This document discusses antihypertensive drugs. It begins by classifying drugs into different groups including diuretics, beta blockers, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha blockers, centrally acting alpha-2 agonists, and direct vasodilators. It then proceeds to describe the mechanisms of action, pharmacokinetics, indications, contraindications and side effects of drugs within each group. The document concludes by discussing treatment algorithms for hypertension based on JNC 7 guidelines and recommendations for treating hypertensive crises.
This document provides an overview of various classes of antihypertensive drugs, including their mechanisms of action and side effects. It discusses ACE inhibitors, ARBs, beta blockers, calcium channel blockers, alpha blockers, central sympatholytics, vasodilators, and combination drugs. The classes are described along with examples of common drugs within each class. Mechanisms involve inhibiting the renin-angiotensin-aldosterone system, blocking adrenoreceptors, or relaxing smooth muscle. Side effects include cough, hypotension, fatigue, sexual dysfunction, and fluid retention depending on the specific drug. Factors like comorbidities and costs help determine which antihypertensive is suitable for an individual patient.
Basic must know things about Anti Hypertensive drugs including the recent JNC-8 classification and protocols for treating Hypertension with various co-morbid condition.
This document summarizes various cardiovascular drugs used to treat conditions like hypertension, angina, myocardial infarction, shock, and congestive heart failure. It discusses classes of drugs like beta-blockers, ACE inhibitors, calcium channel blockers, vasodilators, and cardiac glycosides. For each drug class, it describes the mechanisms of action, common drugs, clinical uses, contraindications, side effects, and nursing considerations for administration and patient education.
This document discusses various drugs used to treat cardiovascular conditions like heart failure and hypertension. It covers different classes of drugs like cardiotonics, antianginals, and antihypertensives. Cardiotonics like digoxin and milrinone work by increasing calcium levels in heart muscle to boost contraction and output. Antianginal drugs like nitrates, beta-blockers, and calcium channel blockers aim to restore the heart's oxygen supply-demand balance. Antihypertensive drug classes discussed are diuretics, adrenergic inhibitors, angiotensin inhibitors, and direct vasodilators. Specific drugs, their mechanisms, indications, dosages and nursing considerations are provided for each class.
Here are the key points of management:
1. Hospital admission and IV access is needed given the hypertensive emergency presentation with severe hypertension and papilledema.
2. Sodium nitroprusside infusion is started at a low dose and titrated up slowly to reach the target BP of 160/100-110 mmHg, with no more than a 25% reduction within 2 hours.
3. Alternatively, enalaprilat can be given in divided doses not exceeding 5mg total over several hours to gradually lower the BP within the target range.
Close monitoring is required given the emergency presentation until BP is stabilized. The goal is to lower BP gradually to avoid rebound hypertension but do so promptly given the
This document provides an overview of antihypertensive agents (blood pressure medications). It discusses the types and classes of antihypertensives, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and alpha blockers. It describes the mechanisms of action, therapeutic uses, and potential side effects of each class. The document is intended to teach healthcare providers about selecting and utilizing different antihypertensive drugs to treat hypertension.
1. ACE inhibitors work by inhibiting the angiotensin converting enzyme and reducing angiotensin II levels, leading to vasodilation and sodium excretion.
2. Common ACE inhibitors include lisinopril, enalapril, ramipril, and benazepril. They are used to treat hypertension, heart failure, myocardial infarction, and diabetic nephropathy.
3. Potential side effects include dry cough, hypotension, hyperkalemia, angioedema, and renal dysfunction. ACE inhibitors can also cause fetal harm during pregnancy.
This document summarizes various classes of cardiovascular drugs used to treat conditions like hypertension, angina, myocardial infarction, shock, and arrhythmias. It describes the mechanisms of action, common drugs, indications, contraindications, side effects, and nursing considerations for beta-blockers, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, and other antihypertensive drugs.
This document provides an overview of various classes of antihypertensive drugs, including their mechanisms of action and side effects. It discusses ACE inhibitors, ARBs, beta blockers, calcium channel blockers, alpha blockers, central sympatholytics, vasodilators, and combination drugs. The classes are described along with examples of common drugs within each class. Mechanisms involve inhibiting the renin-angiotensin-aldosterone system, blocking adrenoreceptors, or relaxing smooth muscle. Side effects include cough, hypotension, fatigue, sexual dysfunction, and fluid retention depending on the specific drug. Factors like comorbidities and costs help determine which antihypertensive is suitable for an individual patient.
Basic must know things about Anti Hypertensive drugs including the recent JNC-8 classification and protocols for treating Hypertension with various co-morbid condition.
This document summarizes various cardiovascular drugs used to treat conditions like hypertension, angina, myocardial infarction, shock, and congestive heart failure. It discusses classes of drugs like beta-blockers, ACE inhibitors, calcium channel blockers, vasodilators, and cardiac glycosides. For each drug class, it describes the mechanisms of action, common drugs, clinical uses, contraindications, side effects, and nursing considerations for administration and patient education.
This document discusses various drugs used to treat cardiovascular conditions like heart failure and hypertension. It covers different classes of drugs like cardiotonics, antianginals, and antihypertensives. Cardiotonics like digoxin and milrinone work by increasing calcium levels in heart muscle to boost contraction and output. Antianginal drugs like nitrates, beta-blockers, and calcium channel blockers aim to restore the heart's oxygen supply-demand balance. Antihypertensive drug classes discussed are diuretics, adrenergic inhibitors, angiotensin inhibitors, and direct vasodilators. Specific drugs, their mechanisms, indications, dosages and nursing considerations are provided for each class.
Here are the key points of management:
1. Hospital admission and IV access is needed given the hypertensive emergency presentation with severe hypertension and papilledema.
2. Sodium nitroprusside infusion is started at a low dose and titrated up slowly to reach the target BP of 160/100-110 mmHg, with no more than a 25% reduction within 2 hours.
3. Alternatively, enalaprilat can be given in divided doses not exceeding 5mg total over several hours to gradually lower the BP within the target range.
Close monitoring is required given the emergency presentation until BP is stabilized. The goal is to lower BP gradually to avoid rebound hypertension but do so promptly given the
This document provides an overview of antihypertensive agents (blood pressure medications). It discusses the types and classes of antihypertensives, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and alpha blockers. It describes the mechanisms of action, therapeutic uses, and potential side effects of each class. The document is intended to teach healthcare providers about selecting and utilizing different antihypertensive drugs to treat hypertension.
1. ACE inhibitors work by inhibiting the angiotensin converting enzyme and reducing angiotensin II levels, leading to vasodilation and sodium excretion.
2. Common ACE inhibitors include lisinopril, enalapril, ramipril, and benazepril. They are used to treat hypertension, heart failure, myocardial infarction, and diabetic nephropathy.
3. Potential side effects include dry cough, hypotension, hyperkalemia, angioedema, and renal dysfunction. ACE inhibitors can also cause fetal harm during pregnancy.
This document summarizes various classes of cardiovascular drugs used to treat conditions like hypertension, angina, myocardial infarction, shock, and arrhythmias. It describes the mechanisms of action, common drugs, indications, contraindications, side effects, and nursing considerations for beta-blockers, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, and other antihypertensive drugs.
6.0 drugs used in Cardio Vascular SystemSaroj Suwal
The document discusses various drugs used for cardiovascular conditions. It covers antihypertensive drugs like diuretics, calcium channel blockers, ACE inhibitors, ARBs, and adrenergic blockers. It defines hypertension and describes the mechanisms and side effects of different classes of antihypertensive drugs. These include thiazide, loop, and potassium sparing diuretics, calcium channel blockers like nifedipine, ACE inhibitors, ARBs, alpha blockers, beta blockers, and centrally acting drugs like clonidine and methyldopa. Cardiotonic drugs are also briefly mentioned.
The document discusses hypertension and its treatment with angiotensin converting enzyme (ACE) inhibitors. It defines hypertension and describes how it results from increased vascular resistance. It then discusses several classes of drugs used to treat hypertension, focusing on ACE inhibitors. Specific ACE inhibitors discussed include captopril, enalapril, and ramipril. Their mechanisms of action involve blocking the conversion of angiotensin I to the vasoconstrictor angiotensin II. This decreases blood pressure by reducing angiotensin II levels and increasing bradykinin. Their clinical uses and adverse effects are also summarized.
1. Hypertension, or high blood pressure, requires treatment to prevent damage to blood vessels and organs like the heart, brain and kidneys.
2. There are several classes of antihypertensive agents that work through different mechanisms such as reducing sympathetic nervous system activity, blocking adrenoreceptors, vasodilation, and inhibiting the renin-angiotensin system.
3. Common antihypertensive drug classes discussed include ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, diuretics, and vasodilators. The appropriate treatment is selected based on the severity of the patient's high blood pressure.
Diuretics are commonly used as first-line therapy for hypertension. Thiazide diuretics such as hydrochlorothiazide are often used due to their effectiveness and favorable side effect profile. If blood pressure is not controlled with one drug, a second drug from a different class is added. Patient compliance is important for successful treatment and selecting a regimen with fewer side effects can help improve compliance. Different drug classes may work better for certain patient populations, such as calcium channel blockers for elderly patients. The document discusses various classes of antihypertensive drugs including diuretics, beta blockers, ACE inhibitors, and vasodilators.
This document discusses antihypertensive agents used to treat hypertension. It describes different categories of agents including adrenergic agents, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and vasodilators. For each category, the document outlines mechanisms of action, examples of medications, therapeutic uses, and potential side effects. It emphasizes the importance of monitoring blood pressure during therapy and avoiding abruptly stopping medications.
The document discusses various classes of antihypertensive agents used to treat hypertension. It describes 12 classes of drugs, including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, beta blockers, alpha blockers, central sympatholytics, vasodilators, ganglionic blockers, 5HT antagonists, adrenergic neuronal blockers, and renin-angiotensin system inhibitors. It provides details on specific drugs like captopril, enalapril, lisinopril, hydralazine, clonidine, reserpine, guanethidine, and sodium nitroprusside. It also discusses the mechanisms of action,
Drugs used in cardio vascular system- Mr. pannehabdou panneh
This document provides an overview of various types of cardiovascular drugs, including:
1. Angiotensin converting enzyme (ACE) inhibitors which lower blood pressure by blocking the conversion of angiotensin I to angiotensin II.
2. Angiotensin II receptor antagonists which compete with angiotensin II for tissue binding sites to reduce blood pressure.
3. Other classes of drugs discussed include alpha blockers, beta blockers, calcium channel blockers, diuretics, and nitrates. Each drug class is described in terms of its mechanisms of action, clinical uses, common side effects and drug examples. The document serves as a reference for cardiovascular drugs and their characteristics.
Heart failure is defined as the inability of the heart to supply sufficient blood flow to meet the body's needs. Left ventricular dysfunction is a key pathophysiology and leads to compensatory mechanisms like RAAS and sympathetic system activation that form a vicious cycle. Common treatments include ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, and diuretics which help relieve symptoms and prolong survival by reversing remodeling. Inotropic drugs like digoxin, milrinone, and dobutamine are used short-term to improve cardiac output.
Hypertension and its update in treatmentAhmed Elberry
This document discusses hypertension (HTN), including its definition, causes, risk factors, complications, classification, manifestations, and treatment options. Some key points:
- HTN is defined as a sustained blood pressure ≥140/90 mmHg. It has no symptoms but can lead to serious complications without treatment.
- Causes include primary (essential) HTN in 90-95% of cases and secondary HTN in 5% of cases related to underlying diseases or drugs.
- Treatment involves non-pharmacological options like diet, exercise, weight control as well as pharmacological options including diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers.
- HTN
This document discusses antihypertensive drugs, classification of blood pressure, and treatment of hypertension. It describes the different classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, diuretics, sympatholytics, and vasodilators. It provides details on their mechanisms of action, therapeutic uses, advantages, adverse effects, and drug interactions. The document also covers non-pharmacological approaches for hypertension and guidelines for selection and combination of antihypertensive drugs based on individual patient factors.
This document summarizes several drugs used to treat hyperlipidemia and cardiovascular conditions. It describes the mechanism of action, clinical use, and side effects of statins, ezetimibe, bile acid resins, niacin, fibrates, and fish oil for treating hyperlipidemia. It also summarizes nitrates, ranolazine, and hydralazine used for angina, as well as beta-blockers, calcium channel blockers, aspirin, ADP receptor inhibitors, and GP IIb/IIIa inhibitors used for antiplatelet and anticoagulant therapy.
Main and important classes of anti-hypertensive drugs.
(antihypertensive drugs, anti hypertensive sites of action, diuretics, diuretics sites of action, sympathoplegic drugs, beta blockers, alpha blokers, vasodilators, calcium channel blockers)
This document provides an overview of hypertension pharmacology. It defines hypertension and discusses its classification, determinants, and measurement techniques. It then covers various drug classes for treating hypertension, including their mechanisms of action, examples of drugs, and side effects. The drug classes discussed are diuretics, ACE inhibitors, ARBs, calcium channel blockers, beta blockers, alpha blockers, vasodilators, and centrally acting drugs. Non-pharmacological treatment options like lifestyle modifications are also summarized.
This document discusses various cardiac medications that are often mixed and matched to treat different heart conditions. It provides information on:
- How sodium-potassium pumps and calcium channels impact heart cell contraction and repolarization.
- Common classes of cardiac medications including antiarrhythmics, beta blockers, calcium channel blockers, ACE inhibitors, and ARBs.
- Specific medications within each class, their mechanisms and uses for treating arrhythmias, hypertension, heart failure, and other conditions.
The document discusses drugs used to treat cardiovascular conditions. It covers antihypertensive drugs including diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and ARBs. It also discusses drugs for angina pectoris and myocardial infarction, including antiplatelets, beta blockers, calcium channel blockers, nitroglycerin, and ACE inhibitors. Finally, it addresses antiarrhythmic drugs and the mechanisms of different types of arrhythmias.
Cardiac arrhythmia refers to an abnormal cardiac rhythm involving changes in rate or regularity. Common causes include physiological changes, valvular heart disease, ischemic heart disease, and cardiomyopathies. Clinical evaluation involves physical exam findings like abnormal pulse and palpitations, as well as ECG and lab tests. Mechanisms of arrhythmogenesis include disorders of impulse formation and conduction. Antiarrhythmic drugs work by affecting sodium, potassium, calcium, and adrenergic channels. First-line drugs include quinidine, procainamide, lidocaine, beta-blockers, amiodarone, verapamil, and lifestyle modifications. Treatment depends on whether the arrhythmia is life-threatening or affecting
This document discusses the effects of ethanol (alcohol) on various body systems. It begins by classifying alcoholic beverages and describing alcohol metabolism in the liver. It then summarizes ethanol's effects on the central nervous system, including its actions on various neurotransmitter systems. The document goes on to discuss ethanol's cardiovascular, gastrointestinal, and other organ-specific effects. It concludes by covering topics like alcohol tolerance, dependence and withdrawal, as well as pharmacological treatments for alcoholism.
This document discusses drugs that affect hemostasis and cardiac pharmacology. It provides details on antiplatelet drugs like aspirin and clopidogrel, anticoagulants like heparin and warfarin, fibrinolytic drugs, and drugs for bleeding disorders. It also covers antihyperlipidemic drugs including statins, bile acid binding resins, niacin, and fibric acid derivatives. For each drug class and example drugs, it describes the mechanism of action, effects, indications, contraindications, and interactions.
The document discusses different types of antihypertensive drugs, their mechanisms of action, uses, and side effects. It defines hypertension and guidelines for initiating treatment. The main drug classes covered are diuretics, beta blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, alpha blockers, vasodilators, and central acting agents. Factors such as age, comorbidities, and resistant hypertension are addressed in principles of treatment.
This document summarizes various antihypertensive drugs. It discusses the etiology and classification of hypertension. It then covers different classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, vasodilators, and others. For each drug class and examples, it provides the mechanism of action, clinical uses, and potential adverse effects. Treatment of hypertension is important to prevent damage to organs and risk of other conditions.
This document provides information about antihypertensive drugs used to treat cardiovascular conditions. It begins with objectives and basic physiology of blood pressure control. It then covers the WHO blood pressure classification and non-pharmacological management of hypertension. The main classes of antihypertensive drugs discussed are diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers, beta blockers, alpha blockers, central acting drugs, and vasodilators. For each class, examples are given along with mechanisms of action, side effects, and contraindications.
6.0 drugs used in Cardio Vascular SystemSaroj Suwal
The document discusses various drugs used for cardiovascular conditions. It covers antihypertensive drugs like diuretics, calcium channel blockers, ACE inhibitors, ARBs, and adrenergic blockers. It defines hypertension and describes the mechanisms and side effects of different classes of antihypertensive drugs. These include thiazide, loop, and potassium sparing diuretics, calcium channel blockers like nifedipine, ACE inhibitors, ARBs, alpha blockers, beta blockers, and centrally acting drugs like clonidine and methyldopa. Cardiotonic drugs are also briefly mentioned.
The document discusses hypertension and its treatment with angiotensin converting enzyme (ACE) inhibitors. It defines hypertension and describes how it results from increased vascular resistance. It then discusses several classes of drugs used to treat hypertension, focusing on ACE inhibitors. Specific ACE inhibitors discussed include captopril, enalapril, and ramipril. Their mechanisms of action involve blocking the conversion of angiotensin I to the vasoconstrictor angiotensin II. This decreases blood pressure by reducing angiotensin II levels and increasing bradykinin. Their clinical uses and adverse effects are also summarized.
1. Hypertension, or high blood pressure, requires treatment to prevent damage to blood vessels and organs like the heart, brain and kidneys.
2. There are several classes of antihypertensive agents that work through different mechanisms such as reducing sympathetic nervous system activity, blocking adrenoreceptors, vasodilation, and inhibiting the renin-angiotensin system.
3. Common antihypertensive drug classes discussed include ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, diuretics, and vasodilators. The appropriate treatment is selected based on the severity of the patient's high blood pressure.
Diuretics are commonly used as first-line therapy for hypertension. Thiazide diuretics such as hydrochlorothiazide are often used due to their effectiveness and favorable side effect profile. If blood pressure is not controlled with one drug, a second drug from a different class is added. Patient compliance is important for successful treatment and selecting a regimen with fewer side effects can help improve compliance. Different drug classes may work better for certain patient populations, such as calcium channel blockers for elderly patients. The document discusses various classes of antihypertensive drugs including diuretics, beta blockers, ACE inhibitors, and vasodilators.
This document discusses antihypertensive agents used to treat hypertension. It describes different categories of agents including adrenergic agents, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and vasodilators. For each category, the document outlines mechanisms of action, examples of medications, therapeutic uses, and potential side effects. It emphasizes the importance of monitoring blood pressure during therapy and avoiding abruptly stopping medications.
The document discusses various classes of antihypertensive agents used to treat hypertension. It describes 12 classes of drugs, including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, beta blockers, alpha blockers, central sympatholytics, vasodilators, ganglionic blockers, 5HT antagonists, adrenergic neuronal blockers, and renin-angiotensin system inhibitors. It provides details on specific drugs like captopril, enalapril, lisinopril, hydralazine, clonidine, reserpine, guanethidine, and sodium nitroprusside. It also discusses the mechanisms of action,
Drugs used in cardio vascular system- Mr. pannehabdou panneh
This document provides an overview of various types of cardiovascular drugs, including:
1. Angiotensin converting enzyme (ACE) inhibitors which lower blood pressure by blocking the conversion of angiotensin I to angiotensin II.
2. Angiotensin II receptor antagonists which compete with angiotensin II for tissue binding sites to reduce blood pressure.
3. Other classes of drugs discussed include alpha blockers, beta blockers, calcium channel blockers, diuretics, and nitrates. Each drug class is described in terms of its mechanisms of action, clinical uses, common side effects and drug examples. The document serves as a reference for cardiovascular drugs and their characteristics.
Heart failure is defined as the inability of the heart to supply sufficient blood flow to meet the body's needs. Left ventricular dysfunction is a key pathophysiology and leads to compensatory mechanisms like RAAS and sympathetic system activation that form a vicious cycle. Common treatments include ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, and diuretics which help relieve symptoms and prolong survival by reversing remodeling. Inotropic drugs like digoxin, milrinone, and dobutamine are used short-term to improve cardiac output.
Hypertension and its update in treatmentAhmed Elberry
This document discusses hypertension (HTN), including its definition, causes, risk factors, complications, classification, manifestations, and treatment options. Some key points:
- HTN is defined as a sustained blood pressure ≥140/90 mmHg. It has no symptoms but can lead to serious complications without treatment.
- Causes include primary (essential) HTN in 90-95% of cases and secondary HTN in 5% of cases related to underlying diseases or drugs.
- Treatment involves non-pharmacological options like diet, exercise, weight control as well as pharmacological options including diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers.
- HTN
This document discusses antihypertensive drugs, classification of blood pressure, and treatment of hypertension. It describes the different classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, diuretics, sympatholytics, and vasodilators. It provides details on their mechanisms of action, therapeutic uses, advantages, adverse effects, and drug interactions. The document also covers non-pharmacological approaches for hypertension and guidelines for selection and combination of antihypertensive drugs based on individual patient factors.
This document summarizes several drugs used to treat hyperlipidemia and cardiovascular conditions. It describes the mechanism of action, clinical use, and side effects of statins, ezetimibe, bile acid resins, niacin, fibrates, and fish oil for treating hyperlipidemia. It also summarizes nitrates, ranolazine, and hydralazine used for angina, as well as beta-blockers, calcium channel blockers, aspirin, ADP receptor inhibitors, and GP IIb/IIIa inhibitors used for antiplatelet and anticoagulant therapy.
Main and important classes of anti-hypertensive drugs.
(antihypertensive drugs, anti hypertensive sites of action, diuretics, diuretics sites of action, sympathoplegic drugs, beta blockers, alpha blokers, vasodilators, calcium channel blockers)
This document provides an overview of hypertension pharmacology. It defines hypertension and discusses its classification, determinants, and measurement techniques. It then covers various drug classes for treating hypertension, including their mechanisms of action, examples of drugs, and side effects. The drug classes discussed are diuretics, ACE inhibitors, ARBs, calcium channel blockers, beta blockers, alpha blockers, vasodilators, and centrally acting drugs. Non-pharmacological treatment options like lifestyle modifications are also summarized.
This document discusses various cardiac medications that are often mixed and matched to treat different heart conditions. It provides information on:
- How sodium-potassium pumps and calcium channels impact heart cell contraction and repolarization.
- Common classes of cardiac medications including antiarrhythmics, beta blockers, calcium channel blockers, ACE inhibitors, and ARBs.
- Specific medications within each class, their mechanisms and uses for treating arrhythmias, hypertension, heart failure, and other conditions.
The document discusses drugs used to treat cardiovascular conditions. It covers antihypertensive drugs including diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and ARBs. It also discusses drugs for angina pectoris and myocardial infarction, including antiplatelets, beta blockers, calcium channel blockers, nitroglycerin, and ACE inhibitors. Finally, it addresses antiarrhythmic drugs and the mechanisms of different types of arrhythmias.
Cardiac arrhythmia refers to an abnormal cardiac rhythm involving changes in rate or regularity. Common causes include physiological changes, valvular heart disease, ischemic heart disease, and cardiomyopathies. Clinical evaluation involves physical exam findings like abnormal pulse and palpitations, as well as ECG and lab tests. Mechanisms of arrhythmogenesis include disorders of impulse formation and conduction. Antiarrhythmic drugs work by affecting sodium, potassium, calcium, and adrenergic channels. First-line drugs include quinidine, procainamide, lidocaine, beta-blockers, amiodarone, verapamil, and lifestyle modifications. Treatment depends on whether the arrhythmia is life-threatening or affecting
This document discusses the effects of ethanol (alcohol) on various body systems. It begins by classifying alcoholic beverages and describing alcohol metabolism in the liver. It then summarizes ethanol's effects on the central nervous system, including its actions on various neurotransmitter systems. The document goes on to discuss ethanol's cardiovascular, gastrointestinal, and other organ-specific effects. It concludes by covering topics like alcohol tolerance, dependence and withdrawal, as well as pharmacological treatments for alcoholism.
This document discusses drugs that affect hemostasis and cardiac pharmacology. It provides details on antiplatelet drugs like aspirin and clopidogrel, anticoagulants like heparin and warfarin, fibrinolytic drugs, and drugs for bleeding disorders. It also covers antihyperlipidemic drugs including statins, bile acid binding resins, niacin, and fibric acid derivatives. For each drug class and example drugs, it describes the mechanism of action, effects, indications, contraindications, and interactions.
The document discusses different types of antihypertensive drugs, their mechanisms of action, uses, and side effects. It defines hypertension and guidelines for initiating treatment. The main drug classes covered are diuretics, beta blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, alpha blockers, vasodilators, and central acting agents. Factors such as age, comorbidities, and resistant hypertension are addressed in principles of treatment.
This document summarizes various antihypertensive drugs. It discusses the etiology and classification of hypertension. It then covers different classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, vasodilators, and others. For each drug class and examples, it provides the mechanism of action, clinical uses, and potential adverse effects. Treatment of hypertension is important to prevent damage to organs and risk of other conditions.
This document provides information about antihypertensive drugs used to treat cardiovascular conditions. It begins with objectives and basic physiology of blood pressure control. It then covers the WHO blood pressure classification and non-pharmacological management of hypertension. The main classes of antihypertensive drugs discussed are diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers, beta blockers, alpha blockers, central acting drugs, and vasodilators. For each class, examples are given along with mechanisms of action, side effects, and contraindications.
This document provides information on antihypertensive drugs. It begins by listing the specific learning objectives, which include defining hypertension, discussing types and drugs for treatment, mechanisms of action, adverse effects, and considerations for use in various conditions. It then covers primary and secondary hypertension, urgency vs emergency, and mnemonics for drug classes. Individual drug classes are discussed in detail, including diuretics, ACE inhibitors, ARBs, calcium channel blockers, arteriolar vasodilators, and beta blockers. Mechanisms, advantages, disadvantages, and special considerations are provided for each class.
1. The document discusses drug therapy for hypertension, outlining several classes of drugs and their mechanisms of action, including diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and other central acting agents.
2. Beta-blockers are recommended for mild to moderate hypertension but have adverse effects like fatigue and should not be used in diabetes or asthma. ACE inhibitors are first-line for essential hypertension and have benefits for conditions like diabetes.
3. Diuretics are commonly used first-line but have side effects like hypokalemia. Combination therapy with multiple drug classes is often needed to control resistant hypertension.
This document discusses various classes of antihypertensive agents used to treat hypertension. It defines hypertension and describes the renin-angiotensin-aldosterone system which is important in regulating blood pressure. Common classes of antihypertensive agents discussed include diuretics, ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, alpha blockers, and central sympatholytics. Lifestyle modifications including weight loss, exercise, diet changes, and avoiding tobacco are also recommended for managing hypertension.
Hypertension is a common cardiovascular condition caused by persistently high blood pressure that damages organs. Antihypertensive drugs work via different mechanisms like inhibiting the renin-angiotensin-aldosterone system, blocking calcium channels, promoting sodium excretion with diuretics, and reducing sympathetic nervous system activity. Common classes of antihypertensives include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, sympatholytics, and vasodilators. Treatment involves beginning with certain drug classes based on patient characteristics and guidelines, and escalating treatment by adding other classes as needed to control blood pressure. Antihypertensive drug choice is also based on minimizing adverse effects and avoiding
This document provides an overview of various classes of antihypertensive drugs including centrally acting alpha adrenergic antagonists, peripheral acting alpha adrenergic antagonists, alpha blockers, beta blockers, calcium channel blockers, diuretics, angiotensin receptor blockers, ACE inhibitors, renin inhibitors, aldosterone inhibitors, vasodilators. It discusses specific drugs from each class, their mechanisms of action, indications, contraindications, side effects, and important nursing considerations.
This document discusses various classes of antihypertensive drugs. It begins by classifying blood pressure levels from normal to grades 1-3 hypertension. It then provides introductions on hypertension prevalence and consequences. The document is primarily focused on detailing specific antihypertensive drug classes including diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and others. For each class, it lists example drugs and discusses mechanisms of action, indications, advantages, disadvantages, and other relevant details. The goal is to serve as a reference for the appropriate use of antihypertensive medications.
This document discusses chronic heart failure and its management. It provides details on:
1. General measures for chronic heart failure including identifying and correcting causes, advising lifestyle changes like smoking cessation, and avoiding triggers that can worsen the condition.
2. Pharmacological management using diuretics, vasodilators, ACE inhibitors, ARBs, aldosterone receptor antagonists, beta-blockers, and other drugs. Loop diuretics are the preferred diuretic choice.
3. Mineralocorticoid receptor antagonists like spironolactone and eplerenone work by blocking aldosterone receptors and have been shown in studies like RALES to reduce mortality in heart failure patients
Basic must know things about Anti-Hypertensives including the latest JNC-8 Classification and protocol for managing hypertension in various co-morbid conditions.
This document summarizes several classes of antihypertensive drugs. It discusses diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, alpha blockers, direct vasodilators, and their mechanisms of action, indications, side effects and monitoring. The document provides tables with examples of drugs within each class and details regarding administration and patient education.
The document discusses various classes of diuretics including loop diuretics, thiazide diuretics, potassium sparing diuretics, carbonic anhydrase inhibitors, and osmotic diuretics. It focuses on the mechanisms of action, indications, and side effects of specific drugs within each class. It provides details on the pharmacology of spironolactone, amiloride, triamterene, acetazolamide, and mannitol. Clinical uses and precautions for different diuretics in conditions like edema, hypertension, heart failure, and kidney stones are also reviewed.
This document discusses several classes of drugs used to treat renal conditions:
- Diuretics such as thiazide, loop, and potassium-sparing diuretics work by increasing sodium and water excretion to lower blood pressure.
- ACE inhibitors, ARBs, and direct renin inhibitors act on the renin-angiotensin-aldosterone system to lower blood pressure by inhibiting vasoconstriction and sodium retention.
- ACE inhibitors are first-line treatments for hypertension and conditions like heart failure. ARBs have similar effects but do not increase bradykinin.
- Antidiuretics reduce urine volume and are primarily used to treat diabetes insipidus but also
Antihypertensives | Classes of Drugs | Baro ReceptorChetan Prakash
This Presentation provides a knowledge about Antihypertensives, types of blood pressure, hypertension types, normal blood pressure regulation, baro receptors, classes of antihypertensive drugs,recent discovery on hypertension. This is an assignment for the subject, Advanced Pharmacology-I, 1st year M.Pharm, 1st semester.
Heart failure is a complex clinical syndrome resulting from structural or functional impairment of the ventricles. It leads to symptoms of dyspnea and fatigue. Treatment involves correcting reversible causes, using diuretics, ACE inhibitors, beta blockers, aldosterone antagonists, and devices like ICDs and CRT. Nonpharmacological treatments include diet, exercise, and procedures like CABG or transplantation for advanced cases. The goal is to relieve symptoms, improve function, and prevent death and hospitalizations.
Hypertension is classified based on blood pressure readings into normal, prehypertension, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. It can be treated through lifestyle modifications and medications. Common antihypertensive drug classes include diuretics, sympatholytics, beta-blockers, alpha-blockers, ACE inhibitors, ARBs, calcium channel blockers, and vasodilators. Treatment involves reducing factors that increase blood pressure such as stress, weight, sodium intake, and sympathetic tone through both non-pharmacological and pharmacological approaches. Certain drugs should be avoided in patients with comorbidities like diabetes, gout, renal disease, etc. to prevent adverse effects.
Hypertension is classified based on blood pressure readings into normal, prehypertension, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. It can be essential or secondary. Treatment approaches aim to reduce sympathetic tone, circulating angiotensin II levels, cardiac force, and increase peripheral vessel dilation. Common drug classes used include diuretics, sympatholytics, beta blockers, alpha blockers, ACE inhibitors, ARBs, CCBs, and vasodilators. Lifestyle changes such as weight control, reduced sodium intake, and exercise can help control early stage 1 hypertension alone or with pharmacological treatment.
Hypertension is classified based on blood pressure readings into normal, prehypertension, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. It can be treated through lifestyle modifications like weight loss, reduced sodium intake, and exercise. Medications used include diuretics, sympatholytics, beta-blockers, alpha-blockers, ACE inhibitors, ARBs, CCBs, and vasodilators. Treatment depends on the individual's medical history and any underlying conditions.
Hypertension is classified based on blood pressure readings into normal, prehypertension, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. It can be treated through lifestyle modifications and medications. Common antihypertensive drug classes include diuretics, sympatholytics, beta-blockers, alpha-blockers, ACE inhibitors, ARBs, calcium channel blockers, and vasodilators. Treatment involves reducing factors that increase blood pressure such as stress, weight, sodium intake, and sympathetic tone through both non-pharmacological and pharmacological approaches. Certain drugs should be avoided in patients with comorbidities like diabetes, gout, renal disease, etc. to prevent adverse effects.
Vk gmailcomcom and care Educate the ‘at the hell is not known meaning in 12 hindi meaning of the positive thought ke liye liye mana kiya hai maine us se baat karunga to delay ho gya h kya mere se baat
Similar to 177791 anti hypertensive drugs2018 (20)
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
Microbial interaction
Microorganisms interacts with each other and can be physically associated with another organisms in a variety of ways.
One organism can be located on the surface of another organism as an ectobiont or located within another organism as endobiont.
Microbial interaction may be positive such as mutualism, proto-cooperation, commensalism or may be negative such as parasitism, predation or competition
Types of microbial interaction
Positive interaction: mutualism, proto-cooperation, commensalism
Negative interaction: Ammensalism (antagonism), parasitism, predation, competition
I. Mutualism:
It is defined as the relationship in which each organism in interaction gets benefits from association. It is an obligatory relationship in which mutualist and host are metabolically dependent on each other.
Mutualistic relationship is very specific where one member of association cannot be replaced by another species.
Mutualism require close physical contact between interacting organisms.
Relationship of mutualism allows organisms to exist in habitat that could not occupied by either species alone.
Mutualistic relationship between organisms allows them to act as a single organism.
Examples of mutualism:
i. Lichens:
Lichens are excellent example of mutualism.
They are the association of specific fungi and certain genus of algae. In lichen, fungal partner is called mycobiont and algal partner is called
II. Syntrophism:
It is an association in which the growth of one organism either depends on or improved by the substrate provided by another organism.
In syntrophism both organism in association gets benefits.
Compound A
Utilized by population 1
Compound B
Utilized by population 2
Compound C
utilized by both Population 1+2
Products
In this theoretical example of syntrophism, population 1 is able to utilize and metabolize compound A, forming compound B but cannot metabolize beyond compound B without co-operation of population 2. Population 2is unable to utilize compound A but it can metabolize compound B forming compound C. Then both population 1 and 2 are able to carry out metabolic reaction which leads to formation of end product that neither population could produce alone.
Examples of syntrophism:
i. Methanogenic ecosystem in sludge digester
Methane produced by methanogenic bacteria depends upon interspecies hydrogen transfer by other fermentative bacteria.
Anaerobic fermentative bacteria generate CO2 and H2 utilizing carbohydrates which is then utilized by methanogenic bacteria (Methanobacter) to produce methane.
ii. Lactobacillus arobinosus and Enterococcus faecalis:
In the minimal media, Lactobacillus arobinosus and Enterococcus faecalis are able to grow together but not alone.
The synergistic relationship between E. faecalis and L. arobinosus occurs in which E. faecalis require folic acid
PPT on Alternate Wetting and Drying presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...Sérgio Sacani
Wereport the study of a huge optical intraday flare on 2021 November 12 at 2 a.m. UT in the blazar OJ287. In the binary black hole model, it is associated with an impact of the secondary black hole on the accretion disk of the primary. Our multifrequency observing campaign was set up to search for such a signature of the impact based on a prediction made 8 yr earlier. The first I-band results of the flare have already been reported by Kishore et al. (2024). Here we combine these data with our monitoring in the R-band. There is a big change in the R–I spectral index by 1.0 ±0.1 between the normal background and the flare, suggesting a new component of radiation. The polarization variation during the rise of the flare suggests the same. The limits on the source size place it most reasonably in the jet of the secondary BH. We then ask why we have not seen this phenomenon before. We show that OJ287 was never before observed with sufficient sensitivity on the night when the flare should have happened according to the binary model. We also study the probability that this flare is just an oversized example of intraday variability using the Krakow data set of intense monitoring between 2015 and 2023. We find that the occurrence of a flare of this size and rapidity is unlikely. In machine-readable Tables 1 and 2, we give the full orbit-linked historical light curve of OJ287 as well as the dense monitoring sample of Krakow.
Discovery of An Apparent Red, High-Velocity Type Ia Supernova at 𝐳 = 2.9 wi...Sérgio Sacani
We present the JWST discovery of SN 2023adsy, a transient object located in a host galaxy JADES-GS
+
53.13485
−
27.82088
with a host spectroscopic redshift of
2.903
±
0.007
. The transient was identified in deep James Webb Space Telescope (JWST)/NIRCam imaging from the JWST Advanced Deep Extragalactic Survey (JADES) program. Photometric and spectroscopic followup with NIRCam and NIRSpec, respectively, confirm the redshift and yield UV-NIR light-curve, NIR color, and spectroscopic information all consistent with a Type Ia classification. Despite its classification as a likely SN Ia, SN 2023adsy is both fairly red (
�
(
�
−
�
)
∼
0.9
) despite a host galaxy with low-extinction and has a high Ca II velocity (
19
,
000
±
2
,
000
km/s) compared to the general population of SNe Ia. While these characteristics are consistent with some Ca-rich SNe Ia, particularly SN 2016hnk, SN 2023adsy is intrinsically brighter than the low-
�
Ca-rich population. Although such an object is too red for any low-
�
cosmological sample, we apply a fiducial standardization approach to SN 2023adsy and find that the SN 2023adsy luminosity distance measurement is in excellent agreement (
≲
1
�
) with
Λ
CDM. Therefore unlike low-
�
Ca-rich SNe Ia, SN 2023adsy is standardizable and gives no indication that SN Ia standardized luminosities change significantly with redshift. A larger sample of distant SNe Ia is required to determine if SN Ia population characteristics at high-
�
truly diverge from their low-
�
counterparts, and to confirm that standardized luminosities nevertheless remain constant with redshift.
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxgoluk9330
Ahota Beel, nestled in Sootea Biswanath Assam , is celebrated for its extraordinary diversity of bird species. This wetland sanctuary supports a myriad of avian residents and migrants alike. Visitors can admire the elegant flights of migratory species such as the Northern Pintail and Eurasian Wigeon, alongside resident birds including the Asian Openbill and Pheasant-tailed Jacana. With its tranquil scenery and varied habitats, Ahota Beel offers a perfect haven for birdwatchers to appreciate and study the vibrant birdlife that thrives in this natural refuge.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
PPT on Sustainable Land Management presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
7. Groups of Antihypertensive Drugs
Diuretics
β Blockers
ACE
Inhibitors
Angiotensin II
Receptor
Blockers
Ca Channnel
Blockers
α1 Blockers
Centrally α2
agonist
Direct
Vasodilator
others
8. Diuretics
Trigger the excretion of water and
electrolytes from the kidneys
Blood Volume
Peripheral Retention
Sodium water retention
Cardiac Output
Decrease Blood Pressure
10. Continue...
III. Potassium Sparing Diuretic
• Diuretics that do not promote secretion of
potassium in the urine.
• As adjunctive drugs, combination with other
drugs
• Actions :
– Aldosterone antagonis : spironolactone,
eplerenone
– Block sodium channel : amiloride, triamteren
11. Thiazide Diuretics
• Diuretic that most widespread use. Derived from
sulfonamides.
• Thiazide diuretics are absorbed rapidly but
incompletely from the GI tract. Cross the
placenta and are secreted in breast milk.
• Therapeutic Uses : long-term treatment of
hypertension. Particularly useful in the treatment
of black or elderly. Also used to treat edema.
• Not effective in patient with inadequate kidney
function (Cr Cl < 50 mL/min).
• Decrease the level of calcium in urine prevent
the development and recurrence of renal calculi.
12. Continue...
• Side effects : hyperurecemia (70%),
hyperglycemia (10%), hypomagnesemia.
Increase the excretion of chloride, potassium,
and bicarbonate electrolyte imbalance
• Potassium levels should be monitored closely
in patient who are predisposed to arrhythmias
or using digitalis glycosides.
13. Loop Diuretics
• Highly potent diuretics. Loop diuretics, with the
exception of ethacrynic acid, contain sulfa.
• Act on proximal tubule the thick, ascending loop
of Henle.
• Cause decreased renal vascular resistance,
increase renal blood flow, increase Ca2+ content
of urine.
• Used to treat edema, hypertension (usually with
a potassium-sparing diuretic or potassium
supplement to prevent hypokalemia)
14. CALCIUM CHANNEL BLOCKERS
Blocking the slow calcium channel in
myocardial and vascular smooth
muscle cell membranes
Inhibits the influx of
extracellular calcium ions
No Contraction =
Dilatation
Have intrinsic
natriuretic effect
Decrease Blood Pressure
15. Pharmacokinetics
• When administered orally, calcium channel
blockers are absorbed quickly and almost
completely.
• Because of the first -pass effect, however, the
bioavailability of these drugs is much lower.
• The calcium channel blockers are highly bound
to plasma proteins.
17. Differences
Classes /Drugs Properties
Verapamil Has significant effect on both
cardiac and vascular smooth
muscle
Diltiazem Affect both cardiac and vascular
smooth muscle, but less
pronounced negative inotropic
effect compare to verapamil
Nifedipine etc Much greater affinity for
vascular smooth muscle
18.
19. Continue...CCB
• Useful in the treatment of hypertensive (mild-
moderate) who also have asthma, diabetes,
angina, peripheral vascular disease.
• Side effects: constipation (10%), dizzines,
headache, feeling fatique. Verapamil
contraindication for congestive heart failure
due to its negative inotropic effects.
24. Actions
• Block the binding of angiotensin II to the AT1
receptor This prevents angiotensin II from
exerting its vasoconstricting properties and
from promoting the excretion of aldosterone -
lowered blood pressure.
25. Continue...
• Valsartan may also be used for the
management of heart failure.
• Decrease nephrotoxicity of diabetes
therapy in hypertensive diabetics (Irbesartan
and losartan).
• Losartan is also used to reduce the risk of
stroke in high-risk patients with hypertension
and left ventricular hypertrophy.
• Side effect similar with ACEI, but risk of cough
and angiodema sigificantly decrease
27. Continue...
• Selective β1 Blockers : metoprolol, atenolol
• Non selective β Blockers (block β1 & β2) :
Propanolol
• May take several (1-2) weeks to develop full
effects
28. Continue...
• Side effect : bradycardia, fatique, insomnia,
hallucination, hypotension, decrease libido, cause
impotence, disturb lipid metabolism, decreasing
HDL, increasing Trigliseride, drug withdrawl
(rebound hypertension should be tapering off)
• Caution in obstructive lung disease, chronic
congestive heart failure, severe symptomatic
occlusive peripheral vascular disease, acute heart
failure, diabetes.
29. α1 Blocker
• Actions : competitive block α1 adrenoceptor relaxation
arterial and venous smooth muscle decrease peripheral
vascular resistance and lower arterial blood pressure.
• Have minimal change in cardiac output, renal blood flow,
glomerular filtration rate.
• Cause short term effect of reflex tachycardia to blunt this
effect concomitant use of β blocker may be needed.
• Prazosin, doxazosin, terazosin.
• Side effect : postural hypotention, reflex tachycardia, first
dose syncope.
30. α-1 and β Blockers
• Actions : blocking both α-1 and β receptors in
the body lowers blood pressure.
• Carvedilol, labetalol
• Contraindication : heart block, heart failure,
asthma, obstructive airway disease, severe
slow heartbeat, severe low blood pressure
31. Clonidine
• It is α2 presinaptic agonist, work centrally
• Action: inhibit the released of noradrenaline
from symphatetics nerves.
• Does not decrease renal blood flow & GFR
Useful in the treatment of hypertention
complicated by renal disease.
• Causes sodium and water retention usually
used in combination with diuretic.
• Side effect : sedation, drying nasal mucosa,
rebound hypertention in abrupt withdrawal
(should be withdrawn slowly)
32. α methyldopa
• It Inhibits dopa decorboxylase and deplete
norepinephrine
• Also valuable in treating hypertensive patient
with renal insufficiency.
• Reduce total peripheral resistance and
decreased blood pressure.
• Cardiac output not decreased Does not
decrease renal blood flow & GFR
• Side effect : sedation, drowsiness.
33. Direct Vasodilators
• Actions : act on arteries, veins, or both.
• Include :
–Diazoxide
–Hydralazine
–Minoxidil
–Nitroprusside
34. Continue...Indications
• They’re usually combined with other drugs to
treat the patient with moderate to severe
hypertension (hypertensive crisis).
• Hydralazine and minoxidil are usually used to
treat resistant or refractory hypertension.
• Diazoxide and nitroprusside are reserved for use
in hypertensive crisis.
• Hydralazine monotherapy accepted method for
controlling blood pressure in pregnancy-induced
hypertension.
35. Continue... Side effect
• Produce reflex stimulation of heart
increased myocardial contractility, heart rate,
oxygen consumption may prompt angina
pectoris, MI, cardiac failure in predisposed
individuals.
• Increase plasma renin concentration
sodium and water retention
• Those undesirable side effects can be blocked
by concomitant use of diuretic and β blocker.
41. Causes of Resistant Hypertension
• Improper BP measurement
• Excess sodium intake
• Inadequate diuretic therapy
• Medication:
– Inadequate doses
– Drug actions and interactions (e.g., nonsteroidal anti-
inflammatory drugs (NSAIDs), illicit drugs,
sympathomimetics, oral contraceptives)
– Over-the-counter (OTC) drugs and herbal supplements
• Excess alcohol intake
• Identifiable causes of hypertension
42. Recommendations for initiating and modifying
pharmacotherapy for patients with elevated
blood pressure (BP) : "2014 Evidence-Based
Guideline for the Management of High Blood
Pressure in Adults: Report From the Panel
Members Appointed to the Eighth Joint National
Committee (JNC 8), published online Dec. 18 by
JAMA: The Journal of the American Medical
Association
43. Initiation pharmacologic treatment (1)
Population Blood Pressure
In the general population
aged ≥60 years
SBP ≥150 mm Hg or DBP
≥90 mm Hg
In the general population
<60 years
SBP ≥140 mmHg or at DBP
≥90 mmHg
In the population aged
≥18 years with chronic
kidney disease (CKD)
SBP ≥140 mmHg or DBP
≥90 mmHg
44. Initiation pharmacologic treatment (2)
Population Drugs
In the general nonblack
population, including those
with diabetes
a thiazide-type diuretic,
calcium channel blocker
(CCB), angiotensin-
converting enzyme inhibitor
(ACEI), or angiotensin
receptor blocker (ARB).
In the general black
population
a thiazide-type diuretic or
CCB.
In the population aged ≥18
years with CKD
ACEI or ARB
45. Evaluation
Initiate with 1 drugs for 1
month
If goal BP cannot be reached ,
increase the dose of the
initial drug or add a second
drug .
If goal BP cannot be reached
with 2 drugs, add and titrate
a third drug .
Referral to a hypertension
specialist may be indicated
for patients in whom goal BP
cannot be attained using the
above strategy or for the
management of complicated
patients
Do not
combine
together ACEI
and an ARB
46. CRISIS HYPERTENSIVE
• Rarely but life threatening situation
(emergency)
• DBP > 150 mmHg in healthy person; DBP >130
mmHg in individual with preexixting
complication (encelopathy, cerebral
hemorrhage, left ventricular failure, aortic
stenosis)
• Therapeutic goal : Rapidly reduce blood
pressure choose drugs with rapid onset
47.
48. Sodium Nitroprusside.
• Administered IV
• Cause reflex tachycardia
• Acting equally in arterial and veous smooth
muscle can reduce cardiac preload.
• Metabolized rapidly require continuous
infusion to maintain hypotensive action.
• Metabolit : cyanide ion
49. • Labetalol
– α and βblocker
– Administered by IV bolus or infusion.
– Does not cause reflex tachycardia
• Fenoldopam
– Peripheral dopamine- 1 receptor agonist.
– Administerd by IV infusion
– Lower blood pressure and also increase renal
perfusion
– Contraindicated in patient with glucoma.
50. • Nicardipne
– Can be given as intravenous infusion.
• Minoxidil
– Dilatation of arteriole but not venules.
– For severe to malignant hypertention that is
refractory to other drugs.
– Concomitant with other drug to diminish side
effect.
– Side effect : hypertrichosis, water nad sodium
retention.
51. Post Test
1. Candesartan adalah obat antihipertensi golongan ....
2. Lisnopril adalah obat antihipertensi golongan ....
3. Furosemid adalah obat antihipertensi golongan ....
4. Amlodipine adalah obat antihipertensi golongan ....
5. Penderita hipertensi denngan penyakit ginjal kronis, maka pilihan obat
antihipertensinya adalah ....
6. Untuk hipertensi emergensi dipilih obat antihipertensi yang ........,
contoh : .....
7. Efek samping kaptopril antara lain ...
8. Seorang pasien hipertensi derajat 1 dengan riwayat asma bronkiale,
golongan obat antihipertensi yang harus dihindari adalah ...
9. Seorang pasien terdiagnosis hipertensi dan edema pretibial. Obat
antihipertensi yang juga dapat menurunkan edemanya adalah ....
10. Seorang pasien 50 tahun dengan riwayat hipertensi, pada
pemeriksaan tekanan darah didapatkan 200/150 mmHg. Obat
antihipertensi pilihan untuk pasien tersebut adalah ....
52. Tuliskan Resep
• Ny. T, 50 tahun. Hasil pemeriksaan tekanan
darah masih tinggi setelah dilakukan
modifikasi gaya hidup. Tekanan darah terakhir
: 150/90 mmHg. Tidak ada penyakit komorbid
lainnya. Berikan resep obat antihipertensi
untuk Ny. T.
53. Rumusan Masalah :
1. Bagaimana pedoman pemilihan obat
antihipertensi yang akan diberikan kepada
pasien yang terdiagnosis hipertensi ?
2. Apakah ada golongan obat antihipertensi yang
lebih superior dibandingkan golongan
antihipertensi lainnya?
Tugas : Buat Artikel
Editor's Notes
Arterial Blood Pressure is directly proportional to the product of cardiac output (CO) dan peripheral vascular ressitance.
Most antihypertensive drugs lower bllod preesure by reducing cardiac output and/ decreaseing in peripheral resistance.
CO and peripheral resistance controlled by barofeflexes (sympathetic nervous system) and renin Angitensin Aldosteron System.
Typically begins with a thiazide diuretic or a calcium channel blocker.
a primary choice in the treatment of renal disease, edema, hypertension, and heart failure.
Initially, diuretic drugs decrease circulating blood volume, leading to reduced cardiac output. However, if therapy is maintained, cardiac output stabilizes but plasma fluid volume decreases.
With long-term use, thiazide diuretics also lower blood pressure by causing arteriolar vasodilation.
decrease blood pressure in both supine & standing position, rarely cuse postural hypotention except in elderly. Useful for combination with others antihypertensive agents, particularly useful in the treatment of black or elderly.
All thiazide are ligands for organic acid secretory system of nephron may compete with uric acid for elimination.
This generation differ in pharmacokinetics, uses and drug interactions. Amlodipine and nicardipine show little interaction with other cardiovascular drugs (ex. Digoxin or warfarin)
Some calcium channel blockers (diltiazem and verapamil) also reduce the heart rate by slowing conduction through the SA and AV nodes.
High dose of short acting CCB should be avoided increased risk myocardial infarction.
Bradykinin is a vasodilator.
patients taking ACE inhibitors should avoid taking all NSAIDs. Besides decreasing the antihypertensive effect of ACE inhibitors, NSAIDs may alter renal function.
antacids may impair the absorption of fosinopril.
quinapril may reduce the absorption of tetracycline
all are highly bound to plasma proteins.
When losartan is taken with fluconazole, an increased blood level of losartan may result, leading to hypotension.
NSAIDs reduce the antihypertensive effects of ARBs.
Rifampin may increase metabolism of losartan and decrease its antihypertensive effect.
Candesartan may increase blood levels of lithium, leading to lithium toxicity.
When digoxin is taken with telmisartan, an increased blood level of digoxin may occur, possibly leading to digoxin toxicity.
Potassium supplements may increase the risk of hyperkalemia when used with ARBs.
Symphatolytics drugs
Effective but have some contraindications.
In the general population ages ≥ 60, pharmacologic treatment to lower BP should be initiated at a systolic blood pressure (SBP) of 150 mmHg or higher or a diastolic blood pressure (DBP) of 90 mmHg or higher. Patients should be treated to a goal SBP lower than 150 mmHg and a goal DBP lower than 90 mmHg. If treatment results in lower achieved SBP and is not associated with adverse effects, treatment does not need to be adjusted.
In the general population younger than age 60, initiate pharmacologic treatment at a DBP of 90 mmHg or higher or an SBP of 140 mmHg or higher and treat to goals below these respective thresholds.
In the population ages 18 years or older with diabetes or CKD, initiate pharmacologic treatment at an SBP of 140 mmHg or higher or a DBP of 90 mmHg or higher and treat to goals below these respective thresholds.