vascular system Flashcards
vasoactive drugs: identify the drugs that impact vascular tone, their mechanisms of actions and their side-effects
step 1 hypertension treatment for under 55s
ACE inhibitor or angiotensin receptor blocker (ARB)
step 1 hypertension treatment for over 55s or afro-Caribbean’s
Ca2+ channel blocker (CCB) or thiazide-like diuretic
step 2 hypertension treatment
CCB or thiazide-like diuretic and ACE inhibitor or ARB
step 2 hypertension treatment for afro-Caribbean’s
same, but ARBs preferred to ACE inhibitors
step 3 hypertension treatment
combination of ACE inhibitor/ARB with CCB and thiazide-like diuretic
step 4 resistant hypertension treatment
low dose spironolactone, B-blocker or a-blocker
2 reactions ACE inhibitors prevent
angiotensin I -> angiotensin II; bradykinin -> inactive metabolites
3 stimuli for renin
decreased renal Na+ reabsorption, decreased renal perfusion pressure, increased SNS
4 normal angiotensin II actions
SNS activation and thirst, vasoconstriction, direct salt and water retention, aldosterone secretion (indirect salt and water retention)
6 uses of ACE inhibitors
hypertension, heart failure, post-myocardial infarction, diabetic nephropathy, progressive renal insufficiency, patients at high risk of cardiovascular disease
example of ACE inhibitor
enalapril (usually -pril)
what will ACE inhibitors help treat by decreasing TPR and venous return
hypertension and heart failure
how do increased TPR and increased venous return worsen hypertension
increased TPR directly contributes to increased BP, and increased venous return leads to increased cardiac contractility (via Starling’s Law), and thus cardiac output and BP
how do increased TPR and increased venous return worsen heart failure
increased vasoconstriction increases afterload and cardiac work, and increased venous return leads to long term fluid retention and congestion, leading to oedema
example of ARB
iosartan