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Antihypersensitives Flashcards

(45 cards)

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1
Q

What are antihypersentitives

A

drugs used when the goal is to lower blood pressure (treat hypertension)

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2
Q

which drugs are considered antihypertensives (10)

A

clonidine
propanolol
metoprolol
prazosin
sodium nitroprusside
verapamil
enalapril
lostartan
hydrochlorothiazide
furosemide

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3
Q

what can happen if hypertension is left untreated?

A

damage to blood vessels
renal failure
heart disease
stroke

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4
Q

anatomy of blood pressure control

A

arteries = resistance
veins = capacitance
heart = rate/cardiac output
kidney = blood volume

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5
Q

how do the kidneys help regulate blood pressure

A
  • longterm BP regulation
  • regulates blood volume by pulling water in or out
  • works via the renin angiotensin system
  • key regulator of BP = angiotensin II
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6
Q

baroreceptors detect bloodpressure changes in…

A

carotid artery and aorta - monitor the stretch of blood vessels (more stretched = higher BP)

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7
Q

how does the renin-angiotensin-aldosterone system regulate BP

A

decreased BP in renal arteries - renin secretion cleaves angiotensinogen to angiotensin I - ACE cleaves it to angiotensin II- causes increased aldosterone to increase BV

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8
Q

more angiotensin II in the bloodstream leads to…

A
  • constriction of blood vessels
  • increased aldosterone - Na+ and water retention - increased blood volume
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9
Q

how do the kidneys contribute to increasing arterial pressure

A
  • when pressure decreses the kidneys secrete renin
  • renin produces angiotensin I
  • ACE cleaves it to angiotensin II
    angiotensin II leads to aldosterone secretion (for salt and water retention) and vasoconstriction
  • both these factors cause arterial pressure to increase
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10
Q

blood pressure grades

A

ideal BP = 90-119/60-79
pre-hypertensive = 120-129/60-79
hypertension stage 1 = 130-139/80-89
hypertension stage 2 = 140/90 or higher

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11
Q

what is the goal of antihypertensive therapy

A
  • intervene to decrease BP and prevent organ damage
  • interferes with mechanisms regulating BP
  • balance toxicity and risk of not treating
  • use monotherapy or combined therapy
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12
Q

which antihypersensitives are centrally acting (effect at level of CNS)

A

clonidine

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13
Q

how does clonidine act as a centrally acting antihypersensitive

A
  • targets receptors that regulate BP in the CNS
  • decreases NE levels in the CNS which decreases SNS activity and therefore decreases BP
  • dilates blood vessels
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14
Q

adverse effects of clonidine as an antihypertensive

A

bradycardia
constipation (a2 in GI tract)
sedation
impaired concentration (a2 CNS effect)

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15
Q

which antihypertensives are considered peripherally acting (PNS)

A

beta-blockers (propanolol and metoprolol)
alpha blockers (prazosin)

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16
Q

effects of betablockers (propranolol and metoprolol) on blood pressure

A
  • block B1 receptors in heart - dereased CO
  • block B1 receptor in kidney - decreased renin release and therefore decreased PVR
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17
Q

toxicities of betablockers

A

bradycardia (B1 antagonism)
bronchoconstriction

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18
Q

effects of alphablockers (prazosin) on blood pressure

A
  • block a1 receptors found in arteries
  • prevent vasoconstriction
  • can lead to salt and water retention so often need to be administered with beta blockers or diuretics
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19
Q

which BP regulating drugs can be classified as vasodilators

Study These Flashcards
A
  • a1 antagonists (prazosin)
  • NO donors (sodium nitroprusside)
  • Ca2+ blockers (verapamil)
20
Q

how do vasodilators work to lower BP

Study These Flashcards
A
  • relax arterial smooth muscle to decrease PVR
  • might get compensatory responses from baroreceptors and renin-angiotensin system
  • work best when combined with anti-hypersensitive that oppose these responses
21
Q

mechanism of NO donord to vasodilate - e.g sodium nitroprusside

Study These Flashcards
A
  • NO activates cGMP
  • cGMP cleaves myosin-PO4 to myosin
  • myosin causes relaxation of smooth muscle cells
21
Q

toxicities associated with NO donors

Study These Flashcards
A

hypotension
cyanide accumulation

22
Q

mechanism of Ca2+ channel blockers - e.g. verapamil

Study These Flashcards
A
  • decreased Ca2+ influx into arterial smooth muscle casues vasodilation (Ca2+ initiates contraction but now this is blocked)
  • also inhibits cardiac Ca2+ channels
23
Q

adverse effects of calcium channel blockers

Study These Flashcards
A

bradycardia (low heart rate)
hypotension (low BP)

24
Angiotensin converting enzyme (ACE)
- enzyme that converts angiotensin I to II - also inactivates bradykinin
25
Angiotensin II - Key regulator of BP in the kidneys
- binds to AT1 and AT2 receptors - very potent vasoconstrictor - increases secretion of aldosterone (from adrenal gland) and ADH (from pituitary gland) - causes NE release
26
how does angiotensin II cause vasoconstriction
- activates AT1 receptor to increase IP3 and DAG - at presynaptic AT1 causes NE release - at smooth muscle AT1 IP3 causes increase Ca2+ release - contraction of SM
27
how does angiotensin II regulate blood volume
- activates aldosterone which increases Na+ reabsorption into blood (H2O follows) - activates ADH which increases permeability of collecting duct in kidney, increases H2O reabsorption
28
what happens when ACE inhibits bradykinin
- bradykinin is a vasodilator, when inhibited by ACE causes BP to increase
29
how does bradykinin work as a vasodilator
causes increased NO (EDRF) to relax blood vessels
30
where do ACE inhibitors work to treat high BP
- block angiotensin I to II conversion - inactivates bradykinin
31
which drugs are considered angiotensin inhibitors
- ACE inhibitors (e.g. Enalapril) - AT1 receptor blocker (e.g. Losartan)
32
properties of Enalapril
- an ACE inhibitor - prodrug metaboilized in liver to become activated - works to lower BP - side effects = hypotension, hyperkalemia, dizziness, headache - can cause a cough by blocking bradykinin
33
properties of Losartan
- an AT1 receptor blocker - prodrug? - side effects = hypotension, hyperkalemia, dizziness, headache
34
what is the role of diuretics
- drugs that decrease BP by depleting body Na+ (H2O follows) - ACE inhibitors enhance their efficiency (e.g. enalapril) - in mild-moderate hypertension can use them alone - in severe hypertension need a powerful one or combine it wirth a sympatholytic and vasodilator
35
diuretics examples
acetazolamide osmotic agents loop agents thiazides aldosterone antagonists ADH antagonists
36
how do loop agents work as diuretics
- powerful diuretic - works at the loop of henle - targets sodium and inpacts potassium
37
how do thiazides work as diuretics
- decrease the water being reabsorbed at the DCT because there is a higher salt concentration
38
Hydrochlorothazide - thiazide diuretic
- inhibits NaCl transport in DCT - absorbed well orally - inexpensive and effective - toxicities include hypokalemia (K+ depletion), gout and hyponatremia (dehydration)
39
Furosemide - loop agent diuretic
- inhibits co-transporter of Na+, K+ and Cl- in loop of Henle (NaCl reabsorption inhibited) - rapid and short acting - used for severe hypertention and pulmonary edema - toxicities include hypokalemia (K+ depletion), gout, hyponatremia (dehydration) and ototoxicity (hearing loss)
40
what are ways to help lower blood pressure before drug intervention
- Na+ restriction - weight loss - exercise
41
initial monotherapy to treat high BP
- thiazide diuretic (mild-moderate) - ACE inhibitor, AT1 receptor blocker - Ca2+ channel blocker - B blockers - a1 blockers, centrally acting sympatholytics
42
combination "stepped" therapy to treat high BP
- used in severe hypertension - drugs added in stepwise fashion untol optimal BP is achieved - first lifestyle changes implimented - next add these drugs one at a time as needed in this order: Diuretics, ACE inhibitors/ARB, Ca2+ channel blocker, sympatholytic/vasodilator
43
problems with combination "stepped" therapy to treat high BP
- lack of patient compliance - side effects common - drugs are expensive - disease is asymptomatic
44
bradycardia is an adverse effect of which drugs
- a2 agonists: clonidine - B-blockers: propanolol, metoprolol - Ca2+ channel blockers: verapamil

Pharmacology (21 decks)

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