3-2, Drugs Affecting Blood Pressure – Focus On Antihypertensives

Front 1

defiene hypertension

Back 1

elevated systemic blood pressure

Front 2

what is normotension

Back 2

normal blood pressure range

Front 3

what is the range for systolic and diastolic blood pressure for a normotensive person

Back 3

systolic < 130

diastolic < 85

Front 4

define hypertension

Back 4

abnormally high chronic blood pressure

Front 5

what is the range for systolic and diastolic blood pressure in mild hypertension

Back 5

systolic --> 140-159mmHg

diastolic --> 90-99

Front 6

what is the range for systolic and diastolic blood pressure in very severe hypertension

Back 6

systolic = >210

diastolic= >120

Front 7

what proportion of hypertensive cases are primary

Back 7

90%

Front 8

what are the causes of primary hypertension

Back 8

smoking

diet (esp. salt)

obesity and lack of exercise

genetic factor

Front 9

what proportion of hypertensive cases are secondary

Back 9

<10%

Front 10

what are the causes of secondary hypertension

Back 10

renal hypertension

pheochromocytoma

Front 11

what is pheochromocytoma

Back 11

a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache

Front 12

what are the further conditions which can be caused as a result of hypertension

Back 12

atherosclerosis

stroke
myocardial infarction

heart failure

renal failure

retinopathy (disease of the retina which results in impairment or loss of vision)

Front 13

statistically what is the benefit of reducing blood pressure

Back 13

40% reduction of stroke
25% reduction in myocardial infarction

>50% reduction in heart failure

Front 14

what is the formula for blood pressure

Back 14

there are 2 btw:

BP = CO X SVR

Front 15

what is the equation for Cardiac Output

Back 15

HR x SV

Front 16

what are the 3 different ways that the sympathetic nervous system can be targeted to lower blood pressure

Back 16

can target heart

can target blood vessels

can reduce renin release from kidney

Front 17

what type of receptors are targeted to reduce the effects on the heart and reduce renin release from the kidney?

Back 17

Beta-1

Front 18

what type of receptors are targeted to reduce the effect on blood vessels

Back 18

alpha-1

Front 19

how can the kidney be targeted to lower blood pressure and through what kind of drug can this effect be achieved

Back 19

kidney can reduce blood volume

this can be achieved through the use of diuretics (helps you pee)

Front 20

which hormones can be inhibited to lower blood pressure

Back 20

RAA (renin-angiotensin-aldosterone) system can be inhibited:

1) inhibit ACE (Angiotensin converting enzyme)

2) angiotensin receptor blockers

Front 21

how can arterioles be targeted to lower blood pressure

Back 21

Vasodilatation of peripheral resistance arterioles through Ca2+ channel blockers

Front 22

give 2 examples of adrenoceptor blockers and give their type of beta blocker (1 or 2)

Back 22

propanolol --> B1 and B2

atenolol --> B1

Front 23

what action do b-adrenoceptor blockers have and are they reversible

Back 23

they are competitive reversible antagonists

Front 24

how do b-adrenoceptor blockers work to decrease blood pressure

Back 24

decrease in blood pressure via blockade of b1 sympathetic tone on heart and reduction in renin release from kidney

also decrease in HR SV and CO (all 3 form equation pretty much)

Front 25

what are the adverse side effects to B-adrenoceptor blockers

Back 25

(a) Exacerbate asthma (block of B2–absolute contraindication)

(b) Intolerance to exercise

(c) Hypoglycaemia
(d) Vivid dreams

Front 26

give 2 examples of adrenoceptor blockers and give their type of alpha blocker (1 or 2)

Back 26

phentolamine (a1 and a2)

doxazosin (a1 selective)

Front 27

what action do a-adrenoceptor blockers have and are they reversible

Back 27

same as beta, they are competitive reversible antagonists

Front 28

how do alpha adrenoceptors work to decrease blood pressure

Back 28

they decrease bp by:

-decreasing sympathetic tone in

arterioles (a1)

-decreasing peripheral resistance

Front 29

what are the adverse effects of alpha-adrenoceptor blockers

Back 29

(a) Postural hypotension (loss of sympathetic venoconstriction)

(b) Reflex tachycardia (via baroreceptors)

(reflex tachycardia is when the blood pressure falls and the heart beats faster to try and "fix it")

Front 30

give 2 examples of ACE inhibitors

Back 30

captopril and enalapril

Front 31

where is ACE found and what is its function

Back 31

it is found on the vascular endothelial surface

it converts angiotensin I to active II

Front 32

what is the main characteristic of angiotensin II

Back 32

it is a vasoconstrictor

Front 33

what is the mechanism through which ACE work

Back 33

1) they prevent the formation of Angiotensin II, which is a vasoconstrictor, this means the peripheral resistance falls and bp lowers too

2) Reduced blood volume (loss of angiotensin II- stimulated release of aldosterone, thus reduction of renal reabsorption of Na+ and water)

Front 34

what are the adverse effects of ACE inhibitors

Back 34

Generally very well tolerated but:

(a) Sudden fall in BP on 1st dose

(b) Persistent irritant cough – due to reduced breakdown of bradykinin, a peptide that activates sensory nerves in lung tissue

Front 35

what are the 2 receptor sub-types of angiotensin II receptor blockers

Back 35

AT1 and AT2

Front 36

what do the AT1 Angiotensin II receptor blockers do

Back 36

AT1 receptor mediates vasoconstrictor and

aldosterone-releasing actions of angiotensin II

Front 37

give 2 examples of AT1 blockers

and what type of agents are these drugs

Back 37

Losartan and candesartan

antihypertensive agents

Front 38

do angiotensin II receptor blockers have any side effects

Back 38

no apparent ones nah

Front 39

give an example of a diuretic

Back 39

bendroflumethiazide

Front 40

how do diuretics lower blood pressure

Back 40

they reduce the blood volume

they do this by reduced renal absorption of Na+ and water

(it also has a vasodilator action which may contribute since it lowers peripheral resistance)

Front 41

what are the adverse effects of diuretics

Back 41

they cause a decrease in plasma K+

Front 42

give 3 examples of Calcium channel blockers

Back 42

verapamil, diltiazem and nifedipine

Front 43

when do L-type voltage operated Calcium channels open, and where does this Calcium then enter into following this

Back 43

upon membrane depolarisation

enters into cardiac and vascular smooth muscle

Front 44

what are the different methods of blocking L-type voltage operated Calcium channels

Back 44

1. Open channel block (cork in a bottle!)

2. Allosteric modulation

Front 45

what drugs work by the open channel block mechanism in the L-type voltage operated Calcium Channels

Back 45

verapamil and diltiazem

Front 46

what is the method of action for allosteric modulation in L-type voltage operated Calcium channel blocking

what type of drugs work in this way?

Back 46

bind at allosteric site and reduce channel opening

nifedipine works this way

Front 47

what is the order of tissue selectivity in terms of the drugs nifedipine, dilitiazem and verapamil in relation to smooth and cardiac muscle

Back 47

Smooth muscle: nifedipine > diltiazem > verapamil

Cardiac muscle: verapamil > diltiazem > nifedipine

Front 48

how do Calcium channel blockers lower blood pressure

Back 48

Reducing peripheral resistance (block of Ca2+ entry into vascular smooth muscle --> vasodilatation)

Reducing cardiac output (block of Ca2+ entry into cardiac muscle - heart rate (HR) and stroke volume (SV) both reduced)

Front 49

what are the potential adverse effects of calcium channel blockers

Back 49

(a) Headache
(b) Constipation

(c) Cardiac dysrhythmias (negative chronotropic effect and slowed conduction)

Front 50

if a person is aged 55 or under, what is the first drug to put them on

Back 50

ACE inhibitor or low cost angiotensin II receptor blocker

Front 51

if a person is aged 55 or older or they are of african or Caribbean origin, what is the first drug they should be put on according to SIGN guidelines

Back 51

Calcium channel blocker

Front 52

As part of "step 1" a patient should be put on ACE/ angiotensin II receptor blocker if they are under the age of 55, and on a Calcium channel blocker if they are over the age of 55 or of African/Caribbean origin, what is step 2

Back 52

they should be put on ACE/angiotensin II receptor blocker as well as a calcium channel blocker

Front 53

As part of "step 1" a patient should be put on ACE/ angiotensin II receptor blocker if they are under the age of 55, and on a Calcium channel blocker if they are over the age of 55 or of African/Caribbean origin. In step 2 they would be put on both of these, what is step 3?

Back 53

they should be put on ACE/angiotensin II receptor blocker as well as a calcium channel blocker and also a thiazide-like diuretic

Front 54

As part of "step 1" a patient should be put on ACE/ angiotensin II receptor blocker if they are under the age of 55, and on a Calcium channel blocker if they are over the age of 55 or of African/Caribbean origin. In step 2 they would be put on both of these, in step 3 they are put on both of these as well as a thiazide-like diuretic, what is step 4 known as and what are the steps undertaken in step 4?

Back 54

they should be put on ACE/angiotensin II receptor blocker as well as a calcium channel blocker and also a thiazide-like diuretic. Lastly they should also consider an alpha or beta blocker

they should also consider seeking expert advice