Pharma 10.2 - Hypertension Flashcards Preview

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Flashcards in Pharma 10.2 - Hypertension Deck (15):
1

What 2 mechanisms detect changes in blood pressure? How does each mechanism exert it's effect on blood pressure?

Baroreceptors detect changes in blood pressure and cause the autonomic nervous system to affect peripheral vasodilation. Macula dense cells in the juxtaglomerular apparatus detect changes in renal perfusion and both cause the RAS to affect vasodilation and sodium reabsorption, and cause a change in urinary output.

2

How does high blood pressure cause organ damage?

High blood pressure causes smooth muscle hypertrophy in arteries leading to decreased arterial compliance. This hardening makes retries more vulnerable to narrowing, atherosclerosis and thrombosis leading to decreased perfusion on the target organ.

3

What are the 2 types of hypertension? How do you distinguish between them?

Primary - no single evident cause. Secondary - a discrete, identifiable underlying cause.

4

What are the minimum systolic and diastolic BP values for mild, moderate, and severe hypertension?

Mild - 140/90 Moderate - 160/100 Severe - 180/110

5

What are the 1st line therapies for hypertension?

 

ACEIs/angiotensin receptor blockers.

Ca2+ channel blockers.

Diuretics.

6

Name 2 ACEIs.

What is their mechanism of action?

4 indications?

2 contraindications?

4 ADRs?

Lisinopril, ramipril.

MoA - preventint the conversion of angiotensin I into angiotensin II, and also potentiating the action of bradykinin.

Indications - HF, LV dysfunction, MI, T1DM, nephropathy.

Contraindications - Pregnancy, renovascular HTN

ADRs - Dry cough, angio-oedema, renal failure, hyperkalaemia.

 

7

Name 2 angiotensin receptor blockers.

What is their mechanism of action?

2 indications?

2 contraindication?

2 ADRs?

Losartan, valsartan.

MoA - Binding to angiotensin receptors preventing vasoconstriction and aldosterone stimulation.

Indications - ACEi intolerance, HTN with left ventricular hypertrophy, T2DM.

Contraindications - Pregnancy, renovascular HTN.

ADRs - Renal failure, hyperkalaemia.

8

Name 3 types of Ca2+ channel blockers with one example of each.

 

Dihydropyridines (Amlodipine) 

Benzothiazepines (Diltiazem)

Phenylalkylamines (Verapamil)

9

Name 1 dihydropyridine Ca2+ channel blocker.

What is their mechanism of action?

2 indications?

6 ADRs?

Amlodipine.

MoA - Vasodialation of peripheral, coronary, and pulmonary arteries (not veins). Baroreflex mediated tachycardia.

Inidcations - Elderly, isolated systolic hypertension.

ADRs - Sympathic nervous system activation (tachycardia/palpitations), flushing, sweating, headache, oedema, gingival hyperplasia.

10

Name 2 rate limiting Ca2+ channel blocker.

What is their mechanism of action?

1 indication?

2 contraindications?

4 ADRs?

Verapamil, diltiazem.

MoA - Impedes Ca2+ transport across myocardial and vascular smooth muscle membranes prolonging refactory periods and increasing peripheral vasodialation.

Indications - Angina

Contraindications - Heart failure, heart block.

ADRs - Bradycardia, negative ionotrope.

11

Name 1 thiazide-like diuretics.

What is their mechanism of action?

3 indications?

2 contraindications?

4 ADRs?

Bendroflumethiazide.

MoA - Sustained reduction of distal tubular reabsorbtion.

Indications - Elderly, isolated systolic HTN, HF

Contraindications - Gout

ADRs - Hypokalaemia, increases urea/uric acid, impaires glucose tolerance, increases cholesterol, activates RAAS.

12

Name 2 beta blockers.

What is their mechanism of action?

2 indications?

3 contraindications?

5 ADRs?

Atenolol, bisoprolol.

MoA - Reduce HR, cardica output, and renin release.

Indications - MI, angina.

Contraindication - Asthma, COPD, heart block.

ADRs - Lethargy, reduced exercise tolerance, bradycardia, Raynaud's, impared glucose tolerance.

13

Name 1 alpha blockers.

What is their mechanism of action?

1 indications?

1 contraindications?

4 ADRs?

Doxasosin

MoA - Antagonises post synaptic a1 adrenoceptors previnting vascular smooth muscle contraction, reducing peripheral resistance.

Indication - Benign prostatic hyperplasia.

Contraindications - Urinary incontenance.

ADRs - Postural HTN, dizziness, headache, oedema.

14

What is the name of the rare adrenaline (and other substance) secreting tumour often found in the adrenal gland?

How are its symptoms managed?

Phaeochromocytoma.

Phenoxybenzamine (powerful alpha antagonist).

15

What 2 conditions are included under primary hyperaldosteronism?

What is the pathogenesis of the condition?

How would you treat 

Conn's syndrome, bilateral adrenal hyperplasia.

Excess aldosterone secretion causing renin supression and HTN.

Treatment - aldosterone antagonists (spironolactone, eplerenone)