This document discusses various classes of drugs used to treat hypertension. It describes the mechanisms of action, effects, and examples of drugs in the following classes: diuretics, ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and vasodilators. It also provides background on renin-angiotensin system and the physiological role of angiotensin-converting enzyme. Specific drugs discussed in detail include captopril, enalapril, losartan, and metoprolol.
This document discusses hypertension and its treatment. It defines hypertension and describes the types as essential or secondary. It explains how factors like stress, sodium intake, obesity, and smoking can cause environmental hypertension. The document outlines the need for treatment to prevent damage to blood vessels and organs. It then details various classes of antihypertensive drugs like diuretics, ACE inhibitors, calcium channel blockers, and others. It focuses on the renin-angiotensin system and how ACE inhibitors work to inhibit angiotensin II production and lower blood pressure.
This document discusses hypertension and its treatment. It defines hypertension as a blood pressure higher than 140/90 mmHg. It describes the types of hypertension and risk factors like stress, sodium intake, obesity, and smoking. Treatment is important to prevent damage to blood vessels and organs. Antihypertensive drugs lower blood pressure by interfering with normal blood pressure regulating mechanisms like the renin-angiotensin system and sympathetic nervous system. Common antihypertensive classes discussed include diuretics, ACE inhibitors, calcium channel blockers, and beta blockers.
This document discusses hypertension and its treatment. It begins by defining hypertension and describing the types. It then discusses the normal blood pressure regulation system and how this is disrupted in hypertension. The remainder of the document focuses on the treatment of hypertension, describing various classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. It provides details on specific drugs in each class, their mechanisms of action, uses, and side effects.
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 various classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and alpha blockers. It provides details on specific drugs in each class, their mechanisms of action, effects, uses, and side effects. Thiazide diuretics like hydrochlorothiazide are recommended as first-line treatment for hypertension when used at low doses to avoid side effects. ACE inhibitors like lisinopril and enalapril are also good first-line options as they lower blood pressure without affecting electrolytes and have additional cardiovascular benefits. Angiotensin receptor blockers such as losartan are an alternative that provide complete blockade
Hypertension, or high blood pressure, is a disorder where blood pressure is consistently above 140/90 mmHg. It can be caused by unknown factors (essential hypertension) or other diseases (secondary hypertension). Untreated hypertension can damage blood vessels and organs over time.
The document discusses various types of medications used to treat hypertension, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and alpha blockers. It provides details on specific drugs, their mechanisms of action, effects, uses, and potential side effects in the treatment of hypertension.
This document summarizes various cardiovascular drugs used to treat cardiac diseases such as hypertension. It discusses major categories including diuretics, ACE inhibitors, calcium channel blockers, beta blockers, and nitrates/nitrites. For each drug class, it describes the mechanisms of action, therapeutic effects, common medications, side effects, nursing considerations and more. The goal is to optimize blood flow and vascular resistance to lower blood pressure.
This document discusses hypertension and its treatment. It defines hypertension and describes the types as essential or secondary. It explains how factors like stress, sodium intake, obesity, and smoking can cause environmental hypertension. The document outlines the need for treatment to prevent damage to blood vessels and organs. It then details various classes of antihypertensive drugs like diuretics, ACE inhibitors, calcium channel blockers, and others. It focuses on the renin-angiotensin system and how ACE inhibitors work to inhibit angiotensin II production and lower blood pressure.
This document discusses hypertension and its treatment. It defines hypertension as a blood pressure higher than 140/90 mmHg. It describes the types of hypertension and risk factors like stress, sodium intake, obesity, and smoking. Treatment is important to prevent damage to blood vessels and organs. Antihypertensive drugs lower blood pressure by interfering with normal blood pressure regulating mechanisms like the renin-angiotensin system and sympathetic nervous system. Common antihypertensive classes discussed include diuretics, ACE inhibitors, calcium channel blockers, and beta blockers.
This document discusses hypertension and its treatment. It begins by defining hypertension and describing the types. It then discusses the normal blood pressure regulation system and how this is disrupted in hypertension. The remainder of the document focuses on the treatment of hypertension, describing various classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. It provides details on specific drugs in each class, their mechanisms of action, uses, and side effects.
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 various classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and alpha blockers. It provides details on specific drugs in each class, their mechanisms of action, effects, uses, and side effects. Thiazide diuretics like hydrochlorothiazide are recommended as first-line treatment for hypertension when used at low doses to avoid side effects. ACE inhibitors like lisinopril and enalapril are also good first-line options as they lower blood pressure without affecting electrolytes and have additional cardiovascular benefits. Angiotensin receptor blockers such as losartan are an alternative that provide complete blockade
Hypertension, or high blood pressure, is a disorder where blood pressure is consistently above 140/90 mmHg. It can be caused by unknown factors (essential hypertension) or other diseases (secondary hypertension). Untreated hypertension can damage blood vessels and organs over time.
The document discusses various types of medications used to treat hypertension, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and alpha blockers. It provides details on specific drugs, their mechanisms of action, effects, uses, and potential side effects in the treatment of hypertension.
This document summarizes various cardiovascular drugs used to treat cardiac diseases such as hypertension. It discusses major categories including diuretics, ACE inhibitors, calcium channel blockers, beta blockers, and nitrates/nitrites. For each drug class, it describes the mechanisms of action, therapeutic effects, common medications, side effects, nursing considerations and more. The goal is to optimize blood flow and vascular resistance to lower blood pressure.
This document discusses types of hypertension, treatment of hypertension, and antihypertensive drugs. It describes the two main types of hypertension as essential and secondary. Treatment is necessary to prevent damage to blood vessels and the heart from high blood pressure. Several classes of antihypertensive drugs are discussed in detail, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. The mechanisms of action and important effects of specific drugs like captopril, enalapril, lisinopril, and losartan are summarized as well.
The document discusses the heart and hypertension. It defines normal blood pressure and describes the types and causes of hypertension. Hypertension usually has no symptoms, but can sometimes cause headaches, confusion or vision changes. Untreated hypertension can damage blood vessels and the heart over time, so treatment is important even in asymptomatic cases. Treatment includes diuretics, ACE inhibitors, calcium channel blockers, and other drugs that work to lower blood pressure by various mechanisms.
This document discusses hypertension and antihypertensive drugs. It defines hypertension as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. It describes the various classes of antihypertensive drugs including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. The mechanisms of action and side effects of these drug classes are explained in detail.
This document discusses hypertension and its treatment with antihypertensive drugs. It defines hypertension and describes the types of hypertension. It explains the need to treat hypertension to prevent target organ damage like eye, brain, kidney and heart disease. It then discusses the normal blood pressure regulation mechanisms involving the heart, blood vessels, kidneys, baroreflex and renin-angiotensin system. The rest of the document summarizes the mechanisms, uses, and side effects of major classes of antihypertensive drugs like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. It emphasizes that these drugs work by interfering with the normal blood pressure regulating mechanisms.
This document discusses various classes of antihypertensive drugs including beta blockers, ACE inhibitors, calcium channel blockers, and diuretics. It explains their mechanisms of action in lowering blood pressure by reducing cardiac output, peripheral resistance, or sodium retention. Some advantages and side effects are provided for each drug class. The renin-angiotensin-aldosterone system and its role in blood pressure regulation is also summarized.
This document summarizes the pharmacology of medications used to treat hypertension, including ACE inhibitors, ARBs, and CCBs. It reviews their mechanisms of action, efficacy, and safety profiles. It also discusses the renin-angiotensin system and its role in hypertension, current treatment guidelines, lifestyle modifications, and algorithms for antihypertensive drug selection and combination therapy.
This document provides an overview of angiotensin-converting enzyme (ACE) inhibitors, including their indications, mechanisms of action, and evidence of effectiveness. ACE inhibitors are used to treat hypertension, congestive heart failure, myocardial infarction, diabetes, proteinuria, and other conditions. They work by inhibiting the conversion of angiotensin I to angiotensin II in the renin-angiotensin-aldosterone system. Clinical trials have shown that ACE inhibitors reduce blood pressure, prevent complications of heart failure and diabetes, and slow the progression of kidney disease. Common ACE inhibitors discussed include captopril, enalapril, lisinopril, and fosinopril.
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.
The document summarizes the renin-angiotensin-aldosterone system (RAAS) and its significance. It discusses the key discoveries in RAAS including the identification of renin, angiotensinogen, angiotensin-converting enzyme (ACE), and aldosterone. It then describes the components and functions of the RAAS pathway and how drugs like ACE inhibitors, angiotensin receptor blockers, and aldosterone antagonists can modulate this system to treat conditions like hypertension and heart failure.
- A 48-year-old male presented with essential hypertension and was prescribed captopril. He returned with a persistent brassy cough.
- Captopril is an ACE inhibitor that works by inhibiting the renin-angiotensin-aldosterone system to lower blood pressure. However, it can cause cough as a side effect by inhibiting the breakdown of bradykinin.
- The patient's cough was likely caused by captopril as a side effect. His blood pressure was now under control, so the doctor would need to consider changing him to an alternative antihypertensive like an ARB that is less likely to cause cough.
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 discusses hypertension (high blood pressure) including its causes, mechanisms of blood pressure control, and antihypertensive drug treatments. It describes how hypertension is defined and its prevalence. It explains the roles of the baroreceptor and renin-angiotensin-aldosterone systems in long-term and short-term blood pressure regulation. Finally, it provides details on major classes of antihypertensive drugs including diuretics, beta blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and others.
ACE Inhibitors and receptor blockers.pptxHaider Ali
This document discusses ACE inhibitors and angiotensin receptor blockers (ARBs). It begins by explaining that ACE stands for angiotensin-converting enzyme, which plays a key role in regulating blood pressure. ACE inhibitors work by blocking this enzyme, reducing angiotensin II and vasoconstriction. The document then covers the classification, mechanisms of action, pharmacokinetics and uses of several common ACE inhibitors and ARBs, including captopril, enalapril, losartan and candesartan. It concludes by describing the renin-angiotensin-aldosterone system and angiotensin receptor types.
1. The document discusses hypertension, its types, causes, and treatment options. It covers the renin-angiotensin system and how drugs like ACE inhibitors and angiotensin receptor blockers work to lower blood pressure by inhibiting this system.
2. Common antihypertensive drug classes are discussed in detail, including diuretics, ACE inhibitors, angiotensin receptor blockers, beta blockers, and their mechanisms, benefits, and side effects.
3. Future potential treatments mentioned include blood pressure vaccinations currently being studied.
Antihypertensives and anesthetic implications - Dr. VaibhavVaibhav Tulsyan
This document discusses recommendations for treating hypertension from the JNC 8 guidelines. It outlines first-line antihypertensive drug classes including thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers. For each class, it provides details on mechanisms of action, advantages, side effects, and implications for anesthesia. Thiazide diuretics are recommended as first-line but can cause hypokalemia, so potassium sparing diuretics are often added. ACE inhibitors and ARBs block the renin-angiotensin system. Calcium channel blockers relax blood vessels. Beta blockers reduce cardiac output and sympathetic outflow. Alpha blockers reduce peripheral resistance
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
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.
This document discusses various drug therapies for hypertension, including diuretics, ACE inhibitors, angiotensin receptor blockers, beta blockers, alpha blockers, and calcium channel blockers. It provides details on the mechanisms of action, advantages, side effects, and current recommendations for each class of antihypertensive medications.
Hypertension is a common condition defined by persistently elevated blood pressure that can lead to serious health issues if left untreated. It is classified based on systolic and diastolic blood pressure readings into normal, elevated, stage 1, or stage 2 categories. Treatment involves both non-pharmacologic and pharmacologic approaches, with the goal of reducing blood pressure to prevent complications. Many classes of antihypertensive medications target different mechanisms involved in blood pressure regulation, including the renin-angiotensin-aldosterone system, sympathetic nervous system, and vasodilation. Proper treatment can effectively control blood pressure and reduce health risks associated with hypertension.
The eyeball is composed of three coats - the fibrous coat (cornea and sclera), vascular coat (iris, ciliary body and choroid), and nervous coat (retina). The cornea forms the anterior 1/6 of the eyeball and receives nutrients through diffusion. The sclera forms the posterior 5/6 and is a dense white tissue. The choroid lines the posterior 5/6 and contains blood vessels. The ciliary body contains muscles that allow the lens to change shape for focusing. The iris is the colored part and contains muscles to control the pupil size. The retina lines the inside and contains rods, cones and the macula which is responsible for sharp central vision.
The document summarizes the anatomy of the cerebral cortex. It describes how the cerebrum is divided into two hemispheres connected by the corpus callosum. Each hemisphere has a grey matter outer layer, white matter inner layer, and subcortical structures. Each hemisphere also has four borders, three surfaces, three poles, and is divided into five lobes by four main sulci. The sulci and gyri on each surface are also outlined.
This document discusses types of hypertension, treatment of hypertension, and antihypertensive drugs. It describes the two main types of hypertension as essential and secondary. Treatment is necessary to prevent damage to blood vessels and the heart from high blood pressure. Several classes of antihypertensive drugs are discussed in detail, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. The mechanisms of action and important effects of specific drugs like captopril, enalapril, lisinopril, and losartan are summarized as well.
The document discusses the heart and hypertension. It defines normal blood pressure and describes the types and causes of hypertension. Hypertension usually has no symptoms, but can sometimes cause headaches, confusion or vision changes. Untreated hypertension can damage blood vessels and the heart over time, so treatment is important even in asymptomatic cases. Treatment includes diuretics, ACE inhibitors, calcium channel blockers, and other drugs that work to lower blood pressure by various mechanisms.
This document discusses hypertension and antihypertensive drugs. It defines hypertension as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. It describes the various classes of antihypertensive drugs including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. The mechanisms of action and side effects of these drug classes are explained in detail.
This document discusses hypertension and its treatment with antihypertensive drugs. It defines hypertension and describes the types of hypertension. It explains the need to treat hypertension to prevent target organ damage like eye, brain, kidney and heart disease. It then discusses the normal blood pressure regulation mechanisms involving the heart, blood vessels, kidneys, baroreflex and renin-angiotensin system. The rest of the document summarizes the mechanisms, uses, and side effects of major classes of antihypertensive drugs like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. It emphasizes that these drugs work by interfering with the normal blood pressure regulating mechanisms.
This document discusses various classes of antihypertensive drugs including beta blockers, ACE inhibitors, calcium channel blockers, and diuretics. It explains their mechanisms of action in lowering blood pressure by reducing cardiac output, peripheral resistance, or sodium retention. Some advantages and side effects are provided for each drug class. The renin-angiotensin-aldosterone system and its role in blood pressure regulation is also summarized.
This document summarizes the pharmacology of medications used to treat hypertension, including ACE inhibitors, ARBs, and CCBs. It reviews their mechanisms of action, efficacy, and safety profiles. It also discusses the renin-angiotensin system and its role in hypertension, current treatment guidelines, lifestyle modifications, and algorithms for antihypertensive drug selection and combination therapy.
This document provides an overview of angiotensin-converting enzyme (ACE) inhibitors, including their indications, mechanisms of action, and evidence of effectiveness. ACE inhibitors are used to treat hypertension, congestive heart failure, myocardial infarction, diabetes, proteinuria, and other conditions. They work by inhibiting the conversion of angiotensin I to angiotensin II in the renin-angiotensin-aldosterone system. Clinical trials have shown that ACE inhibitors reduce blood pressure, prevent complications of heart failure and diabetes, and slow the progression of kidney disease. Common ACE inhibitors discussed include captopril, enalapril, lisinopril, and fosinopril.
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.
The document summarizes the renin-angiotensin-aldosterone system (RAAS) and its significance. It discusses the key discoveries in RAAS including the identification of renin, angiotensinogen, angiotensin-converting enzyme (ACE), and aldosterone. It then describes the components and functions of the RAAS pathway and how drugs like ACE inhibitors, angiotensin receptor blockers, and aldosterone antagonists can modulate this system to treat conditions like hypertension and heart failure.
- A 48-year-old male presented with essential hypertension and was prescribed captopril. He returned with a persistent brassy cough.
- Captopril is an ACE inhibitor that works by inhibiting the renin-angiotensin-aldosterone system to lower blood pressure. However, it can cause cough as a side effect by inhibiting the breakdown of bradykinin.
- The patient's cough was likely caused by captopril as a side effect. His blood pressure was now under control, so the doctor would need to consider changing him to an alternative antihypertensive like an ARB that is less likely to cause cough.
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 discusses hypertension (high blood pressure) including its causes, mechanisms of blood pressure control, and antihypertensive drug treatments. It describes how hypertension is defined and its prevalence. It explains the roles of the baroreceptor and renin-angiotensin-aldosterone systems in long-term and short-term blood pressure regulation. Finally, it provides details on major classes of antihypertensive drugs including diuretics, beta blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and others.
ACE Inhibitors and receptor blockers.pptxHaider Ali
This document discusses ACE inhibitors and angiotensin receptor blockers (ARBs). It begins by explaining that ACE stands for angiotensin-converting enzyme, which plays a key role in regulating blood pressure. ACE inhibitors work by blocking this enzyme, reducing angiotensin II and vasoconstriction. The document then covers the classification, mechanisms of action, pharmacokinetics and uses of several common ACE inhibitors and ARBs, including captopril, enalapril, losartan and candesartan. It concludes by describing the renin-angiotensin-aldosterone system and angiotensin receptor types.
1. The document discusses hypertension, its types, causes, and treatment options. It covers the renin-angiotensin system and how drugs like ACE inhibitors and angiotensin receptor blockers work to lower blood pressure by inhibiting this system.
2. Common antihypertensive drug classes are discussed in detail, including diuretics, ACE inhibitors, angiotensin receptor blockers, beta blockers, and their mechanisms, benefits, and side effects.
3. Future potential treatments mentioned include blood pressure vaccinations currently being studied.
Antihypertensives and anesthetic implications - Dr. VaibhavVaibhav Tulsyan
This document discusses recommendations for treating hypertension from the JNC 8 guidelines. It outlines first-line antihypertensive drug classes including thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers. For each class, it provides details on mechanisms of action, advantages, side effects, and implications for anesthesia. Thiazide diuretics are recommended as first-line but can cause hypokalemia, so potassium sparing diuretics are often added. ACE inhibitors and ARBs block the renin-angiotensin system. Calcium channel blockers relax blood vessels. Beta blockers reduce cardiac output and sympathetic outflow. Alpha blockers reduce peripheral resistance
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
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.
This document discusses various drug therapies for hypertension, including diuretics, ACE inhibitors, angiotensin receptor blockers, beta blockers, alpha blockers, and calcium channel blockers. It provides details on the mechanisms of action, advantages, side effects, and current recommendations for each class of antihypertensive medications.
Hypertension is a common condition defined by persistently elevated blood pressure that can lead to serious health issues if left untreated. It is classified based on systolic and diastolic blood pressure readings into normal, elevated, stage 1, or stage 2 categories. Treatment involves both non-pharmacologic and pharmacologic approaches, with the goal of reducing blood pressure to prevent complications. Many classes of antihypertensive medications target different mechanisms involved in blood pressure regulation, including the renin-angiotensin-aldosterone system, sympathetic nervous system, and vasodilation. Proper treatment can effectively control blood pressure and reduce health risks associated with hypertension.
The eyeball is composed of three coats - the fibrous coat (cornea and sclera), vascular coat (iris, ciliary body and choroid), and nervous coat (retina). The cornea forms the anterior 1/6 of the eyeball and receives nutrients through diffusion. The sclera forms the posterior 5/6 and is a dense white tissue. The choroid lines the posterior 5/6 and contains blood vessels. The ciliary body contains muscles that allow the lens to change shape for focusing. The iris is the colored part and contains muscles to control the pupil size. The retina lines the inside and contains rods, cones and the macula which is responsible for sharp central vision.
The document summarizes the anatomy of the cerebral cortex. It describes how the cerebrum is divided into two hemispheres connected by the corpus callosum. Each hemisphere has a grey matter outer layer, white matter inner layer, and subcortical structures. Each hemisphere also has four borders, three surfaces, three poles, and is divided into five lobes by four main sulci. The sulci and gyri on each surface are also outlined.
This document discusses prioritizing health problems and research ethics in medical research. It provides guidelines for prioritizing health problems based on their impact, potential interventions and solutions, and the feasibility of proposed studies. It also outlines 10 key principles of research ethics around protecting participants, obtaining consent, maintaining privacy and confidentiality, and being transparent. The document advises developing specific, measurable objectives to focus research and avoid collecting unnecessary data. Objectives should be logically ordered and stated using action verbs to evaluate outcomes. Developing a clear research question is also important that reflects the objectives and has not already been answered.
This document discusses lipoprotein cholesterol levels and their relationship to coronary heart disease (CHD). It provides normal levels for total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C). High LDL and low HDL are risk factors for CHD. The ratio of total cholesterol to HDL is used to determine cardiovascular risk, with a higher ratio indicating greater risk. While total cholesterol was once the primary indicator for CHD risk, measuring individual lipoproteins provides more useful information.
Effect of drugs on arterial blood pressure of cat.pptxKhaledEwais1
1. The document describes an experiment that studied the effects of various drugs on the arterial blood pressure of anesthetized cats.
2. The experiment involved exposing the carotid artery of anesthetized cats to record blood pressure changes after administering different drugs via the femoral vein.
3. The results showed that acetylcholine caused a decrease in blood pressure, which was blocked by atropine but not for a large dose of acetylcholine. Epinephrine increased blood pressure, while phentolamine decreased it.
This document summarizes a research project examining barriers to diagnosing and referring patients with suspected rheumatoid arthritis (RA) among primary care physicians (PCPs) in Port Said, Egypt. The study found that most PCPs prefer to order additional tests before referring patients to rule out RA, rather than referring based on clinical symptoms alone. This can delay proper diagnosis and treatment. The study also found limited access to rheumatology clinics for referrals. It concludes with recommendations to establish clear diagnostic guidelines, increase access to early arthritis clinics, and educate PCPs on the importance of clinical assessment over diagnostic tests for suspected RA cases.
This study aimed to identify factors that contribute to willingness to donate blood among students at Port Said University in Egypt. A descriptive cross-sectional study used a convenience sample of 745 students, of which 633 fully responded to an online questionnaire about demographics, motivations, barriers, and knowledge related to blood donation. The results showed that males and those aged 20-21 were more likely to donate. While 21% of students had donated, donors had higher mean knowledge than non-donors. The top motivator for donors was helping patients, while the top barrier for non-donors was failing to meet requirements. Most supported increasing awareness, donation sites, and mobile units to promote donation.
Jaundice is a yellowish pigmentation of the skin and mucous membranes caused by high bilirubin levels in the blood (hyperbilirubinemia). Bilirubin is produced from the breakdown of heme in red blood cells and is normally processed by the liver and excreted in bile or urine. Jaundice can be physiologic in newborns or pathologic due to liver disease, hemolytic disease, or bile duct obstruction. The type of jaundice is determined by measuring conjugated and unconjugated bilirubin levels and depends on whether the cause is excessive bilirubin production, impaired liver function, or bile duct blockage.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
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3. Types of
Hypertension
Essential Secondary
A disorder of unknown origin affecting the
Blood Pressure regulating mechanisms
Secondary to other disease processes
Environmental
Factors
Stress Na+ Intake Obesity Smoking
****************************************************
4. Antihypertensive Drugs
Diuretics:
Thiazides: Hydrochlorothiazide, chlorthalidone
High ceiling: Furosemide
K+ sparing: Spironolactone, triamterene and amiloride
MOA: Acts on Kidneys to increase excretion of Na and H2O –
decrease in blood volume – decreased BP
Angiotensin-converting Enzyme (ACE) inhibitors:
Captopril, lisinopril., enalapril, ramipril and fosinopril
MOA: Inhibit synthesis of Angiotensin II – decrease in peripheral
resistance and blood volume
Angiotensin (AT1) blockers:
Losartan, candesartan, valsartan and telmisartan
MOA: Blocks binding of Angiotensin II to its receptors
5. Antihypertensive Drugs
Centrally acting:
Clonidine, methyldopa
MOA: Act on central α2A receptors to decrease sympathetic
outflow – fall in BP
ß-adrenergic blockers:
Non selective: Propranolol (others: nadolol, timolol, pindolol,
labetolol)
Cardioselective: Metoprolol (others: atenolol, esmolol,
betaxolol)
MOA: Bind to beta adrenergic receptors and blocks the activity
ß and α – adrenergic blockers:
Labetolol and carvedilol
α – adrenergic blockers:
Prazosin, terazosin, doxazosin, phenoxybenzamine and
phentolamine
MOA: Blocking of alpha adrenergic receptors in smooth muscles -
vasodilatation
6. Antihypertensive Drugs –
Calcium Channel Blockers (CCB):
Verapamil, diltiazem, nifedipine, felodipine, amlodipine,
nimodipine etc.
MOA: Blocks influx of Ca++ in smooth muscle cells –
relaxation of SMCs – decrease BP
K+ Channel activators:
Diazoxide, minoxidil, pinacidil and nicorandil
MOA: Leaking of K+ due to opening – hyper polarization
of SMCs – relaxation of SMCs
Vasodilators:
Arteriolar – Hydralazine (also CCBs and K+ channel
activators)
Arterio-venular: Sodium Nitroprusside
8. RAS - Introduction
Renin is a proteolytic enzyme and also called
angiotensinogenase
It is produced by juxtaglomerular cells of kidney
It is secreted in response to:
Decrease in arterial blood pressure
Decrease Na+ in macula densa
Increased sympathetic nervous activity
Renin acts on a plasma protein – Angiotensinogen (a
glycoprotein synthesized and secreted into the bloodstream by
the liver) and cleaves to produce a decapeptide Angiotensin-I
Angiotensin-I is rapidly converted to Angiotensin-II (octapeptide)
by ACE (present in luminal surface of vascular endothelium)
Furthermore degradation of Angiotensin-II by peptidases
produce Angiotensin-III
Both Angiotensin-II and Angiotensin-III stimulates Aldosterone
secretion from Adrenal Cortex (equipotent)
AT-II has very short half life – 1 min
9. RAS – actions of Angiotensin-II.
1. Powerful vasoconstrictor particularly arteriolar – direct action and
release of Adr/NA release
Promotes movement of fluid from vascular to extravascular
More potent vasopressor agent than NA – promotes Na+ and water
reabsorption
It increases myocardial force of contraction (CA++ influx promotion)
and increases heart rate by sympathetic activity, but reflex
bradycardia occurs
Cardiac output is reduced and cardiac work increases
2. Aldosterone secretion stimulation – retention of Na++ in body
3. Vasoconstriction of renal arterioles – rise in IGP – glomerular damage
4. Decreases NO release
5. Decreases Fibrinolysis in blood
6. Induces drinking behaviour and ADH release by acting in CNS –
increase thirst
7. Mitogenic effect – cell proliferation
11. ACE inhibitors in Hypertension
Captopril
Sulfhydryl containing dipeptide and abolishes
pressor action of Angiotensin-I and not
Angiotensin-II and does not block AT
receptors
Pharmacokinetics:
Available only orally, 70% - 75% is absorbed
Partly absorbed and partly excreted
unchanged in urine
Food interferes with its absorption
Half life: 2 Hrs, but action stays for 6-12 Hrs
12. Captopril – Pharmacological actions
1. In Normal:
Depends on Na+ status – lowers BP marginally on single dose
When Na+ depletion – marked lowering of BP
2. In hypertensive:
Lowers PVR and thereby mean, systolic and diastolic BP
RAS is overactive in 80% of hypertensive cases and contributes
to the maintenance of vascular tone – inhibition causes lowering
of BP
Initially correlates with renin-angiotensin status but chronic
administration is independent of renin activity
Captopril decreases t.p.r on long term – arterioles dilate – fall in
systolic and diastolic BP
No effect on Cardiac output
Postural hypotension is not a problem - reflex sympathetic
stimulation does not occur
Renal blood flow is maintained – greater dilatation of vessels
13. Captopril – Adverse effects
Cough – persistent brassy cough in 20% cases – inhibition of
bradykinin and substanceP breakdown in lungs
Hyperkalemia in renal failure patients with K+ sparing diuretics,
NSAID and beta blockers (routine check of K+ level)
Hypotension – sharp fall may occur – 1st dose
Acute renal failure: CHF and bilateral renal artery stenosis
Angioedema: swelling of lips, mouth, nose etc.
Rashes, urticaria etc
Dysgeusia: loss or alteration of taste
Foetopathic: hypoplasia of organs, growth retardation etc
Neutripenia
Contraindications: Pregnancy, bilateral renal artery stenosis,
hypersensitivity and hyperkalaemia
14. ACE inhibitors - Enalapril
It’s a prodrug – converted to enalaprilate
Advantages over captopril:
Longer half life – OD (5-20 mg OD)
Absorption not affected by food
Rash and loss of taste are less frequent
Longer onset of action
Less side effects
15. ACE inhibitors – Ramipril
It’s a popular ACEI now
It is also a prodrug with long half life
Tissue specific – Protective of heart and
kidney
Uses: Diabetes with hypertension, CHF, AMI
and cardio protective in angina pectoris
Blacks in USA are resistant to Ramipril –
addition of diuretics help
Dose: Start with low dose; 2.5 to 10 mg daily
16. ACE inhibitors – Lisinopril
It’s a lysine derivative
Not a prodrug
Slow oral absorption – less chance of 1st
dose phenomenon
Absorption not affected by food and not
metabolized – excrete unchanged in urine
Long duration of action – single daily dose
Doses: available as 1.25, 2.5, 5, 10 1nd 20
mg tab – start with low dose
17. ACE inhibitors and hypertension
1st line of Drug:
No postural hypotension or electrolyte imbalance (no
fatigue or weakness)
Safe in asthmatics and diabetics
Prevention of secondary hyperaldosteronism and K+
loss
Renal perfusion well maintained
Reverse the ventricular hypertrophy and increase in
lumen size of vessel
No hyperuraecemia or deleterious effect on plasma
lipid profile
No rebound hypertension
Minimal worsening of quality of life – general wellbeing,
sleep and work performance etc.
18. ACE inhibitors – other uses
Hypertension
Congestive Heart Failure
Myocardial Infarction
Prophylaxis of high CVS risk subjects
Diabetic Nephropathy
Schleroderma crisis
19. Angiotensin Receptor Blockers
(ARBs) -
Angiotensin Receptors:
Specific angiotensin receptors have been discovered, grouped
and abbreviated as – AT1 and AT2
They are present on the surface of the target cells
Most of the physiological actions of angiotensin are mediated
via AT1 receptor
Transducer mechanisms of AT1 inhibitors: In different tissues
show different mechanisms. For example -
PhospholipaseC-IP3/DAG-intracellular Ca++ release
mechanism – vascular and visceral smooth muscle
contraction
In myocardium and vascular smooth muscles AT1 receptor
mediates long term effects by MAP kinase and others
Losartan is the specific AT1 blocker
20. Angiotensin Receptor Blockers
(ARBs) - Losartan
Competitive antagonist and inverse agonist of
AT1 receptor
Does not interfere with other receptors except
TXA2
Blocks all the actions of A-II -
vasoconstriction, sympathetic stimulation,
aldosterone release and renal actions of salt
and water reabsorption
No inhibition of ACE
21. Losartan
Theoretical superiority over ACEIs:
Cough is rare – no interference with bradykinin and other
ACE substrates
Complete inhibition of AT1 – alternative remains with ACEs
Result in indirect activation of AT2 – vasodilatation
(additional benefit)
Clinical benefit of ARBs over ACEIs – not known
However, losartan decreases BP in hypertensive which is for
long period (24 Hrs)
heart rate remains unchanged and cvs reflxes are not
interfered
no significant effect in plasma lipid profile, insulin sensitivity
and carbohydrate tolerance etc
Mild uricosuric effect
22. Losartan
Pharmacokinetic:
Absorption not affected by food but unlike ACEIs its
bioavailability is low
High first pass metabolism
Carboxylated to active metabolite E3174
Highly bound to plasma protein
Do not enter brain
Adverse effects:
Foetopathic like ACEIs – not to be administered in
pregnancy
Rare 1st dose effect hypotension
Low dysgeusia and dry cough
Lower incidence of angioedema
Available as 25 and 50 mg tablets
23. Beta-adrenergic blockers
Non selective: Propranolol (others: nadolol, timolol, pindolol,
labetolol)
Cardioselective: Metoprolol (others: atenolol, esmolol,
betaxolol)
All beta-blockers similar antihypertensive effects – irrespective of
additional properties
Reduction in CO but no change in BP initially but slowly
Adaptation by resistance vessels to chronically reduced CO –
antihypertensive action
Other mechanisms – decreased renin release from kidney (beta-1
mediated)
Reduced NA release and central sympathetic outflow reduction
Non-selective ones – reduction in g.f.r but not with selective ones
Drugs with intrinsic sympathomimetic activity may cause less
reduction in HR and CO
24. Beta-adrenergic blockers
Advantages:
No postural hypotension
No salt and water retention
Low incidence of side effects
Low cost
Once a day regime
Preferred in young non-obese patients, prevention of sudden
cardiac death in post infarction patients and progression of
CHF
Drawbacks (side effects):
Fatigue, lethargy (low CO?) – decreased work capacity
Loss of libido – impotence
Cognitive defects – forgetfulness
Difficult to stop suddenly
Therefore cardio-selective drugs are preferred now
25. Beta-adrenergic blockers
Advantages of cardio-selective over non-selective:
In asthma
In diabetes mellitus
In peripheral vascular disease
Current status:
JNC 7 recommends - 1st line of antihypertensive along
with diuretics and ACEIs
Preferred in young non-obese hypertensive
Angina pectoris and post angina patients
Post MI patients – useful in preventing mortality
In old persons, carvedilol – vasodilatory action can be
given
26. Αlpha-adrenergic blockers
Non selective alpha blockers are not used in chronic
essential hypertension (phenoxybenzamine,
phentolamine), only used sometimes as in
phaechromocytoma
Specific alpha-1 blockers like prazosin, terazosin and
doxazosine are used
PRAZOSIN is the prototype of the alpha-blockers
Reduction in t.p.r and mean BP – also reduction in
venomotor tone and pooling of blood – reduction in
CO
Does not produce tachycardia as presynaptic auto
(alpha-2) receptors are not inhibited – autoregulation
of NA release remains intact
27. Αlpha-adrenergic blockers.
Adverse effects:
Prazosin causes postural hypotension – start 0.5 mg at bed
time with increasing dose and upto 10 mg daily
Fluid retention in monotherapy
Headache, dry mouth, weakness, dry mouth, blurred vision,
rash, drowsiness and failure of ejaculation in males
Current status:
Several advantages – improvement of carbohydrate
metabolism – diabetics, lowers LDL and increases HDL,
symptomatic improvement in BHP
But not used as first line agent, used in addition with other
conventional drugs which are failing – diuretic or beta
blocker
Doses: Available as 0.5 mg, 1 mg, 2.5 mg, 5 mg etc. dose:1-4
mg thrice daily (Minipress/Prazopress)
29. Calcium Channel Blockers –
Mechanism of action
Three types Ca+ channels in smooth muscles – Voltage
sensitive, receptor operated and leak channel
Voltage sensitive are again 3 types – L-Type, T-Type and N-
Type
Normally, L-Type of channels admit Ca+ and causes
depolarization – excitation-contraction coupling through
phosphorylation of myosin light chain – contraction of vascular
smooth muscle – elevation of BP
CCBs block L-Type channel:
Smooth Muscle relaxation
Negative chronotropic, ionotropic and chronotropic effects in heart
DHPs have highest smooth muscle relaxation and vasodilator
action followed by verapamil and diltiazem
Other actions: DHPs have diuretic action
30. Calcium Channel Blockers
Advantages:
Unlike diuretics no adverse metabolic effects but
mild adverse effects like – dizziness, fatigue etc.
Do not compromise haemodynamics – no
impairment of work capacity
No sedation or CNS effect
Can be given to asthma, angina and PVD patients
No renal and male sexual function impairment
No adverse fetal effects and can be given in
pregnancy
Minimal effect on quality of life
31. Calcium Channel Blockers –
current status
As per JNC 7 CCBs are not 1st line of
antihypertensive unless indicated –
ACEI/diuretics/beta blockers
However its been used as 1st line by many because
of excellent tolerability and high efficacy
Preferred in elderly and prevents stroke
CCBs are effective in low Renin hypertension
They are next to ACE inhibitors in inhibition of
albuminuria and prevention of diabetic nephropathy
Immediate acting Nifedipine is not encouraged
anymore
32. Calcium Channel Blockers
Contraindications:
Unstable angina
Heart failure
Hypotension
Post infarct cases
Severe aortic stenosis
Preparation and dosage:
Amlodipine – 2.5, 5 and 10 mg tablets (5-10 mg
OD) – Stamlo, Amlopres, Amlopin etc.
Nimodipine – 30 mg tab and 10 mg/50 ml injection
– Vasotop, Nimodip, Nimotide etc.
33. Vasodilators - Hydralazine
Directly acting vasodilator
MOA: hydralazine molecules combine with receptors in the
endothelium of arterioles – NO release – relaxation of vascular smooth
muscle – fall in BP
Subsequenly fall in BP – stimulation of adrenergic system leading to
Cardiac stimulation producing palpitation and rise in CO even in
IHD and patients – anginal attack
Tachycardia
Increased Renin secretion – Na+ retention
These effects are countered by administration of beta blockers and
diuretics
However many do not agree to this theory
Uses: 1) Moderate hypertension when 1st line fails – with beta-blockers
and diuretics 2) Hypertension in Pregnancy, Dose 25-50 mg OD
34. Vasodilators - Minoxidil
Powerful vasodilator, mainly 2 major uses – antihypertensive
and alopecia
Prodrug and converted to an active metabolite which acts by
hyperpolarization of smooth muscles and thereby relaxation of
SM – leading to hydralazine like effects
Rarely indicated in hypertension especially in life threatening
ones
More often in alopecia to promote hair growth
Orally not used any more
Topically as 2-5% lotion/gel and takes months to get effects
MOA of hair growth:
Enhanced microcirculation around hair follicles and also by direct
stimulation of follicles
Alteration of androgen effect of hair follicles
35. Sodium Nitroprusside
Rapidly and consistently acting vasodilator
Relaxes both resistance and capacitance vessels and reduces
t.p.r and CO (decrease in venous return)
Unlike hydralazine it produces decrease in cardiac work and no
reflex tachycardia.
Improves ventricular function in heart failure by reducing preload
MOA: RBCs convert nitroprusside to NO – relaxation also by
non-enzymatically to NO by glutathione
Uses: Hypertensive Emergencies, 50 mg is added to 500 ml of
saline/glucose and infused slowly with 0.02 mg/min initially and
later on titrated with response (wrap with black paper)
Adverse effects: All are due release of cyanides (thiocyanate) –
palpitation, pain abdomen, disorientation, psychosis, weakness
and lactic acidosis.
36. Centrally acting Drugs
Alpha-Methyldopa: a prodrug
Precursor of Dopamine and NA
MOA: Converted to alpha methyl noradrenaline which acts
on alpha-2 receptors in brain and causes inhibition of
adrenergic discharge in medulla – fall in PVR and fall in BP
Various adverse effects – cognitive impairement, postural
hypotension, positive coomb`s test etc. – Not used
therapeutically now except in Hypertension during
pregnancy
Clonidine: Imidazoline derivative, partial agonist of central
alpha-2 receptor
Not frequently used now because of tolerance and
withdrawal hypertension
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