This document summarizes the pharmacotherapy of hypertension. It begins by defining blood pressure and classifications of hypertension. It then discusses the goals of antihypertensive therapy and classifications of commonly used drug classes including: diuretics, adrenoceptor antagonists, renin-angiotensin system agents, calcium channel blockers, and other centrally acting drugs. Specific examples are provided within each drug class along with their mechanisms of action and uses for treating hypertension.
This document discusses various drug classes used to treat hypertension. It describes how diuretics, sympathoplegic drugs, alpha-2 agonists, beta blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers are used to lower blood pressure through different mechanisms like reducing blood volume, blocking sympathetic nervous system effects, vasodilation, and inhibiting the renin-angiotensin system. It also covers approaches to treatment, including stepped care using multiple drug classes, monotherapy with a single drug, and emergent treatment of hypertensive crisis with intravenous vasodilators.
This document provides an overview of hypertension including its classification, types, signs and symptoms, causes, and treatment. It defines hypertension as having a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. The document classifies hypertension and discusses the types of essential and secondary hypertension. It outlines the signs and symptoms of hypertension and discusses its causes. The document then describes the classification and mechanisms of antihypertensive drugs and provides details on drug classes including diuretics, ACE inhibitors, calcium channel blockers, and others. It discusses treatment approaches for hypertension and managing hypertensive emergencies.
This document discusses hypertension and its treatment. It defines hypertension as a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. It describes the types of hypertension as essential, secondary, and environmental. Treatment of hypertension is important to prevent damage to blood vessels and organs like the heart, brain, and kidneys. Several classes of antihypertensive drugs are discussed in detail, including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. The renin-angiotensin system and how ACE inhibitors work to treat hypertension by inhibiting the conversion of angiotensin I to angiotensin II are also
This document discusses antihypertensive drugs used to treat hypertension. It begins by defining hypertension and describing the types. It then classifies and describes the mechanisms and examples of major classes of antihypertensive drugs, including ACE inhibitors like enalapril, lisinopril, and ramipril, ARBs like telmisartan and valsartan, calcium channel blockers, beta blockers, and diuretics. For some of the drugs, it provides their chemical structure, mechanism of action, brand/generic names, and references. In summary, the document categorizes and explains the common classes and examples of pharmaceuticals used to lower blood pressure in hypertensive patients.
Sympatholytics, also known as adrenergic antagonists or blocking agents, work in opposition to adrenergic agents by blocking alpha and beta receptor sites. They are classified based on the type of adrenergic receptor they block, including alpha1, alpha2, beta1, beta2, and beta3 receptors. Common alpha blockers include phenoxybenzamine, ergot alkaloids, phentolamine, tolazoline, prazosin, terazosin, doxazosin, and tamsulosin. Common beta blockers mentioned include propanolol, acetabutolol, atenolol, betaxolol, carvedilol, metoprol
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 discusses angiotensin receptor blockers (ARBs) which are used to treat hypertension and other cardiovascular conditions. It notes that ARBs work by competitively blocking the angiotensin receptor type 1, leading to vasodilation and other effects. Some examples of individual ARB drugs are provided like losartan, candesartan, and valsartan. The document compares ARBs to ACE inhibitors, noting that ARBs do not cause cough like ACE inhibitors. It concludes by discussing the theoretical rationale and benefits of combining ARBs with ACE inhibitors to more completely suppress the renin-angiotensin system.
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 discusses various drug classes used to treat hypertension. It describes how diuretics, sympathoplegic drugs, alpha-2 agonists, beta blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers are used to lower blood pressure through different mechanisms like reducing blood volume, blocking sympathetic nervous system effects, vasodilation, and inhibiting the renin-angiotensin system. It also covers approaches to treatment, including stepped care using multiple drug classes, monotherapy with a single drug, and emergent treatment of hypertensive crisis with intravenous vasodilators.
This document provides an overview of hypertension including its classification, types, signs and symptoms, causes, and treatment. It defines hypertension as having a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. The document classifies hypertension and discusses the types of essential and secondary hypertension. It outlines the signs and symptoms of hypertension and discusses its causes. The document then describes the classification and mechanisms of antihypertensive drugs and provides details on drug classes including diuretics, ACE inhibitors, calcium channel blockers, and others. It discusses treatment approaches for hypertension and managing hypertensive emergencies.
This document discusses hypertension and its treatment. It defines hypertension as a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. It describes the types of hypertension as essential, secondary, and environmental. Treatment of hypertension is important to prevent damage to blood vessels and organs like the heart, brain, and kidneys. Several classes of antihypertensive drugs are discussed in detail, including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. The renin-angiotensin system and how ACE inhibitors work to treat hypertension by inhibiting the conversion of angiotensin I to angiotensin II are also
This document discusses antihypertensive drugs used to treat hypertension. It begins by defining hypertension and describing the types. It then classifies and describes the mechanisms and examples of major classes of antihypertensive drugs, including ACE inhibitors like enalapril, lisinopril, and ramipril, ARBs like telmisartan and valsartan, calcium channel blockers, beta blockers, and diuretics. For some of the drugs, it provides their chemical structure, mechanism of action, brand/generic names, and references. In summary, the document categorizes and explains the common classes and examples of pharmaceuticals used to lower blood pressure in hypertensive patients.
Sympatholytics, also known as adrenergic antagonists or blocking agents, work in opposition to adrenergic agents by blocking alpha and beta receptor sites. They are classified based on the type of adrenergic receptor they block, including alpha1, alpha2, beta1, beta2, and beta3 receptors. Common alpha blockers include phenoxybenzamine, ergot alkaloids, phentolamine, tolazoline, prazosin, terazosin, doxazosin, and tamsulosin. Common beta blockers mentioned include propanolol, acetabutolol, atenolol, betaxolol, carvedilol, metoprol
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 discusses angiotensin receptor blockers (ARBs) which are used to treat hypertension and other cardiovascular conditions. It notes that ARBs work by competitively blocking the angiotensin receptor type 1, leading to vasodilation and other effects. Some examples of individual ARB drugs are provided like losartan, candesartan, and valsartan. The document compares ARBs to ACE inhibitors, noting that ARBs do not cause cough like ACE inhibitors. It concludes by discussing the theoretical rationale and benefits of combining ARBs with ACE inhibitors to more completely suppress the renin-angiotensin system.
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 discusses the role of beta blockers in the treatment of hypertension. It covers the pharmacodynamics and pharmacokinetics of beta blockers, specific agents used, their adverse effects, history of use, and concerns regarding their use. While beta blockers were previously considered first-line treatment for hypertension, more recent trials have shown other agents may provide better outcomes. However, beta blockers are still important treatment options, especially newer vasodilating agents like nebivolol and carvedilol which have shown benefits over older non-vasodilating beta blockers.
This presentation deals with the beta blockers commonly used in day-to-day practice alongwith some interesting mnemonics to remember their names & site of action
This document summarizes several classes of antihypertensive drugs, including their mechanisms of action and effects. It discusses diuretics, ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, alpha-blockers, centrally acting drugs, and vasodilators. For each class, it describes their advantages and disadvantages in treating hypertension, as well as recommendations for use.
Antiarrhythmic drugs are used to prevent or treat irregularities in cardiac rhythm caused by disturbances in the heart's electrical impulses. The drugs work by reducing abnormal pacemaker activity or modifying conduction to disable reentrant circuits. Quinidine is a Class IA drug that blocks sodium channels, prolonging the action potential and increasing the refractory period. It can treat both atrial and ventricular arrhythmias but causes side effects like cinchonism. Procainamide is also a Class IA drug that works similarly to quinidine to treat ventricular and some supraventricular arrhythmias but has more ganglionic blocking effects and can cause lupus-like symptoms.
1. Antiplatelet drugs work by inhibiting platelet aggregation which is essential for forming blood clots. They are used to prevent thrombus formation in certain pathological conditions.
2. There are several classes of antiplatelet drugs including aspirin, clopidogrel, abciximab which work via different mechanisms such as inhibiting thromboxane A2, blocking ADP receptors, or inhibiting the glycoprotein IIb/IIIa receptor.
3. Fibrinolytics like streptokinase, alteplase work by activating plasminogen to plasmin to break down fibrin clots and are indicated for pulmonary embolism, myocardial infarction, and ischemic stroke. The major risks are bleeding complications.
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.
This presentation deals with the most common antihypertensive drugs used in our day-to-day practice. The common 4 ABCDs (Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretics)
Anti hypertensives and diuretics drugs - pharmacology Areej Abu Hanieh
Hypertension is defined as blood pressure greater than 140/90 mmHg. It can be caused by increased vascular resistance or reduced venous capacitance. While often asymptomatic, long term effects include strokes, heart failure, kidney damage, etc. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, ACE inhibitors, and calcium channel blockers to lower blood pressure and reduce risks. Careful management is needed as uncontrolled hypertension can lead to serious health issues.
This document discusses various classes of antihypertensive drugs used to treat hypertension. It defines hypertension as a systolic blood pressure over 140 mmHg or diastolic over 90 mmHg based on JNC-VII and WHO-ISH guidelines. The main classes discussed are diuretics, ACE inhibitors, calcium channel blockers, beta blockers, alpha blockers, and vasodilators. For each class, some examples are provided along with their mechanisms of action, pharmacokinetics, uses, and potential adverse effects. The document provides a comprehensive overview of the major antihypertensive drug classes and how they are used to lower blood pressure.
Alpha blockers work by blocking alpha-1 and alpha-2 adrenergic receptors. They can be classified as non-selective or selective. Non-selective alpha blockers like phentolamine cause vasodilation and reduce blood pressure but can also cause side effects like nasal congestion and hypotension. Selective alpha-1 blockers like prazosin, terazosin, and doxazosin are used to treat hypertension and benign prostatic hyperplasia as they cause less side effects. Newer drugs like tamsulosin and alfuzosin are more uroselective and effective for treating BPH with minimal effects on blood pressure. Alpha blockers have various clinical uses including treatment of phae
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
This document discusses alpha blockers, which are drugs that inhibit the interaction of hormones like norepinephrine with alpha receptors. It describes their classification as selective or non-selective, their functions in relaxing smooth muscle and reducing vasoconstriction, and individual drugs like prazosin, terazosin, and doxazosin. These drugs are important in managing conditions like pheochromocytoma, benign prostatic hyperplasia, hypertension, and peripheral vascular disease, but can cause adverse effects like postural hypotension and reflex tachycardia.
This document summarizes various classes of antihypertensive drugs. It discusses how diuretics like thiazide and loop diuretics work to reduce blood pressure by increasing sodium excretion. It also covers ACE inhibitors which work by inhibiting angiotensin-converting enzyme and blocking vasoconstriction and sodium retention. Angiotensin receptor blockers produce similar effects. Other classes discussed include beta blockers, alpha blockers, direct renin inhibitors, calcium channel blockers, and central sympatholytics. Specific drugs within each class are provided along with their mechanisms and uses for treating hypertension.
Drugs used in ischaemic heart disease 2Pravin Prasad
This document discusses drugs used to treat ischemic heart disease. It compares classes of calcium channel blockers and describes how they work by blocking calcium channels. Verapamil, diltiazem, and dihydropyridines like amlodipine are discussed. Other anti-anginal drugs mentioned include trimetazidine, ranolazine, ivabradine, and dipyridamole. The document also reviews drug combinations used for angina, noting that beta blockers should not be combined with verapamil or diltiazem.
This document discusses the overall actions of adrenaline and noradrenaline on various body systems. It describes how these drugs act on adrenergic receptors to increase heart rate and contractility, increase blood pressure through vasoconstriction and increased peripheral resistance, and cause bronchodilation. The document also outlines the therapeutic uses of adrenergic drugs in conditions like hypotension, asthma, obesity, and uterine relaxation.
Hypertension, or high blood pressure, is a common cardiovascular disease defined by elevated blood pressure in the arteries. It is categorized based on systolic and diastolic blood pressure readings into prehypertension, stage 1 hypertension, stage 2 hypertension, and stage 3 hypertension. There are many risk factors that can contribute to hypertension, and it is classified as either essential or secondary hypertension. Treatment involves use of several classes of antihypertensive drugs, including diuretics, sympatholytics, beta blockers, calcium channel blockers, ACE inhibitors, and others. These drugs work to lower blood pressure through various mechanisms like reducing fluid volume, decreasing sympathetic nervous system activity, blocking adrenoreceptor sites, and inhibiting the renin
John experiences seasonal allergies each winter, taking an over-the-counter antihistamine that makes him drowsy and causes dry mouth. His doctor diagnoses him with allergies and prescribes loratadine, a second-generation antihistamine that relieves his symptoms without adverse effects. Antihistamines work by blocking histamine H1 receptors to reduce allergic responses. First-generation antihistamines are more sedating due to additional anticholinergic effects, while second-generation antihistamines like loratadine selectively block H1 receptors without crossing the blood-brain barrier.
This document summarizes a seminar on hypertension and antihypertensive drugs presented by Debam Chakrabarty. It defines hypertension and blood pressure, describes symptoms of hypertension. It also explains what antihypertensive drugs are, how they work, and examples of different classes of antihypertensive drugs. The document lists side effects of various antihypertensive drugs and natural ways to treat hypertension. It also discusses the structure and synthesis of some antihypertensive drugs and provides updates on new antihypertensive drugs under development.
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.
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 discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
- The document discusses the etiology, treatment, and classifications of antihypertensive drugs for hypertension. It covers drugs that alter sodium/water balance (diuretics), inhibit the sympathetic system (beta-blockers, alpha-blockers, centrally-acting drugs), are direct vasodilators (calcium channel blockers, hydralazine, minoxidil), and block the renin-angiotensin-aldosterone system (ACE inhibitors, ARBs). The classifications are based on mechanisms of action and sites of regulation in the body. Side effects and clinical uses are discussed for each drug class.
This document discusses the role of beta blockers in the treatment of hypertension. It covers the pharmacodynamics and pharmacokinetics of beta blockers, specific agents used, their adverse effects, history of use, and concerns regarding their use. While beta blockers were previously considered first-line treatment for hypertension, more recent trials have shown other agents may provide better outcomes. However, beta blockers are still important treatment options, especially newer vasodilating agents like nebivolol and carvedilol which have shown benefits over older non-vasodilating beta blockers.
This presentation deals with the beta blockers commonly used in day-to-day practice alongwith some interesting mnemonics to remember their names & site of action
This document summarizes several classes of antihypertensive drugs, including their mechanisms of action and effects. It discusses diuretics, ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, alpha-blockers, centrally acting drugs, and vasodilators. For each class, it describes their advantages and disadvantages in treating hypertension, as well as recommendations for use.
Antiarrhythmic drugs are used to prevent or treat irregularities in cardiac rhythm caused by disturbances in the heart's electrical impulses. The drugs work by reducing abnormal pacemaker activity or modifying conduction to disable reentrant circuits. Quinidine is a Class IA drug that blocks sodium channels, prolonging the action potential and increasing the refractory period. It can treat both atrial and ventricular arrhythmias but causes side effects like cinchonism. Procainamide is also a Class IA drug that works similarly to quinidine to treat ventricular and some supraventricular arrhythmias but has more ganglionic blocking effects and can cause lupus-like symptoms.
1. Antiplatelet drugs work by inhibiting platelet aggregation which is essential for forming blood clots. They are used to prevent thrombus formation in certain pathological conditions.
2. There are several classes of antiplatelet drugs including aspirin, clopidogrel, abciximab which work via different mechanisms such as inhibiting thromboxane A2, blocking ADP receptors, or inhibiting the glycoprotein IIb/IIIa receptor.
3. Fibrinolytics like streptokinase, alteplase work by activating plasminogen to plasmin to break down fibrin clots and are indicated for pulmonary embolism, myocardial infarction, and ischemic stroke. The major risks are bleeding complications.
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.
This presentation deals with the most common antihypertensive drugs used in our day-to-day practice. The common 4 ABCDs (Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretics)
Anti hypertensives and diuretics drugs - pharmacology Areej Abu Hanieh
Hypertension is defined as blood pressure greater than 140/90 mmHg. It can be caused by increased vascular resistance or reduced venous capacitance. While often asymptomatic, long term effects include strokes, heart failure, kidney damage, etc. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, ACE inhibitors, and calcium channel blockers to lower blood pressure and reduce risks. Careful management is needed as uncontrolled hypertension can lead to serious health issues.
This document discusses various classes of antihypertensive drugs used to treat hypertension. It defines hypertension as a systolic blood pressure over 140 mmHg or diastolic over 90 mmHg based on JNC-VII and WHO-ISH guidelines. The main classes discussed are diuretics, ACE inhibitors, calcium channel blockers, beta blockers, alpha blockers, and vasodilators. For each class, some examples are provided along with their mechanisms of action, pharmacokinetics, uses, and potential adverse effects. The document provides a comprehensive overview of the major antihypertensive drug classes and how they are used to lower blood pressure.
Alpha blockers work by blocking alpha-1 and alpha-2 adrenergic receptors. They can be classified as non-selective or selective. Non-selective alpha blockers like phentolamine cause vasodilation and reduce blood pressure but can also cause side effects like nasal congestion and hypotension. Selective alpha-1 blockers like prazosin, terazosin, and doxazosin are used to treat hypertension and benign prostatic hyperplasia as they cause less side effects. Newer drugs like tamsulosin and alfuzosin are more uroselective and effective for treating BPH with minimal effects on blood pressure. Alpha blockers have various clinical uses including treatment of phae
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
This document discusses alpha blockers, which are drugs that inhibit the interaction of hormones like norepinephrine with alpha receptors. It describes their classification as selective or non-selective, their functions in relaxing smooth muscle and reducing vasoconstriction, and individual drugs like prazosin, terazosin, and doxazosin. These drugs are important in managing conditions like pheochromocytoma, benign prostatic hyperplasia, hypertension, and peripheral vascular disease, but can cause adverse effects like postural hypotension and reflex tachycardia.
This document summarizes various classes of antihypertensive drugs. It discusses how diuretics like thiazide and loop diuretics work to reduce blood pressure by increasing sodium excretion. It also covers ACE inhibitors which work by inhibiting angiotensin-converting enzyme and blocking vasoconstriction and sodium retention. Angiotensin receptor blockers produce similar effects. Other classes discussed include beta blockers, alpha blockers, direct renin inhibitors, calcium channel blockers, and central sympatholytics. Specific drugs within each class are provided along with their mechanisms and uses for treating hypertension.
Drugs used in ischaemic heart disease 2Pravin Prasad
This document discusses drugs used to treat ischemic heart disease. It compares classes of calcium channel blockers and describes how they work by blocking calcium channels. Verapamil, diltiazem, and dihydropyridines like amlodipine are discussed. Other anti-anginal drugs mentioned include trimetazidine, ranolazine, ivabradine, and dipyridamole. The document also reviews drug combinations used for angina, noting that beta blockers should not be combined with verapamil or diltiazem.
This document discusses the overall actions of adrenaline and noradrenaline on various body systems. It describes how these drugs act on adrenergic receptors to increase heart rate and contractility, increase blood pressure through vasoconstriction and increased peripheral resistance, and cause bronchodilation. The document also outlines the therapeutic uses of adrenergic drugs in conditions like hypotension, asthma, obesity, and uterine relaxation.
Hypertension, or high blood pressure, is a common cardiovascular disease defined by elevated blood pressure in the arteries. It is categorized based on systolic and diastolic blood pressure readings into prehypertension, stage 1 hypertension, stage 2 hypertension, and stage 3 hypertension. There are many risk factors that can contribute to hypertension, and it is classified as either essential or secondary hypertension. Treatment involves use of several classes of antihypertensive drugs, including diuretics, sympatholytics, beta blockers, calcium channel blockers, ACE inhibitors, and others. These drugs work to lower blood pressure through various mechanisms like reducing fluid volume, decreasing sympathetic nervous system activity, blocking adrenoreceptor sites, and inhibiting the renin
John experiences seasonal allergies each winter, taking an over-the-counter antihistamine that makes him drowsy and causes dry mouth. His doctor diagnoses him with allergies and prescribes loratadine, a second-generation antihistamine that relieves his symptoms without adverse effects. Antihistamines work by blocking histamine H1 receptors to reduce allergic responses. First-generation antihistamines are more sedating due to additional anticholinergic effects, while second-generation antihistamines like loratadine selectively block H1 receptors without crossing the blood-brain barrier.
This document summarizes a seminar on hypertension and antihypertensive drugs presented by Debam Chakrabarty. It defines hypertension and blood pressure, describes symptoms of hypertension. It also explains what antihypertensive drugs are, how they work, and examples of different classes of antihypertensive drugs. The document lists side effects of various antihypertensive drugs and natural ways to treat hypertension. It also discusses the structure and synthesis of some antihypertensive drugs and provides updates on new antihypertensive drugs under development.
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.
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 discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
- The document discusses the etiology, treatment, and classifications of antihypertensive drugs for hypertension. It covers drugs that alter sodium/water balance (diuretics), inhibit the sympathetic system (beta-blockers, alpha-blockers, centrally-acting drugs), are direct vasodilators (calcium channel blockers, hydralazine, minoxidil), and block the renin-angiotensin-aldosterone system (ACE inhibitors, ARBs). The classifications are based on mechanisms of action and sites of regulation in the body. Side effects and clinical uses are discussed for each drug class.
Medicinal Chemistry of Antihypertensive agents pptxSameena Ramzan
This document provides an overview of antihypertensive agents. It begins with an introduction to hypertension and classifications of hypertension. It then discusses the pharmacological classifications of antihypertensive drugs and provides details on the synthesis, mechanisms of action, adverse effects and dosage of various classes of antihypertensive agents including diuretics, ACE inhibitors, calcium channel blockers, beta-blockers, central sympatholytics, and arterial dilators. It also discusses structure-activity relationships of ACE inhibitors and ARBs. The document aims to inform healthcare professionals about the different types of antihypertensive drugs.
1. The document discusses cardiovascular pharmacology, focusing on drugs used to treat hypertension and heart failure.
2. Several classes of antihypertensive drugs are described, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and vasodilators.
3. Drugs used to treat heart failure that are mentioned include diuretics, ACE inhibitors, beta-blockers, and vasodilators.
Hypertension is a major health problem affecting 25% of adults and 50% of those over 60. It causes dangerous complications like heart attack, heart failure, stroke, and renal failure. The causes are mostly unknown except for 5% of secondary cases. Lifestyle modifications like reduced salt and fat intake, weight loss, exercise, and stopping smoking are beneficial for reducing blood pressure and complications. There are several classes of antihypertensive drugs that work through different mechanisms like reducing blood volume and pressure, blocking nerve signals, dilating blood vessels, and inhibiting hormone systems. The choice of drugs depends on individual patient factors and risks.
This document discusses antihypertensive drugs used to treat hypertension. It defines hypertension and its causes. It then classifies and describes the mechanisms and properties of major classes of antihypertensive drugs, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. For each class, it provides details on representative drugs, dosages, effects, advantages, and disadvantages in treating hypertension.
This document discusses hypertension and its treatment with antihypertensive drugs. It defines hypertension and its classification. It then describes various classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, sympatholytics, beta blockers, calcium channel blockers, vasodilators and their mechanisms of action, side effects and uses. It concludes with nursing implications of administering antihypertensive drugs like monitoring for hypotension and palpitations.
This document discusses antihypertensive drugs. It defines hypertension and describes its causes and classifications. It then discusses the body's mechanisms for controlling blood pressure via the baroreflex and renin-angiotensin-aldosterone system. The goals of treatment are to reduce cardiovascular risks. First-line therapies include thiazide diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and their adverse effects.
This document discusses antihypertensive drugs. It begins by defining hypertension and describing the types and outcomes of hypertension. It then covers the normal blood pressure regulation mechanisms. The document classifies antihypertensive drugs into several categories including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. For each drug class, it provides examples, discusses the mechanism of action, desirable properties, and drawbacks. It concludes by discussing the current treatment approaches and guidelines for selecting antihypertensive drugs.
This document discusses antihypertensive drugs. It begins by defining hypertension and describing the types and outcomes of hypertension. It then covers the normal blood pressure regulation mechanisms. The document classifies antihypertensive drugs into several categories including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. For each drug class, it provides examples, discusses the mechanism of action, desirable properties, and drawbacks. It concludes by discussing the current treatment approaches and guidelines for selecting antihypertensive drugs.
Hello friends. In this PPT I am talking about Cardiovascular system drugs. If you like it, please do let me know in the comments section. A single word of appreciation from you will encourage me to make more of such videos. Thanks. Enjoy and welcome to the beautiful world of pharmacology where pharmacology comes to life. This video is intended for MBBS, BDS, paramedical and any person who wishes to have a basic understanding of the subject in the simplest way.
Cardiovascular drugs affect the circulatory system. This document discusses several classes of drugs used to treat cardiovascular conditions like hypertension, congestive heart failure, arrhythmias, angina, hyperlipidemia, and thrombosis. It describes common antihypertensive drugs including diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and ARBs. It also lists drugs used for congestive heart failure, arrhythmias, angina, hyperlipidemia, thrombolysis, and anticoagulation.
Pharmacology of Hypertension.
Pulmonary Hypertension.
Regulation of blood pressure.
Classification of Anti-Hypertensive drugs.
Treatment of Hypertension.
Diuretics.
This document summarizes drugs used to treat congestive cardiac failure (CCF), including their mechanisms and side effects. Key drugs include:
- Diuretics like furosemide to reduce edema.
- ACE inhibitors and ARBs like enalapril and losartan which reduce mortality by inhibiting vasoconstriction and sodium retention.
- Beta blockers like carvedilol and metoprolol which reduce disease progression and mortality in chronic CCF despite earlier concerns.
- Digoxin increases contractility and slows heart rate but can cause arrhythmias at high doses requiring monitoring.
This document discusses drugs used to treat cardiac failure. It begins by defining cardiac failure and ejection fraction. The main treatments discussed are:
1. ACE inhibitors to reduce preload and afterload.
2. Diuretics like thiazides and loop diuretics to increase salt and water loss and reduce blood volume.
3. Cardiac glycosides like digoxin which have a positive inotropic effect to increase contractility without increasing oxygen consumption.
4. Other drugs discussed include beta-blockers, aldosterone antagonists, organic nitrates, calcium sensitizers, and inotropic drugs for acute heart failure. The document provides details on the mechanisms and uses of these
The document discusses antihypertensive agents, providing an overview and classification of types including diuretics, beta blockers, calcium channel blockers, and their mechanisms of action. It covers the indications, dosages, side effects, and toxicity management of these classes of antihypertensive drugs used to treat hypertension.
The drug that is absolutely contraindicated in pregnancy is losartan, an angiotensin II receptor blocker (ARB). While all antihypertensives should be used cautiously in pregnancy, ARBs like losartan are contraindicated due to the risk of fetal harm, including the possibility of fetal death. Atenolol, methyldopa, nifedipine and propranolol can be used in pregnancy with appropriate monitoring by an obstetrician. The answer is B.
This document provides information on antihypertensive drugs. It defines hypertension as elevated blood pressure and discusses its classification. The mechanisms involved in hypertension development include increased heart rate, stroke volume, cardiac output, peripheral vascular resistance, and vasoconstriction. Antihypertensive drug classes include those that inhibit the renin-angiotensin-aldosterone system, sympathetic nervous system, calcium channels, and drugs that cause vasodilation or diuresis. Specific drug mechanisms and examples from each class are described along with their advantages and adverse effects in summarizing the pharmacology of antihypertensive treatment options.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
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12. Comprehend the vectorial analysis of the normal ECG
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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3. Definition:
The first number, called systolic blood pressure, measures the
pressure in arteries when heart beats.
The second number, called diastolic blood pressure, measures the
pressure in arteries when heart rests between beats.
If the measurement reads 120 systolic and 80 diastolic, you would
say, “120 over 80,” or write, “120/80 mmHg.”
4. BP=CO X TPR
Cardiac output affecting factors: Heart rate, Stroke volume,
Velocity flow, Cross section of blood vessels etc.
Total Peripheral Resistance affecting factors: Blood viscosity,
blood vessels radius and length, Blood Flow (Laminar, Turbulent)
etc.
Risk Factors:
5. Hypertension is classified into: On aetiology
Primary hypertension: hypertension without any identifiable medical
cause (>95%).
Environmental
Genetic
Secondary hypertension: hypertension due to a specific medical
pathology (<5%).
6.
7. The current NICE guidelines (2011) have graded hypertension as:
According to JAC-10 & AHA guidelines:
8.
9.
10.
11.
12.
13. A. Principles of blood pressure regulation
1. Blood pressure is regulated by the following:
a. Cardiac output
b. Peripheral vascular resistance
c. Volume of intravascular fluid (controlled at the kidney)
2. Baroreflexes adjust moment-to-moment blood pressure. Carotid
baroreceptors respond to stretch, and their activation inhibits
sympathetic discharge.
3. The renin–angiotensin system provides tonic, longer-term regulation
of blood pressure. Reduction in renal perfusion pressure results in
increased reabsorption of salt and water. Decreased renal pressure
stimulates renin production and leads to enhanced levels of
angiotensin II. This agent in turn causes resistance vessels to
constrict and stimulates aldosterone synthesis, which ultimately
increases the absorption of sodium by the kidney
14. B. Goal of therapy
1. The goal of therapy is to reduce elevated blood pressure, which
would ultimately lead to end organ damage, increased risk of
stroke, and MI.
2. This goal is achieved through the use of various drug classes, and
treatment often involves a combination of agents
15.
16.
17. I. Diuretics increase sodium excretion and lower blood volume.
1. Thiazide diuretics
a. Thiazide diuretics are effective in lowering blood pressure 10–15
mm Hg.
b. When administered alone, thiazide diuretics can provide relief for
mild or moderate hypertension.
c. Thiazide diuretics are used in combination with sympatholytic
agents or vasodilators in severe hypertension.
2. Loop diuretics are used in combination with sympatholytic agents
and vasodilators for hypertension refractory to thiazide treatment.
3. Potassium-sparing diuretics are used to avoid potassium depletion,
especially when administered with cardiac glycosides.
eg: Spironolactone, Eplerenone.
18. II. Adrenoceptor antagonists
1. β-Adrenoceptor antagonists (Beta blockers)
a. Propranolol
(1) Propranolol antagonizes catecholamine action at both β1- and
β2-receptors. It produces sustained reduction in peripheral
vascular resistance.
(2) Blockade of cardiac β1-adrenoceptors reduces heart rate and
contractility. β2- Adrenoceptor blockade increases airway
resistance and decreases catecholamine induced glycogenolysis
and peripheral vasodilation.
(3) Blockade of β-adrenoceptors in the CNS decreases sympathetic
activity.
(4) Propranolol also decreases renin release.
(5) Propranolol is used in mild-to-moderate hypertension
19. b. Nadolol , timolol, carteolol, pindolol, penbutolol
(1) These drugs are similar in action to propranolol and block both
β1- and β2- adrenoceptors.
(2) Nadolol has an extended duration of action.
(3) Pindolol, carteolol, and penbutolol have partial agonist activity
(sympathomimetic).
c. Metoprolol, atenolol, acebutolol, bisprolol
(1) These drugs are relatively selective for β1-adrenoceptors.
(2) Acebutolol has partial agonist activity.
d. Abrupt discontinuation of β -adrenoceptor blockers can worsen
angina and increase risk of MI. Dose should be gradually
reduced over a period of several weeks.
20. 2. α-Adrenoceptor antagonists
a. α -Adrenoceptor antagonists lower total peripheral resistance by
preventing stimulation (and consequent vasoconstriction) of α -
receptors, which are located predominantly in resistance vessels
of the skin, mucosa, intestine, and kidney.
These drugs reduce pressure by dilating resistance and
conductance vessels.
b. The effectiveness of these drugs diminishes in some patients
because of tolerance.
(1) Prazosin, terazosin, and doxazosin
(a) These drugs are α 1-selective antagonists.
(b) These drugs are used in treating hypertension, especially in the
presence of CHF but use has diminished because no evidence of
reduced cardiovascular events with doxazosin was found in a
large clinical trial.
21. (c) Prazosin, terazosin, and doxazosin are often administered with a
diuretic and a β-drenoceptor antagonist.
(d) These drugs may produce initial orthostatic hypotension. Other
adverse effects are minimal.
(2) Phentolamine and phenoxybenzamine
(a) Phentolamine and phenoxybenzamine antagonize α 1- and α 2-
adrenoceptors.
(b) These drugs are used primarily in treating hypertension in the
presence of pheochromocytoma.
Phentolamine is administered parenterally; phenoxybenzamine is
administered orally
22. 3. Labetalol and carvedilol
a. Labetalol is an α - and β-adrenoceptor antagonist.
b. Labetalol reduces heart rate and contractility, slows AV
conduction, and decreases peripheral resistance.
c. Labetalol is available for both oral and IV administration.
d. Labetalol is useful for treating hypertensive emergencies and in the
treatment of hypertension of pheochromocytoma.
e. Labetalol does not cause reflex tachycardia.
f. Carvedilol has a significantly greater ratio of β to α antagonist
activity than labetalol.
23. III. Agents that affect the renin–angiotensin system
1. Angiotensin converting enzyme (ACE) inhibitors
a. ACE inhibitors reduce vascular resistance and blood volume; they
lower blood pressure by decreasing total peripheral resistance.
b. ACE inhibitors include captopril , enalapril, lisinopril, ramipril,
fosinopril , benazepril, moexipril, quinapril, perindopril, and trandolapril.
c. These drugs are useful in treating mild-to-severe hypertension. Recent
studies have established beneficial effect in patients with angina, CHF,
cardiac ischemia, and post-MI.
d. ACE inhibitors may be less effective in African Americans than in
Caucasians.
24. 2. Angiotensin II receptor antagonists: losartan potassium
a. These drugs block angiotensin II type-1 (AT-1) receptors.
b. The effects of these drugs are similar to those seen with ACE
inhibitors.
c. These drugs are effective as monotherapy for hypertension.
3. Inhibitors of renin activity: aliskiren
a. Aliskiren inhibits renin and thereby reduces the production of all
angiotensins.
b. Initial clinical trials have combined aliskiren with a diuretic or an
ARB and its effectiveness seems comparable to ARBs.
c. Adverse effects are fewer compared to ACE inhibitors but include
diarrhea, headache, and dizziness
25. IV. Calcium channel-blocking agents
1. Calcium channel-blocking (CCB) agents inhibit the entry of
calcium into cardiac and smooth muscle cells by blocking the L-
type Ca2+-channel; they lower blood pressure by reducing
peripheral resistance.
2. CCBs used for treatment of hypertension include verapamil,
nifedipine, nicardipine, nisoldipine , isradipine, amlodipine ,
felodipine , and diltiazem.
3. CCBs are effective in the treatment of mild-to-moderate
hypertension.
4. When combined with a β-adrenoceptor antagonist, these agents may
lower blood pressure to a greater extent than when either class of
drug is administered separately.
5. Short-acting preparations of the dihydropyridines such as nifedipine
have been associated with an increase in cardiovascular mortality
and events, including MI and increased anginal attacks.
26. V. Other drugs
1. Centrally acting sympathomimetic agents reduce peripheral
resistance, inhibit cardiac function, and increase pooling in
capacitance venules.
a. Methyldopa
(1) Methyldopa has an active metabolite, a-methyl-norepinephrine, a
potent false neurotransmitter.
(2) Methyldopa activates pre-synaptic inhibitory α-adrenoceptors and
postsynaptic α2- receptors in the CNS and reduces sympathetic
outflow. It decreases total peripheral resistance.
(3) Methyldopa reduces pressure in standing and supine positions.
(4) Methyldopa is used to treat mild-to-moderate hypertension; it can
be added to the regimen when a diuretic alone is not successful.
(5) Methyldopa produces adverse effects that include drowsiness, dry
mouth, and GI upset. Sexual dysfunction may occur and reduce
compliance.
27. b. Clonidine
(1) Clonidine stimulates postsynaptic α 2-adrenoceptors in the central
nervous system (CNS) and causes reduction in total peripheral
resistance.
(2) Clonidine is frequently combined with a diuretic.
(3) Clonidine commonly produces drowsiness and lethargy, dry mouth,
and constipation.
(4) This drug is available as a transdermal patch (Catapres-TTS) that
allows weekly dosing.
28. c. Guanabenz acetate
(1) Guanabenz acetate activates central α 2-adrenoceptors and
inhibits sympathetic outflow from the brain, which results in
reduced blood pressure.
(2) This drug is used in mild-to-moderate hypertension, most
commonly in combination with a diuretic.
(3) Guanabenz acetate most commonly produces sedation and dry
mouth as adverse effects but with reduced frequency compared to
clonidine.
29. 2. Adrenergic neuronal blocking drugs
a. Reserpine
(1) Reserpine eliminates norepinephrine release in response to nerve
impulse by preventing vesicular uptake. It depletes norepinephrine
from sympathetic nerve terminals in the periphery and in the
adrenal medulla.
(2) Reserpine is used in mild-to-moderate hypertension.
(3) Reserpine most commonly produces GI disturbances, Mental
depression, sometimes severe, may result, especially with high
doses; use of reserpine is contraindicated in patients with a history
of depression.
30. 3. Vasodilators
a. Vasodilators relax smooth muscle and lower total peripheral
resistance, thereby lowering blood pressure.
b. The use of vasodilators is declining as a result of newer modalities,
such as ACE inhibitors and calcium channel-blocking agents,
which are more effective with fewer adverse effects.
(1) Hydralazine
(a) Hydralazine reduces blood pressure directly by relaxing arteriolar
muscle. This effect is probably mediated by increasing K+ efflux
and decreasing Ca2+ influx, and increasing the production of nitric
oxide.
(b) Hydralazine elicits the baroreceptor reflex, necessitating
coadministration with a diuretic to counteract sodium and water
retention and a β-blocker to prevent tachycardia.
(c) This drug is used to treat chronic hypertension and in hypertensive
crises accompanying acute glomerular nephritis or eclampsia.
(d) Hydralazine may cause a lupusl ike syndrome
31. (2) Minoxidil
(a) Minoxidil has effects similar to hydralazine.
Minoxidil acts to increase K+ efflux, which hyperpolarizes cells and
reduces the activity of L-type (voltage-sensitive) calcium channels.
Minoxidil vasodilates predominantly arteriolar vessels.
(b) Minoxidil also elicits the baroreceptor reflex, necessitating use of a
beta-adrenoceptor antagonist and a diuretic.
(c) Minoxidil is useful for long-term therapy of refractory
hypertension.
(d) Minoxidil produces hirsutism, an advantage in formulations that
are now used to reduce hair loss in both males and females.
32. (3) Sodium nitroprusside
(a) It dilates both resistance and capacitance vessels; it increases heart
rate but not output.
(b) This drug is frequently used in hypertensive emergencies because
of its rapid action. Continuous infusion is necessary to maintain
effects.
(c) Sodium nitroprusside is usually administered with furosemide.
(d) On initial infusion, it may cause excessive vasodilation and
hypotension.
(e) This drug can be converted to cyanide and thiocyanate.
The accumulation of cyanide and risk of toxicity are minimized by
concomitant administration of sodium thiosulfate or
hydroxocobalamin.
33. (4) Diazoxide
(a) Diazoxide is used intravenously to reduce blood pressure rapidly,
usually in an emergency situation.
(b) Diazoxide is administered with furosemide to prevent fluid
overload.
(c) This drug is declining in use because of its unpredictable action and
adverse effects.
4. Fenoldopam is a selective agonist at dopamine DA1 receptors that
increases renal blood flow while reducing blood pressure.
Administered by infusion, it is a useful drug in the control of
emergency hypertension.
34. 5. Specialized vasodilators
a. Drugs used to treat pulmonary hypertension
(1) Ambrisentan is a selective endothelin A receptor antagonist used to
treat pulmory hypertension.
Plasma endothelin-1 is elevated in patients with pulmonary
hypertension. Ambrisentan is administered orally.
Peripheral edema is a common adverse effect of endothelin
receptor antagonists.
(2) Bosentan antagonizes both endothelin A and B receptors and
reduces pulmonary hypertension. Headache and edema are
common side effects.
(3) Use of both ambrisentan and bosentan is controlled by access
programs.
35. b. Drugs used to treat erectile dysfunction
(1) Drugs in this class include sildenafil citrate, tadalafil, and
vardenafil hydrochloride.
(2) Viagra was originally developed as an antianginal and
antihypertensive agent but proved very effective in treating
erectile dysfunction.
(3) These agents specifically inhibit phosphodiesterase type V, the
class of enzymes that are responsible for the breakdown of
cGMP.
The type V isoform is expressed in reproductive tissues and the
lung. Inhibition of the breakdown of cGMP enhances the
vasodilatory action of NO in the corpus callosum and in the
pulmonary vasculature.
36. (4) These agents are useful in the treatment of erectile dysfunction,
and sildenafil citrate is approved for treatment of pulmonary
hypertension.
(5) The most common adverse effects of the phosphodiesterase type
V inhibitors are headache, flushing, ocular disturbances, and
abdominal pain.
The most serious adverse effects are cardiovascular: arrhythmias,
heart block, cardiac arrest, stroke, and hypotension.
(6) These drugs are contraindicated in patients taking nitrates,
because of exacerbation of the effects of these drugs, or in patients
taking α1-adrenoceptor antagonists such as doxazosin.
37. Future Approach for HTN
1.Recent Trends-Drug based therapy
2.Newer approach- Gene therapy and vaccine therapy
3.Device based therapy
New targets and drugs
•RAS modulators- Pro rennin Receptor blockers-Handle region peptide
•Ang(1-7)/Mass receptor/ACE-2 Activator (DIZE)
Vaso peptide inhibitors: Neprilysin inhibitors (LCZ696)
Valsartan+Sacubitral)
ANP Agonists: PL-3994
Endothelin Converting Enzyme Inhibitors: Daglutril
Aldosterone synthase inhibitor: LCI 699, Fadrazole
38. 2.Gene based therapy:
Target: ACEII & AT2 receptor expression enhanced
(Adeniviral vactor—gene—Increase eNOS/NO)
Antisense gene for ACE &AT2 receptor
Vaccine: PMO 3117—Against Angiotensin-II
CYT 006-- Against Angiotensin-II
3.Device based therapy:
Renal Sympathetic denervation
Baro-reflex activation therapy
Arterio-Venous fistula
39. TREATMENT OF HYPERTENSION
The aim of antihypertensive therapy is to prevent morbidity and
mortality associated with raised BP.
Both systolic and diastolic BP predict the likelihood of target organ
damage (TOD)and complications such as:
• Cerebrovascular disease, TIA, stroke, encephalopathy.
• Hypertensive heart disease-left ventricular hypertrophy, HF.
• Coronary artery disease (CAD), angina, MI, sudden cardiac death.
• Arteriosclerotic PVD, retinopathy.
• Dissecting aneurysm of aorta.
• Glomerulopathy, renal failure.
Patients who have already suffered some TOD have greater risk of
further organ damage and death at any level of raised BP.
40. Risk of complications depends not only on the level of BP, but also
on other risk factors and existing target organ damage
41. The JNC8 have also identified compelling indications, mandate to
use of specific antihypertensive drugs with BP values lower than
140/90 mm Hg.
Moreover, presence of compelling indications may suggest fixing
a lower target BP value to be attained by drug therapy.
42. However, for patients aged ≥60 years the JNC 8 (2014) has
suggested threshold systolic BP value of 150 mm Hg for initiating
treatment, as well as to be the treatment goal (< 150 mm Hg).
The threshold and goal diastolic BP value of 90 mm Hg is the
same as for patients <60 years age.
Studies has shown that effective use of antihypertensive drugs
reduces occurrence of stroke by 30- 50%, HF by 40- 50% and
CAD by ~ 15%.
•If the cause of hypertension can be identified (hormonal, vascular
abnormality, tumour, renal disease, drugs) all efforts should be made
to remove it.
•Nonpharmacological measures(life style modification- diet. Na+
restriction, aerobic activity or exercise, wt reduction, mental
relaxation, etc.) should be tried first and concurrently with drugs.
45. HTN treatment: JNC 8 guidelines was released by the JNC ( joint national
committee ) in association with ACC ( American college of cardiology ) and AHA .
46.
47. Combination therapy
diuretics, vasodilators, CCBs,
ACEIs
β blockers, clonidine,
methyldopa
Plasma renin activity
All sympathetic inhibitors
(exp b blocker)&
vasodilators ( expt CCB)
diuretics Fluid retention
Hydralazine and DHPs β blockers Tachycardia
β blockers vasodilator. Initial increase in t.p.r
Combinations to be
avoided
α or β adrenergic blocker clonidine antagonism of clonidine at
presynaptic receptor
Hydralazine DHP or prazosin similar pattern of
haemodynamic action
Verapamil or diltiazem β blocker Marked bradycardia, A-V
block
48.
49.
50. Hypertensive emergency/ urgency
Hypertensive Urgency:
• Systolic BP > 220 or diastolic BP > 120 mm Hg without overt signs
of end organ damage
•Blood pressure should be reduced within few hours
Hypertensive Emergency:
• Evidence of active end organ damage is labelled
•Reduction of BP within 1 hour to avoid the risk of serious
morbidity or death.
Include
Hypertensive encephalopathy
hypertensive nephropathy, intracranial hemorrhage, aortic dissection,
preeclampsia-eclampsia, unstable angina, myocardial infarction.
51. • Initial goal – reduce no more than 25% (within minutes to 1 or 2 hrs)
level of 160/100 mm Hg within 2–6 hours.
• Excessive reductions – harmful - avoid sublingual or oral fast-acting
nifedipine
• In acute ischemic stroke antihypertensives should only be used if BP >
180–200 mm Hg, BP reduced by 10-15%
•In hemorrhagic stroke minimize MAP <130mmhg
• Nicardipine I.V.- Is better tolerated and less toxic than Nitroprusside.
52.
53. Hypertension in pregnancy:
• A sustained BP above 140/90 mm Hg during pregnancy has
implications both for the mother and the fetus:
Two types :
(a) A woman with pre-existing essential hypertension becomes
pregnant.
(b) Pregnancy induced hypertension; as in toxaemia of pregnancy—
preeclampsia
54. Antihypertensives found safer during pregnancy:
Hydralazine and Methyldopa (a positive Coombs’ test occurs,
but has no adverse implication).
Dihydropyridine CCBs: if used, they should be discontinued
before labour as they weaken uterine contractions.
Cardio selective β blockers and those with ISA, e.g. atenolol,
metoprolol, pindolol, acebutolol: may be used if no other choice.
Prazosin and clonidine—provided that postural hypotension can
be avoided.
55. Antihypertensives to be avoided during pregnancy
ACE inhibitors, ARBs: Risk of foetal damage, growth retardation.
Diuretics: Tend to reduce blood volume— accentuate
uteroplacental perfusion deficit (of toxaemia)—increase risk of foetal
wastage, placental infarcts, miscarriage, stillbirth.
Nonselective β blockers: Propranolol cause low birth weight,
decreased placental size, neonatal bradycardia and hypoglycaemia.
Sod. nitroprusside: Contraindicated in eclampsia.
56. ANIMAL MODELS OF HYPERTENSION
1. Acute Renal Hypertension in Rats
2. Chronic Renal Hypertension in Rats
3. Chronic Renal Hypertension in Dogs
4. Neurogenic Hypertension in Dogs
5. DOCA- (Deoxycorticosterone acetate) salt Induced
Hypertension in Rats
6. Fructose Induced Hypertension in Rats
7. Genetic Hypertension in Rats
8. Hypertension Induced by Chronic NO-Synthase Inhibition
9. Pulmonary Hypertension Induced by Monocrotaline
10. Portal Hypertension in Rats .
57. Chronic model (one kidney one clip ) Renal HTN Rats
One kidney is clamped & other kidney is removed
Advantage - compensatory natriuersis & pressure diuresis is absent
with increased NA & water retention
Procedure
Sprague Dawley rats - anesthetized – flank incision- kidney removed
– u shaped sliver clip on renal artery near aorta
4-5 weeks after clipping BP monitored if >150mmhg selected
Drug is administered pre & post drug 2 hr BP readings taken.
58. Chronic renal hypertension in dogs ( wrapping tech)
•Dog is anesthetized – midline abd incision - one kidney is wrapped
with cellophane & replaced Other kidney artery , vein & ureter is
ligated – abd closed
•Antibiotic treatment 3-4 days, temp monitored
•6 weeks BP recorded indirect tail cuff method/ carotid artery
•Test drug is given 5days
Day 1 readings every 2hours before giving drug
readings every 2 & 4 hr after giving drug
Day 3 & 4 readings every 2 & 4 hr after drug
•Evaluation – starting value is average of 2 reading before test drug
Test values are subtracted with this value
59. Fructose induced HTN in rats
•Feeding a high fructose diet induces hypertension and insulin
resistance
•Fructose feeding induce hypertension in normal in high salt fed
animals & increased AT 1 receptor
•Procedure : wistar rats caged seprated
10% fructose in drinking water
body wt, fluid & food intake, - measured
SBP & PR measured- tail cuff method
blood sample every 2nd week during treatment to
determine glucose ,insulin etc
60. DOCA (Deoxycorticosterone acetate) salt rats-
•Principle- mineralocorticoid increase BP by Na retention increase
in ECF
•Procedure – DOCA (mineralocorticoid) + high salt diet &unilateral
nephrectomy induces hypertension
• Sprague Dawley – anesthetized – flank incision –left kidney is
removed DOCA salt injected– NaCl orally
BP starts to increases after 1week upto 160-180 mmhg after 4 wks.
61. References
Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th
ed.
Essentials of Medical Pharmacology, K D. Tripathi, 8th ed
Pharmacology and Pharmacotherapeutics, RS Satoskar, 26th ed
Harrison’s Principles of Internal Medicine. 20th ed .New Delhi.
Mcgraw Hill Publications
http://circres.ahajournals.org (AHA Journal)