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Acei
 

Acei

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    Acei Acei Presentation Transcript

    • ACEI
    • Captopril
    • Actions
      • Hypotension
      • Both systolic and diastolic BP falls
      • No postural hypotension
      • No sympathetic stimulation
      • RBF is not compramised even when thr is hypotension-due to greater dialatation of renal vessels
      • Lowering of BP depends on
      • Na status
      • RAS activity
      • Greater fall in BP –in renovascular,accelerated and malignant hypertension
    • Essential Hypertension
      • 20% RAS over active
      • 60% RAS normal
      • 20% RAS hypoactive
      • Thus useful in 60% cases
      • Fall in BP is due to decrease in TPR
      • Arterioles dilate
      • Compliance of large arteries increase
      • ---leads to fall in SBP and DBP
      • No effect on COP
      • Low effect on veins---no postural hypotension
      • Reflex symapathetic stimulation won’t occur despite vasodilatation
      • Safe in patients with IHD
      • RBF is not compramised even when thr is hypotension-due to greater dialatation of renal vessels
      • Reflex changes in aldosterone is abolished
    • ADR
      • Hypotension
      • Hyperkalemia
      • Cough
      • Hypersensitve reaction
      • Angioedema
      • Dysgeusia
      • Foetopathic
      • Granulocytopenia
      • Acute renal failure
    • USE of ACEI
      • Hypertension
      • CHF
      • MI
      • Px CV risk
      • Diabetic nephropathy
      • Nondiabetic nephropathy
      • Scleroderma crisis
    • Hypertension
      • First line drug in all forms of hypertension
      • 50% responds to monotherapy
      • Rest with diuretic/ beta blockers
      • Effect develops after 2-3 weeks
    • ADV as anti Hypertensives
      • No postural hypotension,electrolyte disturbances,feeling of weakness
      • Safe in asthmatics,diabetes,PVD
      • Reduce incidence of Type 2 DM
      • Prevention of secondary hyper aldosteronism and K loss due to diuresis
      • Renal blood flow os well maintained
      • Reverse left ventricular hypertrophy and the increasd wall to lumen ratio of blood vessels that occur in hypertensive people
      • No hyperuricaemia
      • No effect on lipid profile
      • No rebound hypertension on withdrawel
      • Suitable for diabetic hypertensive,renovascular and resistant hypertension
    • CHF
      • Reduce after load and preload
      • Inc strokle voluma,COP
      • Reduced HR
      • Loss of accumulated salt and water—improved renal perfusion
      • Withdrawel of A-2 mediated ventricular hypertrophy,remodelling,accelerated myocyte apoptosis and fibrosis
      • Indirect—sympathetic inactivation
    • MI
      • More if effect if associated with hytpertension and dibetes
    • Diabetic nephropathy
      • Delay end stage renal disease in type 1 and 2
      • Stables albuminuria
      • More creatine clearance
      • Reduce abnormal mesangial cell proliferation
      • Reduce intra glomerular pressure and hyperfiltration
      • Reduce all micro and macro cascular complications caused by RAS
    • Losarten Competitive antagonist and inverse agonist of A-2
    • Adv over ACEI
      • No degradation of bradykinin---no cough
      • Alternative pathway of A2 activation is also inhibted