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Pharmacology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the 4 types of drugs used to treat hypertension?

A

Diuretics
Vasodilators
B-blockers
ACE inhibitors

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2
Q

What is hypertension a risk factor for?

A

Stroke

Ischaemic heart disease

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3
Q

What is the criteria for hypertensive treatment?

A

Systolic >160
OR
Diastolic >100

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4
Q

What is the criteria for hypertensive treatment in those with known CV disease, diabetes or organ damage?

A

Systolic 140-159
AND/OR
Diastolic 90-99

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5
Q

Reducing what 3 things in turn reduces cardiac output?

A

Heart rate
Stroke volume
Plasma volume

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6
Q

How can you reduce total peripheral resistance?

A

Dilating arterioles

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7
Q

What is the role of diuretics?

A

Reduce plasma volume

Gradually reduce TPR

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8
Q

What is the role of vasodilators?

A

Directly lower TPR

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9
Q

What is the role of B-blockers?

A

Reduce cardiac output and kidney renin secretion

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10
Q

What is the role of ACE inhibitors?

A

Inhibit endogenous vasoconstrictor production

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11
Q

What is the role of A-blockers

A

Reduce TPR by inhibiting noradrenaline action

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12
Q

What is the role of angiotensin antagonists?

A

Reduce TPR by inhibiting angiotensin action

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13
Q

What are the actions of diuretics?

A

Increase Na+ secretion by reducing salt re absoption from glomerular filtrate

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14
Q

What happens as a result of diuretic action?

A

Water loss
Reduce plasma volume
Reduce cardiac output

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15
Q

Where do loop diuretics act?

A

Ascending loop of henle

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16
Q

Where do thiazide diuretics act?

A

Between the ascending loop and the distal convoluted tubule

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17
Q

What are thiazides?

A

Moderately potent diuretic that reduces systolic & diastolic pressure

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18
Q

How do thiazides work?

A

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

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19
Q

What additional action does thiazide provide?

A

Vasodilation

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20
Q

What are examples of thiazides derived from benzothiadiazine?

A

Chlorothiazide
Hyrdrochlorothiazide
Bendrofluazide

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21
Q

What are examples of drugs with a thiazide like structure?

A

Chlorthalidone

Metolazone

22
Q

What is the adverse effect of thiazides?

A

More frequent urination

23
Q

What are loop diuretics?

A

Very potent diuretics that are reserved for patients with renal insufficiency, resistant hypertension or heart failure

24
Q

What are the 6 vasodilators?

A 
Calcium antagonists (MAIN)
A1 blockers
Angiotensin antagonists
Potassium channel activators
Sodium nitroprusside
Hydralazine
25
Q

What are the actions of vasodilators?

A

Direct action on smooth muscle cells of arteries and arterioles
Lower the intracellular calcium concentration
Cause muscle cell relaxation

26
Q

What do calcium antagonists do?

A

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

27
Q

What are dihdropyridines?

A

Calcium antagonists highly selective for smooth muscle that affect most smooth muscle

28
Q

What are the 3 dihdropyridines?

A

Nifedepine
Amlodipine
Nicardipine

29
Q

What is an advantage of amlodipine?

A

Long acting (once daily)

30
Q

Which dihdropyridine has some selectivity for cerebral & coronary arteries?

A

Nicardipine

31
Q

What does benzophiazepine do?

A

Block calcium channels in conducting tissue of the heart
Slow heart rate
Potentiate b-blocker action

32
Q

What is an example of a benzophiazepine?

A

Diltiazem

33
Q

What are some adverse effects of calcium antagonists?

A

Flushing

Ankle oedema

34
Q

What are adverse effects of diltiazem specifically?

A

Cardiac depression

Interaction with b-blockers

35
Q

What are a-blockers?

A

Selective blockers of a1-adrenoceptors that prevent vasoconstrictor action of endogenous
noradrenaline

36
Q

What are the 3 examples of a-blockers?

A

Doxazosin
Terazosin
Prazosin (shorter acting)

37
Q

What are the adverse effects of a1-blockers?

A

Postural hypotension

Possible severe hypotension after first dose

38
Q

What are the 2 b-blockers?

A

Atenolol

Metoprolol

39
Q

What is the action of b-blockers?

A

Bind to and block b1-adrenoceptors in the heart (sino atrial node & ventricular muscle)
Block action of noradrenaline

40
Q

What is the initial effects of b-blockers?

A

Reduce rate and force of heart beat

Decrease cardiac output

41
Q

What is the effect of b-blockers after continued treatment?

A

CO returns to normal but BP remains low (TPR reset at lower level)

42
Q

What are the adverse effects of b-blockers?

A 
Cold hands
Fatigue
Asthma attack
Heart failure
Conduction block in heart
Blood lipids
43
Q

What are the 4 ACE inhibitors?

A

Captopril (2 daily)
Enalapril (O.D)
Lisinopril (lysine analogue of enalapril)
Ramipril

44
Q

What is an ACE inhibitor?

A

Potent vasodilator that prevents conversion of angiotensin I to angiotensin II

45
Q

What do ACE inhibitors stimulate?

A

Aldosterone secretion which inhibits salt and H2O excretion

46
Q

What do ACE inhibitors cause?

A

Vasodilation

Reduced plasma volume

47
Q

What are the adverse effects of ACE inhibitors?

A 
Dry cough
Initial hypotension (esp if given with diuretic)
48
Q

What are the 4 angiotensin II receptor antagonists?

A

Losartan
Candesartan
Eprosartan
Valsartan

49
Q

How do angiotensin II receptor antagonists work?

A

Compete for binding to AT receptors and block the action of AT II

50
Q

What is the first choice antihypertensive?

A

Thiazide

Pharmacology (7 decks)

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