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ACE INHIBITORS.pptx

This document provides information about ACE inhibitors, which are a class of drugs used to treat hypertension. It begins by defining hypertension and describing antihypertensive drugs. It then focuses on ACE inhibitors, explaining their mechanism of action in blocking the conversion of angiotensin I to angiotensin II, thereby reducing vasoconstriction and sodium retention. The document outlines the therapeutic uses of ACE inhibitors for conditions like heart failure and kidney disease, and discusses potential adverse effects like cough, hypotension, and hyperkalemia. It concludes by listing contraindications like previous angioedema or hypersensitivity to ACE inhibitors.

Health & Medicine◦
ACE INHIBITORS Presented by CHHAVI M. Pharm 1st Year Delhi Pharmaceutical Sciences & Research University, New Delhi
Contents • Introduction • Hypertensives • ACE Inhibitors • Mechanism of action • Therapeutic uses • Adverse effects • Contraindications & Precautions
Introduction Hypertension • Defined as either a sustained systolic blood pressure of greater than 140 mm Hg OR • A sustained diastolic blood pressure of greater than 90 mm Hg • Hypertension results from increased peripheral vascular smooth muscle tone, which leads to increased arteriolar resistance and reduced capacitance of the venous system
Antihypertensives • A class of drugs that are used to treat hypertension • Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction
CLASSIFICATION OF ANTIHYPERTENSIVE DRUGS • ACE (Angiotensin Converting Enzyme)inhibitor Captopril, Enalapril, Ramipril etc • Angiotensin (AT1 Receptor) blocker Losartan, Candesartan, Valsartan etc. • Calcium channel blocker Verapamil, Diltiazem, Nifedipine etc • Beta Adrenergic bocker Propanolol, Atenolol, Metoprolol • Alpha Adrenergic blocker Prazosin,Terazosin • Beta & Alpha Adrenergic blocker Labetalol, Carvedilol
CLASSIFICATION OF ANTIHYPERTENSIVE DRUGS • Diuretics Thiazide - Hydrochlorothiazide, Chlorothiazide High ceiling – Furosemide Potassium sparing - Spironolactone, Amiloride • Central Sympatholytics Clonidine, Methyldopa. • Vasodilators Arteriolar - Hydralazine, Minoxidil Arteriolar & Venous - Sodium nitroprusside • Adrenergic neurone blocker Reserpine, Guanethidine
ACE INHIBITOR • ACE (Angiostensin converting enzyme) inhibitor is an agent which block the angiotensin converting enzyme which ultimately inhibit the conversion of Angiotensin - ɪɪ from Angiotensin - ɪ Classification of ACE Inhibitor 1. Direct action but internalized metabolite to disulphide group. Ex. captopril 2. Prodrug (Ester dicarboxylic acid) They have the effects when they are changed to active metabolized. Ex enalapril, benazepril 3. Soluble in water and not change in the body Ex. lisinopril
MECHANISM OF ACTION • The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance. • Block the ACE that cleaves angiotensin I to form the potent vasoconstrictor angiotensin II. • ACE inhibitors decrease angiotensin II and increase bradykinin levels. • ACE inhibitors also decrease the secretion of aldosterone, resulting in decreased sodium and water retention.
Drop in blood pressure Drop in fluid volume Angiotensinogen Angiotensin 1 Renin release from kidney Renin acts on Angiotensinogen to form ACE release from lungs ACE acts on Angiotensin 1 to form Angiotensin 2 Angiotensin 2 also acts directly on blood vessels, stimulating vasoconstriction Angiotensin 2 acts on adrenal gland to stimulate release of Aldsosterone RENIN ANGIOTENSIN SYSTEM NaCl H2O Aldosterone acts on Kidneys to stimulate reabsorption of salt & water ACE Inhibitors act on ACE to block conversion of Angiotensin 1 to 2
THERAPEUTIC USES Used in patients with • Cardiac failure • Renal disease • Systemic sclerosis • Diabetic nephropathy • Left ventricular hypertrophy
ADVERSE EFFECT • Dry cough • Rash • Fever • Hypotension (in hypovolemic states) • Hyperkalaemia • Fatigue • Angioedema • Headache • Dizziness
CONTRAINDICATION & PRECAUTION Contraindicated in patients with • Previous angioedema associated with ACE inhibitor therapy • Hypersensitivity to ACE inhibitors Should be used with caution in patients with • Impaired renal function • Hypovolemia or dehydration
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