin. Terazosin

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16
Q

how do sympathetic ganglion blockers lower blood pressure?

A
  • they block sympathetic action potentials from being transmitted beyond the ganglion to the receptors = no neurotransmitters released = no effect = relaxation
17
Q

give an example of a ganglion blocker drug (hypertension)

A
  • hexamethonium ( not used anymore)
18
Q

how do K sparing diuretics lower blood pressure?

A
  • block ENaC or inhibit aldosterone receptor (which normally causes Na and thus water reabsoption in the kidneys)
  • therefore they cause more Na and water to be excreted, decreasing blood volume and thus blood pressure
19
Q

give some examples of K sparing diuretics (hypertension)

A

Spironolactone
Amiloride
Triamterene
Eplerenone

20
Q

how do alpha 2 adrenoreceptors agonists lower blood pressure?

A
  • they are similar to noradrenaline, so act as negative feedback in the vasomotor centre in the medulla, so reduce excitation to pre-ganglionic neurones, so no release of noradrenaline = relaxation
21
Q

give some examples of alpha 2 agonists (hypertension)

A

clonidine and guanabenz, guanfacine

22
Q

give some examples of drugs that lower blood pressure by inhibiting the synthesis of catecholamines

A
  • a-methyltyrosine = inhibit tyrosine hydroxylase which converts L-tyrosine to L-DOPA
  • disulfiram = inhibit dopamine Beta-hydroxylase which converts dopamine to noradrenaline
23
Q

give some examples of drugs that act on the medulla to decrease blood pressure

A
  • alpha 2 agonists
  • a-methyl DOPA
  • a-methyl Dopamine
  • a-methyl Noradrenaline
    = all similar to the precursor or noradrenaline, act as negative feedback in the medulla to reduce excitation to preganglionic neurons = prevent release of NA = relaxation
24
Q

describe how beta blockers lower blood pressure

A
  • block the effects of adrenaline/noradrenaline on Beta adrenoreceptors in the heart and blood vessels which causes both to contract less = heart beat less and vessels vasodilate and relax = decrease blood vessels
  • they also reduce renin release, reduce sympathetic tone and reset baroreceptor reflex
25
Q

give some examples of beta blockers used to treat hypertension

A

atenolol
bisoprolol
carvedilol.
metoprolol
nebivolol
propranolol

26
Q

describe the renin-angiotensin-aldosterone system

A
  • decreased Na concentration (low bp) of the juxtaglomerular apparatus in the kidneys causes renin secretion
  • renin causes angiotensinogen (from the liver) to convert to angiotensin 1
  • ACE from the lungs and renal endothelium converts angiotensin 1 to angiotensin 2
  • angiotensin 2 = increases sympathetic activity, increases aldosterone which increases Na,Cl and water reabsorption and K excretion in kidneys, vasoconstriction of blood vessels, causes pituitary gland to secret more ADH which causes water reabsorption from kidneys
    all = increased BP
27
Q

give some examples of how the renin-angiotensin-aldosterone system can be targeted to lower bp

A
  • the system increases bp, so blocking different parts of it will decrease bp
  • renin blockers
  • ACE inhibitors
  • angiotensin 1 receptor blockers
  • aldosterone receptor blockers
28
Q

give an example of a renin blockers (hypertension)

A
  • aliskiren
29
Q

give some examples of ACE inhibitors (hypertension)

A
  • Benazepril, Captopril, Enalapril, Quinapril, Ramipril
30
Q

give some examples of angiotensin 1 receptor blockers (ARBs)

A

irbesartan, valsartan, losartan and candesartan

Pharmacology year 2 (8 decks)

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