Acei

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Acei

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

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