CARDIOVASCULAR DRUGS http://crisbertcualteros.page.tl
<ul><li>ANTIHYPERTENSIVE DRUGS </li></ul><ul><li>ANTIANGINAL DRUGS </li></ul><ul><li>CONGESTIVE HEART FAILURE DRUGS </li><...
Anti-hypertensive Drugs
HYPERTENSION <ul><li>IDIOPATHIC (ESSENTIAL OR PRIMARY HYPERTENSION </li></ul><ul><li>> 90%  ; 15 – 40 yrs </li></ul><ul><l...
ANTIHYPERTENSIVE DRUGS <ul><li>I . DIURETICS </li></ul><ul><li>II. SYMPATHOPLEGICS BLOCKERS  </li></ul><ul><li>A. ALPHA OR...
ANTIHYPERTENSIV3S <ul><li>III. VASODILATORS </li></ul><ul><li>A. OLDER ORAL VASODILATORS </li></ul><ul><li>B. CALCIUM BLOC...
DIURETICS <ul><li>Initially  ↓  BP & thus CO. Eventually CO returns to normal but is accompanied by a  ↓  in PVR. </li></u...
LOOP DIURETICS <ul><li>FUROSEMIDE (Lasix) </li></ul><ul><li>Inhibits Na+K+2Cl+ symporter </li></ul><ul><li>Inhibits reabso...
LOOP DIURETICS <ul><li>CLINICAL INDICATIONS: </li></ul><ul><li>edema, pulmonary edema </li></ul><ul><li>Hypercalcemia </li...
THIAZIDE DIURETICS <ul><li>HYDROCHLOROTHIAZIDE </li></ul><ul><li>inhibits Na +  Cl +  symporter </li></ul><ul><li>INDAPAMI...
THIAZIDES <ul><li>CLINICAL INDICATIONS </li></ul><ul><li>Hypertension  /  Edema </li></ul><ul><li>Nephrotic diabetes insip...
POTASSIUM SPARING DIURETICS <ul><li>SPIRONOLACTONE </li></ul><ul><li>Aldosteroine antagonist </li></ul><ul><li>Inhibits st...
POTASSIUM SPARING DIURETICS <ul><li>CLINICAL INDICATIONS </li></ul><ul><li>Edema / Hypertension </li></ul><ul><li>Primary ...
PERIPHERAL SYMPATHOLYTICS <ul><li>Decrease PVR &/or CO </li></ul><ul><li>RESERPINE </li></ul><ul><li>GLUANETHIDINE </li></...
PERIPHERAL SYMPATHOLYTICS <ul><li>RESERPINE </li></ul><ul><li>Irreversibly binds to storage vesicles in adrenergic neurons...
Peripheral Sympatholytics <ul><li>GUANETHEDINE </li></ul><ul><li>Enters neurons by norepinephrine reuptake transporter and...
GUANETHIDINE <ul><li>USES:  Severe Hypertension </li></ul><ul><li>ADVERSE EFFECTS </li></ul><ul><li>Orthostatic hypotensio...
Alpha Adrenergic Blockers <ul><li>DOXAZOSIN  (cardura) </li></ul><ul><li>PRAZOSIN  ( minipress) </li></ul><ul><li>TERAZOSI...
Alpha Adrenergic Blockers <ul><li>CLINICAL USES </li></ul><ul><li>HYPERTENSION </li></ul><ul><li>BENIGN PROSTATIC HYPERPLA...
BETA ADRENERGIC BLOCKER <ul><li>PROPRANOLOL ( inderal) </li></ul><ul><li>> non selective </li></ul><ul><li>Antianginal eff...
PROPRANOLOL <ul><li>USES :  </li></ul><ul><li>Angina: stable </li></ul><ul><li>Arrhythmias  Myocardial infarction </li></u...
METOPROLOL <ul><li>Selective beta one </li></ul><ul><li>Antianginal effect </li></ul><ul><li>Antiarrythmic effects </li></...
CENTRAL SYMPATHOLYTICS <ul><li>Decrease PVR by inhibiting sympathetic outflow centrally </li></ul><ul><li>METHYLDOPA </li>...
METHYLDOPA (Aldomet) <ul><li>Prodrug …> methyl norepinephrine which activates alpha adrenergic receptors to inhibits sympa...
CLONIDINE <ul><li>Stimulates alpha two receptors..> inhibits sympathetic outflow </li></ul><ul><li>Antihypertensive effect...
Vasodilators
Mechanism of Action of Vasodilators MECHANISM EXAMPLES Release of nitric oxide from drug or endothelium NItroprusside Hydr...
DIRECT VASODILATORS <ul><li>Directly vasodilating arterioles </li></ul><ul><li>HYDRALAZINE </li></ul><ul><li>MONOXIDIL </l...
DIRECT VASODILATORS <ul><li>HYDRALAZINE ( APROESOLINE) </li></ul><ul><li>arteriolar smooth muscle ,,,>  ↓  PVR </li></ul><...
MINOXIDIL <ul><li>> arteriolar smooth muscle vasodilator </li></ul><ul><li>Increases K efflux by opening K channels …> hyp...
ANGIOTENSIN CONVERTING ENZYMES INHIBITOR  (acei) <ul><li>↓  PVR by  ↓ level pf vaspcpmtroctomg  angiotensin II </li></ul><...
CAPTOPRIL (capoten) <ul><li>Reversibly inhibits angiotensin convering  enzyme ( Kinase III)  preventing the conversion of ...
CAPTOPRIL <ul><li>USES: hypertension </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Scleroderma renal crsisi...
ANGIOTENSIN II RECEPTOR ANTAGONISTS <ul><li>LOSARTAN </li></ul><ul><li>Inhibits  the vasocontrictor & aldosterone secretin...
LOSARTAN <ul><li>USE:  HYPERTENSION </li></ul><ul><li>ADVERSE EFFECTS: </li></ul><ul><li>Headache </li></ul><ul><li>Hypote...
CALCIUM CHANNEL BLOCKERS <ul><li>↓  CALCIUM INFLUX IN VASCULAR SMOOTH MUSCLE &/OR CARDIAC MUSCLE </li></ul><ul><li>Effect ...
NIFEDIPINE <ul><ul><li>↓  Calcium influx…>  Relaxation of araterial smooth muscle &  ↓  PVR </li></ul></ul><ul><ul><li>> r...
DILTIAZEM <ul><li>Binds cardiac L tupe calcium channels *  ↓  SA node automaticity & AV nodal conduction with some  (-) in...
VERAPAMIL <ul><li>MOA  same as diltiazem </li></ul><ul><li>Exhibits mild vasodilatory effects on arterioles </li></ul><ul>...
HYPERTENSIVE EMERGENCIES <ul><li>I. DIAZOXIDE:  </li></ul><ul><li>Activates ATP sensitive K +  channels causing hyperpolar...
SODIUM NITROPRUSSIDE <ul><li>Nitric Oxide>>>> cGMP…> ↓ Ca ions in arteriolar & venous vessels causing vasodilatation..>↓ p...
TRIMETHAPHAN <ul><li>Ganglionic glocking agent which competitively antagonizes postsynaptic acetylcholine receptors </li><...
LABETALOL <ul><li>MIXED ADRENERGIC ANTAGONIST </li></ul><ul><li>WITH INTRINSIC SYMPATHOMIMETIC ACTIVITY </li></ul><ul><li>...
CLINICAL USES OF ANTIHYPERTENSIVE DRUGS <ul><li>A. STEPPED CARE </li></ul><ul><li>B. MONOTHERAPY </li></ul><ul><li>C. AGE ...
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Cardiovascular Drugs

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Cardiovascular Drugs

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  1. 1. CARDIOVASCULAR DRUGS http://crisbertcualteros.page.tl
  2. 2. <ul><li>ANTIHYPERTENSIVE DRUGS </li></ul><ul><li>ANTIANGINAL DRUGS </li></ul><ul><li>CONGESTIVE HEART FAILURE DRUGS </li></ul><ul><li>ANTIARRYTHMIC DRUGS </li></ul><ul><li>DIURETIC DRUGS </li></ul><ul><li>ANTITHROMBOTICS </li></ul><ul><li>ANTIHYPERLIPIDEMICS </li></ul>
  3. 3. Anti-hypertensive Drugs
  4. 4. HYPERTENSION <ul><li>IDIOPATHIC (ESSENTIAL OR PRIMARY HYPERTENSION </li></ul><ul><li>> 90% ; 15 – 40 yrs </li></ul><ul><li>Genetic inheritance </li></ul><ul><li>SECONDARY HYPERTENSION </li></ul><ul><li>Renal artery disease, 1 o aldosteronism, pheochromocytoma, renal parenchymal dse, glom’it is, toxemia of pregnancy </li></ul><ul><li>CNS disorders, estrogen use </li></ul>
  5. 5. ANTIHYPERTENSIVE DRUGS <ul><li>I . DIURETICS </li></ul><ul><li>II. SYMPATHOPLEGICS BLOCKERS </li></ul><ul><li>A. ALPHA OR BETA RECEPTORS </li></ul><ul><li>B. NERVE TERMINALS </li></ul><ul><li>C GANGLIA </li></ul><ul><li>D.CNS SYMPATHETIC OUTFLOW </li></ul>
  6. 6. ANTIHYPERTENSIV3S <ul><li>III. VASODILATORS </li></ul><ul><li>A. OLDER ORAL VASODILATORS </li></ul><ul><li>B. CALCIUM BLOCKERS </li></ul><ul><li>C. [ARENTERAL VASODILATORS </li></ul><ul><li>IV, ANTIOTENSIN ANTAGONISTS </li></ul><ul><li>A. ACE INHIBITORS </li></ul><ul><li>B. RECEPTOR BLOCKERS </li></ul>
  7. 7. DIURETICS <ul><li>Initially ↓ BP & thus CO. Eventually CO returns to normal but is accompanied by a ↓ in PVR. </li></ul><ul><li>LOOP DIURETICS </li></ul><ul><li>THIAZIDES & RELATED DRUGS </li></ul><ul><li>POTASSIUM SPARING DIURETICS </li></ul>
  8. 8. LOOP DIURETICS <ul><li>FUROSEMIDE (Lasix) </li></ul><ul><li>Inhibits Na+K+2Cl+ symporter </li></ul><ul><li>Inhibits reabsorption of Ca+ & Mg+ </li></ul><ul><li>Short t ½ , PO, IV </li></ul><ul><li>BUMETANIDE </li></ul><ul><li>TORSEMIDE </li></ul><ul><li>ETHACYRINIC ACID </li></ul>
  9. 9. LOOP DIURETICS <ul><li>CLINICAL INDICATIONS: </li></ul><ul><li>edema, pulmonary edema </li></ul><ul><li>Hypercalcemia </li></ul><ul><li>Hypertension </li></ul><ul><li>ADVERSE EFFECTS </li></ul><ul><li>Hypokalemic metabolic alkalosis, ↓ Na ↓ Cl </li></ul><ul><li>↓ K ↓ Ca ↓ Mg ↑ Uric Acid ↑ calciuria </li></ul><ul><li>Orthostatic hypotension. Allergic rxs </li></ul><ul><li>Ototoxicity ( ethacrynic acid) </li></ul>
  10. 10. THIAZIDE DIURETICS <ul><li>HYDROCHLOROTHIAZIDE </li></ul><ul><li>inhibits Na + Cl + symporter </li></ul><ul><li>INDAPAMIDE Strongest vasodilator effect) </li></ul><ul><li>CHLORTHALIDONE </li></ul><ul><li>METOLAZONE </li></ul>
  11. 11. THIAZIDES <ul><li>CLINICAL INDICATIONS </li></ul><ul><li>Hypertension / Edema </li></ul><ul><li>Nephrotic diabetes insipidus </li></ul><ul><li>Calcium nephrolitiasis </li></ul><ul><li>ADVERSE EFFECTS </li></ul><ul><li>↓ Na ↓ Cl ↓ K ↓ Ca ↓ Mg </li></ul><ul><li>↑ Uric Acid, ↑sugar ↑ lipids </li></ul><ul><li>Allergic rxa, orthostatic hypotension </li></ul><ul><li>DRUG INTERACTIONS : LITHIUM/ DIGOXIN </li></ul>
  12. 12. POTASSIUM SPARING DIURETICS <ul><li>SPIRONOLACTONE </li></ul><ul><li>Aldosteroine antagonist </li></ul><ul><li>Inhibits steroid biosynthesis, antagonist at androgen receptors </li></ul><ul><li>AMILORIDE/ TRIAMTERENE </li></ul><ul><li>Block sodium channels </li></ul>
  13. 13. POTASSIUM SPARING DIURETICS <ul><li>CLINICAL INDICATIONS </li></ul><ul><li>Edema / Hypertension </li></ul><ul><li>Primary hyperaldosteronism / Hirsutism </li></ul><ul><li>ADVERSE EFFECTS </li></ul><ul><li>↑ K, metabolic acidosis, for spironolactone: gynecomastia, menstrual irreg </li></ul><ul><li>GIT effects: diarrhea, gastritis, GIT bleeding & peptic ulcer </li></ul><ul><li>CNS effects: drowsiness, lethargy, ataxia, confusion & headache </li></ul>
  14. 14. PERIPHERAL SYMPATHOLYTICS <ul><li>Decrease PVR &/or CO </li></ul><ul><li>RESERPINE </li></ul><ul><li>GLUANETHIDINE </li></ul><ul><li>ALPHA 1 ADRENERGIC BLOCKERS </li></ul><ul><li>BETA ADRENERGIC BLOCKERS </li></ul>
  15. 15. PERIPHERAL SYMPATHOLYTICS <ul><li>RESERPINE </li></ul><ul><li>Irreversibly binds to storage vesicles in adrenergic neurons …> ↓ uptake & storage of norepinephrine, dopamine & serotonin both centrally & peripherally </li></ul><ul><li>USES: hypertension/ Huntington’s dse </li></ul><ul><li>ADVERSE EFFECTS: sedation, inability to concentrate, dizziness, loss of appetite, nasal congestion, N & V, dryness of mouth, diarrhea </li></ul><ul><li>Extrapyramidal effect, depression </li></ul>
  16. 16. Peripheral Sympatholytics <ul><li>GUANETHEDINE </li></ul><ul><li>Enters neurons by norepinephrine reuptake transporter and slowly displace norepi in the synaptic vesicles…> blocks the release of norepi normally produced by nerve stimulations </li></ul><ul><li>VASODILATATION (due to deoletion of catecholamines </li></ul><ul><li>Not enter CNS </li></ul><ul><li>Salt & water retention </li></ul>
  17. 17. GUANETHIDINE <ul><li>USES: Severe Hypertension </li></ul><ul><li>ADVERSE EFFECTS </li></ul><ul><li>Orthostatic hypotension, impotence </li></ul><ul><li>Diarrhea </li></ul><ul><li>Bradycardia, weakness </li></ul><ul><li>Peripheral edema </li></ul><ul><li>C I : pheochromocytoma </li></ul>
  18. 18. Alpha Adrenergic Blockers <ul><li>DOXAZOSIN (cardura) </li></ul><ul><li>PRAZOSIN ( minipress) </li></ul><ul><li>TERAZOSIN (Mytrin) </li></ul><ul><li>Antagonist at both arterioles & veins…> ↓ PVR & venous return to the heart </li></ul><ul><li>↓ cardiac preload & afterload with minimal effects on CO & HR </li></ul><ul><li>Relax smooth muscle in the bladder neck & prostate </li></ul><ul><li>↓ plasma lipid & LDL & ↑ HDL </li></ul>
  19. 19. Alpha Adrenergic Blockers <ul><li>CLINICAL USES </li></ul><ul><li>HYPERTENSION </li></ul><ul><li>BENIGN PROSTATIC HYPERPLASIC </li></ul><ul><li>ADVERSE EFFECTS </li></ul><ul><li>First Dose Phenomena </li></ul><ul><li>Dizziness / Headache </li></ul><ul><li>lassiture </li></ul>
  20. 20. BETA ADRENERGIC BLOCKER <ul><li>PROPRANOLOL ( inderal) </li></ul><ul><li>> non selective </li></ul><ul><li>Antianginal effect : negative inotropic & chronotropic effects…> ↓myocardial oxygen demand </li></ul><ul><li>Antiarrythmic (class III) </li></ul><ul><li>Anthypertensive effectsL ↓ CO ↓sympathetic outflow to peripheral vasculature..> ↓ PVR..> inhibition of renin relase by the kidney </li></ul>
  21. 21. PROPRANOLOL <ul><li>USES : </li></ul><ul><li>Angina: stable </li></ul><ul><li>Arrhythmias Myocardial infarction </li></ul><ul><li>Hypertrophic cardiomegaly, </li></ul><ul><li>Hyperthyroidism, pheochromocytoma </li></ul><ul><li>Migraine prophylaxis, stage fright </li></ul><ul><li>ADVERSE EFFECTS: mpotence bronchoconstriction, Arrythmias, CHF or angina (abrupt withdrawal) </li></ul><ul><li>CNS: drowsiness, insomnia, fatique </li></ul><ul><li>Hypoglycemia,, lipidemia, claudication of peripheral vessels </li></ul>
  22. 22. METOPROLOL <ul><li>Selective beta one </li></ul><ul><li>Antianginal effect </li></ul><ul><li>Antiarrythmic effects </li></ul><ul><li>Antihypertensive effects </li></ul><ul><li>USES: hypertension, angina, arrythmias, MI </li></ul><ul><li>ADVERSE EFFECTS: bradycardia, sedation, fatique, bronchospasm, hypoglycemia, hyperlipidemia </li></ul><ul><li>congestive heart failure </li></ul>
  23. 23. CENTRAL SYMPATHOLYTICS <ul><li>Decrease PVR by inhibiting sympathetic outflow centrally </li></ul><ul><li>METHYLDOPA </li></ul><ul><li>CLONIDINE </li></ul>
  24. 24. METHYLDOPA (Aldomet) <ul><li>Prodrug …> methyl norepinephrine which activates alpha adrenergic receptors to inhibits sympathetic outflow </li></ul><ul><li>Antihypertensive effect mediated by a ↓ PVR and ↓ in CO </li></ul><ul><li>Renal blood flow maintained </li></ul><ul><li>USE : hyperetensive </li></ul><ul><li>Adverse effects : edema, drowsiness, dry mouth, hepatotoxicity, + Coombs test </li></ul>
  25. 25. CLONIDINE <ul><li>Stimulates alpha two receptors..> inhibits sympathetic outflow </li></ul><ul><li>Antihypertensive effect: ↓ PVT ↓ CO </li></ul><ul><li>Duration < 8 hrs. PO, IV, transdernal patch </li></ul><ul><li>USE: hypertension </li></ul><ul><li>ADVERSE EFFECTS : Drowsiness, itching & redness of skin, dizziness, constipation, reduced libido, rebound hypertension </li></ul>
  26. 26. Vasodilators
  27. 27. Mechanism of Action of Vasodilators MECHANISM EXAMPLES Release of nitric oxide from drug or endothelium NItroprusside Hydralazine Hyperpolarization of vascular smooth muscle thru opening of K channels NImoxidil Diazepoxide Reudction of Calcium Influx Verapa,o;. Diltiazem Nifedipine Activation of dopamine receptors Fenoldopam
  28. 28. DIRECT VASODILATORS <ul><li>Directly vasodilating arterioles </li></ul><ul><li>HYDRALAZINE </li></ul><ul><li>MONOXIDIL </li></ul>
  29. 29. DIRECT VASODILATORS <ul><li>HYDRALAZINE ( APROESOLINE) </li></ul><ul><li>arteriolar smooth muscle ,,,> ↓ PVR </li></ul><ul><li>↑ renal blood flow </li></ul><ul><li>< 8 hrs ; IV, PO, IM </li></ul><ul><li>USES: hypertension, CHF </li></ul><ul><li>Adverse Effects: headache, nausea, diarrhea, hypotension, palpatation, tachycardia, angina </li></ul><ul><li>Lupus like syndrome, edema </li></ul>
  30. 30. MINOXIDIL <ul><li>> arteriolar smooth muscle vasodilator </li></ul><ul><li>Increases K efflux by opening K channels …> hyperpolarization…> relaxation of smooth muscle </li></ul><ul><li>Vasodilatation…> ↓ PVR </li></ul><ul><li>More potent than hydralozine </li></ul><ul><li>USE : hypertension </li></ul><ul><li>alopecia androgenetica </li></ul><ul><li>Adverse Effects: edema, reflex tachycardia, flushing, hypertrichosis </li></ul>
  31. 31. ANGIOTENSIN CONVERTING ENZYMES INHIBITOR (acei) <ul><li>↓ PVR by ↓ level pf vaspcpmtroctomg angiotensin II </li></ul><ul><li>↓ blood volume by ↓ aldosterone secretion </li></ul><ul><li>CAPTOPRIL </li></ul><ul><li>LISINOPRIL </li></ul><ul><li>ENALAPRIL </li></ul>
  32. 32. CAPTOPRIL (capoten) <ul><li>Reversibly inhibits angiotensin convering enzyme ( Kinase III) preventing the conversion of angiotensin I into the vasocontrictor angiotension II </li></ul><ul><li>↓ AT II levels…> ↓ aldosterone,,,> ↓ Na & H2O retention </li></ul><ul><li>↓ AT II levels…> ↑ renin release & the formation of AT I </li></ul><ul><li>ACEI….. ↑ bradykinin….> ↑ PG synthesis (vasodilators) </li></ul>
  33. 33. CAPTOPRIL <ul><li>USES: hypertension </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Scleroderma renal crsisi </li></ul><ul><li>Diabetic nephropathy </li></ul><ul><li>ADVERSE EFFECTS: dry cough, headache, fatique, hypotension, skin rash, dysgeusia, hyperkalemia, proteinuria </li></ul><ul><li>Acute renal failure </li></ul>
  34. 34. ANGIOTENSIN II RECEPTOR ANTAGONISTS <ul><li>LOSARTAN </li></ul><ul><li>Inhibits the vasocontrictor & aldosterone secreting effects of angiotensin II </li></ul><ul><li>Converted to a 5 carboxylic acid metabolite </li></ul><ul><li>↓ AT II levels,,, > ↓ aldosterone levels,,,> ↓ Na & H2O retention </li></ul><ul><li>Also ↑ renin release & the formation of angintensin 1 </li></ul><ul><li>Possess uricosuric effects </li></ul>
  35. 35. LOSARTAN <ul><li>USE: HYPERTENSION </li></ul><ul><li>ADVERSE EFFECTS: </li></ul><ul><li>Headache </li></ul><ul><li>Hypotension </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Contraindications: pregnancy, fetal exposure >>>hypotension, renal failure, anuria, skull hypoplasia, death </li></ul>
  36. 36. CALCIUM CHANNEL BLOCKERS <ul><li>↓ CALCIUM INFLUX IN VASCULAR SMOOTH MUSCLE &/OR CARDIAC MUSCLE </li></ul><ul><li>Effect on vascular smooth muscle </li></ul><ul><li>Nifedipine > diltiazem > Verapamil </li></ul><ul><li>Effect on cardiac muscle </li></ul><ul><li>Verapamil > Diltiazem > NIfedipine </li></ul>
  37. 37. NIFEDIPINE <ul><ul><li>↓ Calcium influx…> Relaxation of araterial smooth muscle & ↓ PVR </li></ul></ul><ul><ul><li>> reflex ↑ in sympathetic tone which may mask the ( - ) inotropic effect </li></ul></ul><ul><ul><li>Less effect on SA node on SA node, automaticity & AV nodal conduction </li></ul></ul><ul><ul><li>USES: HYPERTENSION/ ANGINA </li></ul></ul><ul><ul><li>ADVERSE EFFECTS: headache, dizziness, peripheral edema, tachycardia, flushing nausea, fatigue, constipation, hypotension </li></ul></ul>
  38. 38. DILTIAZEM <ul><li>Binds cardiac L tupe calcium channels * ↓ SA node automaticity & AV nodal conduction with some (-) inotropic effect on the heart </li></ul><ul><li>mild vasodilatory effects on blood vessels </li></ul><ul><li>USES : Hypertension, Angina, supraventricular arrhythmias </li></ul><ul><li>Adverse Effects : rash, hypotension, CHF, dizziness, flushing, headache </li></ul>
  39. 39. VERAPAMIL <ul><li>MOA same as diltiazem </li></ul><ul><li>Exhibits mild vasodilatory effects on arterioles </li></ul><ul><li>USES: Hypertension, Angina </li></ul><ul><li>supraventricular arrhythmias </li></ul><ul><li>Hypertrophic cardiomyopathy </li></ul><ul><li>ADVERSE EFFECTS: rash, bradycardiak CHF, hypertension, peripheral edema, constipation, dizziness, fatigue, headache </li></ul>
  40. 40. HYPERTENSIVE EMERGENCIES <ul><li>I. DIAZOXIDE: </li></ul><ul><li>Activates ATP sensitive K + channels causing hyperpolarization of arterioles smooth msucle cells,…> arteriolar vasodilatation </li></ul><ul><li>Stimulates reflex sympathetic tone…> ↑ CO, HR, contractility </li></ul><ul><li>USES: Hypertensive Emergensies </li></ul><ul><li>Adverse effects: edema, tachycardia, hyperglycemia </li></ul>
  41. 41. SODIUM NITROPRUSSIDE <ul><li>Nitric Oxide>>>> cGMP…> ↓ Ca ions in arteriolar & venous vessels causing vasodilatation..>↓ preload & afaterload </li></ul><ul><li>USES: hypertensive emergencies, CHF </li></ul><ul><li>Adverse Effects: hypotension, arrhythmias </li></ul><ul><li>Cyanide toxicity, thiocycnate poisoning </li></ul>
  42. 42. TRIMETHAPHAN <ul><li>Ganglionic glocking agent which competitively antagonizes postsynaptic acetylcholine receptors </li></ul><ul><li>↓ both arterial BP & the upslope of the arterial pressure wave in the aorta </li></ul><ul><li>Direct peripheral vasodilatation & release of histamines </li></ul><ul><li>USES: hypertensive emergencies </li></ul><ul><li>ADVERSE EFFECTS: orthostatic hypotension, constipation, urinary retention, blurred vision, dry mouth, impotency </li></ul>
  43. 43. LABETALOL <ul><li>MIXED ADRENERGIC ANTAGONIST </li></ul><ul><li>WITH INTRINSIC SYMPATHOMIMETIC ACTIVITY </li></ul><ul><li>USES: Hypertensive emergensives </li></ul><ul><li>HYPERTENSION </li></ul><ul><li>ADVERSE EFFECTS: </li></ul><ul><li>orthostatic hypotension, dizziness </li></ul>
  44. 44. CLINICAL USES OF ANTIHYPERTENSIVE DRUGS <ul><li>A. STEPPED CARE </li></ul><ul><li>B. MONOTHERAPY </li></ul><ul><li>C. AGE & ETHNICITY </li></ul><ul><li>D. MALIGNANT HYPERTENSION </li></ul>
  45. 45. http://crisbertcualteros.page.tl

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