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Pharmacology II > CV II - Antihypertensive agents > Flashcards

CV II - Antihypertensive agents Flashcards

1
Q

How is hypertension diagnosed?

A

High BP measured multiple times

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2
Q

What is mild hypertension?

A

Over 140/90 mm Hg

  • Asymptomatic until damage to heart, brain, retina, kidney etc. occurs
  • systolic/diastolic
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3
Q

What is primary hypertension?

A

Unknown cause of hypertension

The cause is known in 10-15% cases

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4
Q

True or false? Blood pressure control mechanisms are working normally in hypertensive people

A

True

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5
Q

Give the two systems for controlling blood pressure

A

SNS: Fast control.

Renin-angiotensin system (RAS): Longer term control.

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6
Q

How does the CNS control blood pressure?

A
  • Carotid baroreceptors senses low blood pressure and send a signal to raise blood pressure to the brain
  • Sympathetic NS ganglia activated
  • β1 receptors in heart increase heart rate and contraction force
  • β1 receptors in kidney increase renin secretion
  • α1 receptors constrict vascular smooth muscle veins
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7
Q

How does the renin-angiotensin system control blood pressure? Describe pathway.

A
  • Angiotensin converted to angiotensin I by renin
  • Angiotensin I converted to angiotensin II by ACE (angeiotensin converting enzyme)

Angiotensin II:

  • α1 receptors cause vasoconstriction on vascular smooth muscle
  • Aldosterone released, causing sodium and water retention
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8
Q

What four types of drugs are used to treat hypertension?

A
  • Diuretics
  • Drugs that affect the SNS (centrally acting, β blockers, α1 blockers)
  • Vasodilators (Ca channel blockers, other)
  • Drugs that affect the RAS (ACE inhibitors, AII antagonists)
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9
Q

True or false? Hypertension often requires polypharmacy

A

True. Though monotherapy is always preferable.

Some effective drugs have toxic effects at maximal doses, so additional drugs with different mechanisms of action can be added

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10
Q

How do diuretics treat hypertension?

A
  • Act on cells in renal tubule to promote diuresis (water excretion) and naturiesis (sodium excretion)
  • Depletion of Na in body decreases stiffness of vascular smooth muscle cells
  • Initial decrease in BP due to decreased blood volume and reduced cardiac output
  • Over time CO returns to normal but lowered peripheral resistance can be left lowered by 10-15 mm Hg (may be all you need)
  • Effective and safe, especially in elderly (over 85)
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11
Q

What are the three types of diuretics most commonly used to treat hypertension?

A
  • Loop diuretics
  • Thiazides
  • Potassium sparing diuretics
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12
Q

How do loop diuretics work?

A
  • Ascending loop of henle
  • Chlorine/sodium/potassium transporter brings sodium back into body, loop diuretics inhibit this transporter
  • Sodium, potassium and water loss
  • VERY POWERFUL
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13
Q

How do thiazides work?

A
  • Distal convoluted tubule
  • Inhibits Na reuptake
  • Sodium and potassium lost
  • Used along with K-sparing diuretics for hypertension
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14
Q

How do potassium sparing diuretics work?

A
  • Collecting tubule
  • Inhibit Na/K pump
  • K accumulates (not excreted)
  • Na and water excreted (lost)
  • Used along with thiazides for hypertension
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15
Q

How do centrally acting SNS drugs lower blood pressure?

A
  • Decrease SNS outflow by inhibiting hypothalamic SNS activity
  • Causes sedation as well, so not popular, used for eclampsia in pregnant women
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16
Q

How do beta blockers decrease blood pressure? Who shouldn’t take them?

A
  • β1 receptor cardioselective
  • Decrease HR and reduce force of contraction (reducing CO and BP)
  • Over the long term beta blockers decrease renin release

Asthmatics should not take beta blockers

17
Q

How do α1 blockers reduce blood pressure?

A

Causes vasodilation on vascular smooth muscles

  • Effectively blocks effects of SNS on blood vessels
18
Q

What are some adverse effects to α1 blockers?

A

Orthostatic hypotension

  • Sudden decrease in BP upon standing
  • Other SNS effecting drugs can do this as well
19
Q

How do calcium channel blockers lower blood pressure? Name two.

A

They inhibit influx of calcium and therefore cause relaxation of vascular smooth muscle cells

Used to treat: angina, hypertension and arrhythmia

Nifedipine: acts on blood vessels only

Diltiazem and verapamil: Both heart and blood vessels

20
Q

Name three other vasodilators in addition to calcium channel blockers

A
  • Hydralazine (pregnancy safe)
  • Sodium nitroprusside (emergency drug)
  • Minoxidil (Rogaine)
21
Q

Why can’t you use ACE inhibitors or angiotensin II inhibitors during pregnancy?

A

Teratogenic (fetal malformations)

22
Q

How do angiotensin II antagonists lower blood pressure?

A

Block AII receptors causing vasodilation and a decrease in BP

Block of receptors at adrenal gland causes a decrease in aldosterone release, leading to decrease in sodium and water retention and a decrease in BP.

Pharmacology II (12 decks)

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