Drugs you need to know, easy to remember

1. HYPERTENSION &
ANTI-HYPERTENSIVE DRUGS
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2. What is hypertension ?
› Blood pressure is the force of blood pushing against the wall of the
arteries as your heart pumps out blood into the arteries. Its level varies
with age, sex, level of physical activity and emotional changes.
› Hypertension refers to the sustained elevation of blood pressure above
normal range. According to the World Health Organization,
“hypertension” is defined as systolic/diastolic pressure persistently
higher than 140/90mmHg.
› Risk factors for hypertension include increasing age, family history,
overweight and smoking. Sometimes, high blood pressure may also be
caused by certain medications or underlying diseases such as kidney or
endocrine diseases.
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4. What Is "Normal" Blood Pressure?
› A blood pressure reading is written like this: 120/80. It's read
as "120 over 80." The top number is called the systolic, and
bottom number is called the diastolic. The ranges are:
a. Normal: Less than 120 over 80 (120/80)
b. Elevated: 120-129/less than 80
c. Stage 1 high blood pressure: 130-139/80-89
d. Stage 2 high blood pressure: 140 and above/90 and above
e. Hypertension crisis: higher than 180/higher than 120.
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5. REGULATION OF BLOOD PRESSURE
› Blood pressure is maintained by Renin angiotension
aldosterone system “RAAS”.
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6. RAAS - events
1. When Blood pressure drops
2. Afferent arterioles in the kidneys releases Renin by detecting the blood
pressure through the baroreceptors.
3. Liver produces a protein “ANGIOTENSINOGEN”
4. Renin acts on angiotensinogen and converts it into Angiotensin I
5. Angiotensin I is converted into Angiotensin II by ACE in lungs
6. Angiotensin II acts on adrenal gland and releases “ALDOSTERONE”.
7. ALDOSTERONE works on collecting duct of nephrons causing retention
of H2o & sodium.
8. Blood pressure is increased.
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7. ANTI- HYPERTENSIVE DRUGS
› A variety of blood pressure lowering medicines (antihypertensive drugs)
is available in the market.
› Your doctor will use the most appropriate drug or a combination of drugs
after considering their risks and benefits. Good blood pressure control is
important for preventing cardiovascular or cerebrovascular events.
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8. The BIG FOUR classes of drugs, the most
common and the 1st line drugs for HTN.
1. ACE inhibitors
2. ARBs
3. Thiazide type diuretics
4. CCB
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9. 1.Angiotensin converting enzyme [ACE]
› MOA - Blocks the conversion of angiotensin I into angiotensin
II which is a potent vasoconstrictor
› Suffix - “Pril” for ex. Lisinopril, Enalapril, captopril.
› Brand name – cipril, lipril, enace, Enam, enapril.
› Good for kidneys.
› Unique side effect is “coughing”.
› Cannot be used with ARBs.
› Not allowed in pregnancy.
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10. 2. Angiotensin receptors blockers [ARBs]
› MOA – Blocks the receptors of angiotensin II.
› Suffix – “Sartan” for ex. Losartan potassium, Telmisartan.
› Brand name – telma , alsartan 50mg, angizaar, locard, arbitel,
cresar, ozotel
› Causes NO cough.
› Cannot be used with ACE inhibitors.
› Contraindicated in pregnancy.
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11. 3. Thiazide type diuretics
› MOA – prevents sodium reabsorption in the kidneys,
increasing urinary excretion of Na and lowering the amount of
sodium in the body thus lowering the blood pressure.
› Not with the kidney disease.
› Messes with other electrolytes.
› For eg. HCTZ [hydrochlorothiazide], Diuretics.
› Brand name – Hydride, Hytide, Hydropril.
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12. 4.Calcium channel blockers
› MOA – Prevents calcium from entering the cells of the Heart &
reduces the electrical conduction [conduction system of heart]
› There are 2 types of CCB:- DHP & Non-DHP.
› Calcium channel blockers (CCBs) are drugs that bind to and block L-
type calcium channels, which are the predominant calcium
channels in the Myocardium and vascular smooth muscles.
› CCBs are classified into two major groups according to the main
site of action: Dihydropyridines (e.g., Nifedipine, Amlodipine) are
potent vasodilators, and Non-Dihydropyridines (e.g, Verapamil,
diltiazem) are potent myocardial depressants.
.
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14. 4a.Dihydropyridines
› Suffix – “Pine”
› Side effect: causes peripheral edema
› Focus is to maintain blood pressure
› For eg. Amlodipine, nifedipine, clinidipine.
› Brand name – Amdepin, Amlodec, Amlogard, Amlong,Cilacar,
Depin, Nifelat.
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15. 4b.Non-Dihydropyridines
› More central conduction based.
› Focus is HR & arrhythmia control but still for hypertension
control.
› For eg. Diltiazem, verapamil.
› Brand name – Calaptin, Dilgard, Dilzem SR
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16. 5.Beta blockers
› MOA – blocks the receptors of beta 1 & beta 2 at various
degrees.
› This affects various combination of vasodilatation.
› Reduces the heart rate & controls heart rate contraction.
› Suffix – “LOL” for eg. Atenolol, metaprolol, propranolol
› Slows everything down [heart rate, rhythm of contraction]
› Typically used in other heart conditions along with blood
pressure.
› Brand name – Metolar 12.5 mg, Atecard 25 mg, Atenex,
Embeta XR, Lopresor, Metapro XL.
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18. 6. Other diuretics ( k-sparing & loop diuretics)
a) k- sparing
› MOA – potassium sparing acts on the distal renal tubules as a
competitive antagonist of the aldosterone. It increases the
excretion of sodium chloride and water while conserving
potassium and hydrogen ions.
› For eg- spironolactone
› Used for odema, HTN, hyperaldosteronism, CHF also controls
blood pressure.
› Blocks aldosterone and androgen.
› Brand name – spirolac, spilac.
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19. b)Loop diuretics
› MOA - loop diuretics such as frusemide Lasix inhibits the
reabsorption of sodium and chloride mainly in the medullary
portion of the ascending loop of henle.
› For eg. Frusemide Lasix, Torasemide
› Used for oedema, HTN.
› Brand name – Lasix, urised
**Commonly these two diuretic are sold in combination of
spironolactone+frusemide and brand name for this is Dytor ,
Dytor plus, Amifru S, Fruselac, Lasilactone.
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21. 7.Alpha blockers
› MOA – blocks alpha 1 adrenergic receptors which causes
relaxation of smooth muscles in the bladder neck and
prostate, resulting in improved urine flow.
› Indications – benign prostatic hyperplasia
› Blocks alpha – 1 receptors which causes vasodilatation
› Not recommended for BP
› Suffix – “Zosin”
› For eg. Alfuzosin, doxazosin, terazosin
› Brand name – Alfoo 10, minipress XL, prazopress
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