Lectures 10 and 11: Hypertension

Question 1

Define hypertension.

Answer 1

Persistently higher than normal blood pressure

Question 2

When should hypertension be treated?

Answer 2

When mean BP > 150/95mmHg

Question 3

What is the equation for BP?

Answer 3

BP = CO x TPR

Question 4

What is the equation for CO?

Answer 4

CO = SV x HR

Question 5

What regulates SV?

Answer 5

Ventricles

Question 6

What regulates the HR?

Answer 6

SA node

Question 7

Where are baroreceptors found?

Answer 7

Kidneys, carotid arteries, arch of aorta

Question 8

What signals are received by medulla?

Answer 8

Vagus and glossopharengeal

Question 9

What receptors in the heart does the sympathetic system act on?

Answer 9

beta1

Increases cAMP and calcium to increase rate and force of contraction

Question 10

What receptors in the heart does the parasympathetic system act on?

Answer 10

M2 receptors

Decrease cAMP levels

Question 11

What receptors in the periphery does the sympathetic system act on?

Answer 11

NA –> alpha 1 –> IP3 –> Ca2+ –> constriction

A –> beta 2 –> cAMP –> relaxation

Question 12

What effects does Ang2 have?

Answer 12

Increases sympathetic activity

Increases salt and water retention

Increases aldosterone

Increases ADH

Arteriolar vasoconstriction

Question 13

What is AT1R the receptor for?

Answer 13

Angiotensin 2

Question 14

How does aldosterone work?

Answer 14

Binds cytoplasmic receptors which binds to the nucleus to increase expression of Na channels

Question 15

What would be the drug of choice for someone under the age of 55 suffering from hypertension?

Answer 15

ACE inhibitor or angiotensin receptor blocker

Question 16

What would be the drug of choice for someone over the age of 55 suffering from hypertension?

Answer 16

Calcium channel blocker

Question 17

What would be the drug of choice for a Black African/American suffering from hypertension?

Answer 17

Calcium channel blocker

Question 18

What are the 5 classes of anti-hypertensives?

Answer 18

ACE inhibitors and angiotensin receptor blockers

Calcium channel blockers

Diuretics

Beta blockers

Vasodilators

Question 19

What are the side effects of ACE inhibitors?

Answer 19

Dry cough
1st dose hypotension
Renal impairment
Hyperkalaemia

Question 20

What kind of drug is ramipril?

Answer 20

ACE inhibitor

Question 21

Name an ACE inhibitor.

Answer 21

Ramipril

Question 22

What kind of drug is losartan?

Answer 22

Angiotensin receptor blocker (ARB)

Question 23

Name an ARB.

Answer 23

Losartan

Question 24

What kind of drug is Spironolactone?

Answer 24

Aldosterone antagonist

Question 25

What kind of drug is amlodipine?

Answer 25

Dihydropyridine (CCB)

Question 26

Name a dihydropyridine.

Answer 26

Amlodipine

Question 27

Name a phenylalkylamine.

Answer 27

Verapamil

Question 28

Name a benzothiazepine.

Answer 28

Diltiazem

Question 29

What are the three main classes of calcium channel antagonist?

Answer 29

Dihydropyridines Phenylalkylamines Benzothiazepines

Question 30

What kind of drug is verapamil?

Answer 30

Phenylalkylamine (CCB)

Question 31

What kind of drug is Diltiazem?

Answer 31

Benzothiazepine (CCB)

Question 32

What are the side effects of CCBs?

Answer 32

Peripheral oedema | Flushing and headaches

Question 33

What protein metabolises CCBs in the liver?

Answer 33

CYP3A4

Question 34

What kind of drug is indapamide?

Answer 34

Thiazide (thiazide-like) diuretic

Question 35

How does indapamide work as a diuretic?

Answer 35

Opens kATP allowing K to flow out of cell - hyperpolarises smooth muscle cells - Ca channels never activated to open -relaxation/dilation of the arteriole

Question 36

Name a thiazide (thiazide-like) diuretic.

Answer 36

Indapamide

Question 37

What are the side effects of diuretics?

Answer 37

Hypokalaemia Increased urate Increased glucose Increased blood lipids

Question 38

What condition may make diuretics contraindicated?

Answer 38

Diabetes

Question 39

What are the side effects of beta blockers?

Answer 39

Fatigue Vaso/bronchoconstriction Hypoglycaemia

Question 40

Name a selective b1 antagonist.

Answer 40

Bisprolol

Question 41

Name a non-selective (B1 and B2) beta blocker.

Answer 41

Propranolol

Question 42

Name a vasodilator.

Answer 42

Doxazosin