lecture 06

Question 1

Treatment goal of hypertension

Answer 1

acheiving and maintaining pb of <140/<90

Question 2

How to minimise organ damage in terms of blood pressure

Answer 2

better control of bp = less damage to organs

Question 3

non pharmacological treatment of hypertension

Answer 3

lifestyle modification: including weight reduction, ohysical exercise, dash diet, lowered alcohol consumption

Question 4

Pharmacological treatment of hypertension

Answer 4

first line - ACEi/ARB or calcium channel blocker
thiazide like diuretics can be used if heart failure

Question 5

whats a sympatholytic

Answer 5

drugs which oppose the downstream effects of postganglionic nerve firing in effectors innervated by the SNS. eg propanolol

Question 6

which high risk comorbid conditions should a diuretic not be used in

Answer 6

post MI or CKD

Question 7

which high risk comorbid conditions should a Beta blocker not be used in

Answer 7

CKD and recurrent strokes

Question 8

which high risk comorbid conditions should a ARB not be used in

Answer 8

post MI, CAD , recurrent strokes

Question 9

which high risk comorbid conditions should a CCB not be used in

Answer 9

Heart failure, post MI, CKD, recurrent strokes

Question 10

which high risk comorbid conditions should Aldosterone antagonists not be used in

Answer 10

CAD, diabetes, CKD, recurrent stroke

Question 11

loop Diuretic examples

Answer 11

furosemide

Question 12

what do all diuretics do

Answer 12

indirectly prevent re- absorption of water in kidneys.

Question 13

how do loop diuretics work

Answer 13

act at the thick segment of ascending limb of loop of henle and inhibit the sodium potassium chloride co transporter by binding to the chloride active site, blocking its activity

Question 14

Biggest problem with loop diuretics

Answer 14

hypokalaemia ( lack of potassium )

Question 15

what symptoms come with hypokalalaemia

Answer 15

fatigue, muscle spasms, if life threatening - arrhythmias

Question 16

Thiazide diuretic examples

Answer 16

bendroflumethiazide

Question 17

how do thiazide diuretics work

Answer 17

work on the distal convoluted tubule and inhibtit the sodium chloride transporter. Used most commonly but less efficacious than loop diuretics in the production of urine/sodium loss.

Question 18

how much sodium is reabsorbed using a thiazide diuretic

Answer 18

only around 5%

Question 19

potassium sparing diuretic examples

Answer 19

spironolactone, eplerenone

Question 20

how do potassium Sparing diuretics work

Answer 20

they inhibit the sodium sodium channel on the distal convoluted tubule

Question 21

potassium sparing diuretics are also what kind of antagonists

Answer 21

aldosterone

Question 22

what 2 diuretics are commonly given together

Answer 22

loop diuretics and potassium sparing - this optimises their effect whilst reducing likelihood of hypokalaemia

Question 23

Thiazide like diuretics examples

Answer 23

indapamide

Question 24

how do thiazide like diuretics work

Answer 24

they dont have the benxothiadiazine molecular structure but have similar mechanisms - they have a longer duration of action and effectiveness in renal impairment

Question 25

Drugs used for the inhibition of renin

Answer 25

beta 1 antagonists

Question 26

ACE inhibitors examples

Answer 26

ramapril, lisinopril , enalapril

Question 27

where do ace inhibitors work

Answer 27

primarily in the lungs

Question 28

ACE inhibitor is short for what

Answer 28

angiotensin converting enzyme inhibitor - stops the conversion of angiotensin 1 to angiotensin 2

Question 29

what is the effect of angiotensin 2

Answer 29

it causes vasoconstriction of arterioles and reabsorption of sodium in kidneys, it also reduces the production of aldosterone = increased blood volume, lowered peripheral vasular resistance and ultimately reduces blood pressure blood pressure

Question 30

why are ACEi beneficial in heart failure

Answer 30

reduces aldosterone levels -> promotion of sodium and water excretion, This helps to reduce venous return which is beneficial in heart failure

Question 31

issue with ACE inhibitors

Answer 31

they increase the amount of bradykinin - which causes vasodialation but can also cause a chronic dry cough. rarely it can also cause angiodema ( deep tissue swelling)

Question 32

ARB examples

Answer 32

losartan, valsartan, candesartan

Question 33

ARB stands for

Answer 33

angiotensin 2 receptor blockers

Question 34

how do ARB work

Answer 34

they block the action of angotensin 2 on the AT1 receptors - this causes the same effects as an ACEi

Question 35

Aldosterone anagonists examples

Answer 35

spironolactone, eplerenone

Question 36

how do aldosterone antagonists work

Answer 36

bind to aldosterone receptor to promote sodium and water eccretion in the collecting tubule

Question 37

sympatholytic meaning

Answer 37

drugs which act on the nervous system

Question 38

examples of sympatholytics used to treat hypertension

Answer 38

beta blockers, alpha 1 blockers , alpha 2 agonists, adrenergic neuron blockers

Question 39

beta adrenergic blockers are used when

Answer 39

important in treating hypertension in heart failure.

Question 40

blocking beta 1 receptors in juxtaglomerular cells of the kidneys does what

Answer 40

reduces renin release , leading to reduction of RAAS mediated vasoconstriction ( by ag2) and volume expansion ( by aldosterone)

Question 41

blocking of cardiac beta 1 receptors leads to

Answer 41

reduces heart rate and contractility - leading to reduced cardiac output which improves efficiency

Question 42

what medication can suppress the reflex tachycardia caused by vasodilators

Answer 42

beta 1 antagonists

Question 43

if a beta blocker is a partial agonist they are said to have ___

Answer 43

intrinsic sympathomimetic activity

Question 44

describe a cardioselective beta blocker

Answer 44

more affinity for beta 1 than beta 2

Question 45

dihydropyridine calcium channel blocker example

Answer 45

nifedipine , amlodipine

Question 46

dihydropyridines mode of action

Answer 46

block calcium channels in arterioles to dilate peripheral vessels - reducing blood pressure, and dilate coronary arteries - increasing coronary perfusion. they dont block cardiac calcium channels. They have reflex effects: lowering bp increases baroreceptor reflex which stimulates medulla to increase SNS firing which increases hr and contractility. this isnt desirable in someone with heart disease

Question 47

non dihydropyridines example

Answer 47

verapamil, diltiaxem

Question 48

how do non dihydropyridines work

Answer 48

reduce the TPvR and also act on the heart to slow conduction and decrease contractility. They block calcium channels in arteroles of heart to dilate peripheral vessels, coronary arteries they also block SA node which decreases the hr and block the AV bode to reduce nodal conduction. Also block myocardium which reduces contractile force