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Pharmacology - Year 2 AC > Week 7 - Hypertension Treatments > Flashcards

Week 7 - Hypertension Treatments Flashcards

(43 cards)

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1
Q

Why treat hypertension?

A
  • major risk factor for stroke

- major risk factor for ischaemic heart disease - e.g. angina, MI

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2
Q

When is hypertension treated?

A

-sustained systolic BP of >160mmHg
OR
-sustained diastolic BP of >100mmHg

If known CV disease, diabetes or organ damage:
-sustained systolic 140-159mmHg
OR
-sustained diastolic BP of 90-99mmHg

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3
Q

What are the types of anti hypertensive drugs?

A

Diuretics

Vasodilators (calcium antagonists, a1-blockers, angiotensin antagonists)

B-blockers

ACE inhibitors

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4
Q

How is BP calculated?

A

BP = CO (cardiac output) X TPR (total peripheral resistance)

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5
Q

How can cardiac output be reduced?

A
  • HR
  • stroke volume
  • plasma volume
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6
Q

How can total peripheral resistance be reduced?

A

-dilating arterioles

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7
Q

What do diuretics do?

A
  • reduce plasma volume then gradually TPR

- act on the kidney to increase diuresis

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8
Q

What do vasodilators do?

A

Directly lower TPR

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9
Q

What do B-blockers do?

A

Reduce cardiac output and kidney renin secretion

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10
Q

What do ACE inhibitors do?

A

Inhibit endogenous vasoconstrictor production

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11
Q

What do a-blockers do?

A

Reduce TPR by inhibiting noradrenaline action

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12
Q

What do angiotensin antagonists do?

A

Reduce TPR by inhibiting angiotensin action

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13
Q

What are the actions of diuretics?

A
  • increase Na+ excretion (reduce salt reabsorption from glomerular filtrate)
  • water loss follows
  • reduce plasma volume
  • reduce cardiac output
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14
Q

What are the types of diuretics?

A
  • thiazide diuretics

- loop diuretics

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15
Q

Describe thiazide diuretics

A
  • moderately potent diuretics
  • reduce systolic and diastolic pressure
  • widely used antihypertensive, suitable for most patients
  • inhibit Na+, Cl- co-transport in distal tubule
  • additional vasodilator action
  • potentiate effects of other antihypertensives
  • increase renin release (may counteract effects on BP)
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16
Q

What is the mechanism of action of thiazide diuretics?

A

Inhibit Na+, Cl- co-transport in distal tubule

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17
Q

Name some examples of thiazide diuretics

A

Derived from benzothiadiazine:

  • chlorothiazide
  • hydrochlorothiazide
  • bendrofluazide

Thiazide like structure:

  • chlorthalidone
  • metolazone
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18
Q

What are the side effects of thiazides?

Study These Flashcards
A

-more frequent urination
but
-high safety
-low profile of side effects

19
Q

Describe loop diuretics

Study These Flashcards
A
  • very potent diuretics
  • no more effective than thiazides at reducing BP
  • reserved for use in patients with renal insufficiency, resistant hypertension or heart failure
20
Q

Name the different types of vasodilator drugs

Study These Flashcards
A

Calcium antagonists (main type)

A1-blockers 
Angiotensin antagonists (both used but less often)

Potassium channel activators
Sodium nitroprusside
Hydralazine (others used in special circumstances)

21
Q

What is the action of vasodilators?

Study These Flashcards
A
  • act directly on the smooth muscle cells of arteries and arterioles
  • lower the intracellular calcium concentration
  • cause muscle cell relaxation
  • results in vasodilation
22
Q

Name some caccium channel antagonists

Study These Flashcards
A

Dihydropyridines

  • amlodipine
  • nicardipine
  • nifedipine

Benzothiazepine
-diltiazem

-verapamil

23
Q

What are calcium channel antagonists mechanism of action?

Study These Flashcards
A

Block Ca2+ entry through voltage-operated calcium channels in arterial smooth muscle cells - vasodilation

24
Q

Describe how Dihydropyridines act

Study These Flashcards
A

-highly selective for smooth muscle but affect most smooth muscle

  • nifedipine
  • amlodipine - longer acting (once daily dose)
  • nicardipine - some selectively for cerebral and coronary arteries
25
Describe how benzothiazepines act
- also block calcium channels in the conducting tissue of the heart - diltiazem - slows heart rate, potentiate a B-blocker action
26
What are the side effects of calcium antagonists?
All: - flushing - ankle oedema Diltiazem: - cardiac depression - interaction with B-blockers
27
What is the mechanism of action of a1-blockers?
- drugs used for hypertension are selective blockers of a1-adrenoceptors - prevent vasoconstrictor action of endogenous noradrenaline
28
Name some examples of alpha receptor antagonists/a1-blockers
- doxazosin - once daily - terazosin - once daily - prazosin - shorter acting, 3X daily
29
What are the adverse effects of a1-blockers
-postural hypertension (dizziness, light headedness) -possible severe hypotension after first dose but -generally well tolerated
30
Name some examples of B-blockers
- atenolol | - metoprolol
31
What is the mechanism of action of B-blockers?
- bind to and block B1-adrenoreceptors in the heart (sino atrial node and ventricular muscle) - block action of noradrenaline released from sympathetic nerves and circulating adrenaline
32
What is the initial effect of B-blockers?
- reduce rate and force of heart beat | - decrease cardiac output
33
What is the effect of bB-blockers after continued treatment?
- CO returns to normal but BP remains low | - TPR reset at lower level
34
What are the adverse effects of B-blockers?
Common: - cold hands - fatigue Less common but serious: - can provoke asthma attack in asthmatic - heart failure - conduction block in heart Also: -may affect blood lipids
35
Name some examples of ACE inhibitors
Angiotensin-converting enzyme inhibitors - captopril - 2x daily dose - enalapril -single daily dose - lisinopril - lysine analogue of enalapril - ramipril
36
What system do ACE inhibitors have an effect on?
Renin angiotensin system Angiotensinogen--> (renin helps convert to) angiotensin I --> (angiotensin converting enzyme (ACE helps convert to)) angiotensin II --> vasoconstriction
37
What is the mechanism of action of ACE inhibitors?
-prevent conversion of angiotensin I to angiotensin II (potent vasoconstrictor, stimulates aldosterone secretion - which inhibits salt and H2O excretion) - causes vasodilation - reduces plasma volume
38
What are the adverse effects of ACE inhibitors?
- dry cough - hypotension initially, especially if given with a diuretic - these effects usually wear off with time
39
Name some angiotensin II receptor antagonists
- losartan - candesartan - eprosartan - valsartan
40
What is the mechanism of action of angiotensin II receptor antagonists?
- block the action of angiotensin II (vasoconstriction) at its receptors - competes for binding to AT receptors - so vasodilation
41
How and when are angiotensin II receptor antagonists used?
- in combination with an ACE inhibitor (improved mortality and morbidity vs. ACE inhibitor alone) - alternative to ACE inhibitor in intolerant patients
42
How are antihypertensive drugs chosen for patients?
1. Thiazide diuretic - effective, safe history and few side effects 2. If thiazide ineffective - add ACE inhibitor or calcium antagonist 3. Until recently B-blockers were first line choice but now: - less effective at reducing risk of stroke - more side effects
43
What is hypertension?
Blood pressure is above normal level

Pharmacology - Year 2 AC (14 decks)

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