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.
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 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 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 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.
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 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.
Hypertension is defined as a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg. It can be essential (of unknown cause) or secondary to other diseases. Normal blood pressure is regulated by the kidney which controls blood volume via the renin-angiotensin-aldosterone system (RAAS). RAAS is activated when blood pressure or sodium levels drop, causing vasoconstriction and sodium retention. Antihypertensive drugs target different parts of this system, like ACE inhibitors which block the conversion of angiotensin I to angiotensin II, reducing peripheral resistance and blood volume. Captopril is an ACE inhibitor that lowers blood pressure by
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 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 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 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.
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 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.
Hypertension is defined as a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg. It can be essential (of unknown cause) or secondary to other diseases. Normal blood pressure is regulated by the kidney which controls blood volume via the renin-angiotensin-aldosterone system (RAAS). RAAS is activated when blood pressure or sodium levels drop, causing vasoconstriction and sodium retention. Antihypertensive drugs target different parts of this system, like ACE inhibitors which block the conversion of angiotensin I to angiotensin II, reducing peripheral resistance and blood volume. Captopril is an ACE inhibitor that lowers blood pressure by
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 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 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
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 discusses antihypertensive drugs used to treat hypertension. It begins by defining hypertension and classifying it based on blood pressure levels. It then describes the normal regulation of blood pressure via baroreceptor reflexes and the renin-angiotensin-aldosterone system. The rest of the document is spent classifying and describing the mechanisms and effects of major classes of antihypertensive drugs, including diuretics, vasodilators, drugs affecting the sympathetic nervous system, beta-blockers, and others. Adverse effects and clinical uses are provided for many individual 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 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 outlining its pathophysiology, including potential mechanisms like the renin-angiotensin-aldosterone system. It then classifies antihypertensive drugs and provides examples in each category, describing their mechanisms of action. The categories discussed are centrally acting drugs, adrenergic receptor blockers, vasodilators, drugs blocking the renin-angiotensin-aldosterone axis like ACE inhibitors and angiotensin receptor blockers, calcium channel blockers, and diuretics. Specific drugs like clonidine, prazosin, and hydrochlorothiazide are explained in more detail.
This document summarizes various classes of antihypertensive drugs including diuretics, sympatholytic agents, adrenergic receptor blockers, direct vasodilators, calcium channel blockers, angiotensin converting enzyme inhibitors, and their mechanisms of action, therapeutic uses, and side effects. It also provides guidelines on the management of hypertension including recommendations for first-line drugs for mild or moderate vs. severe hypertension as well as considerations for special populations and hypertensive emergencies.
This document discusses various types of antihypertensive drugs including diuretics, renin-angiotensin system inhibitors, sympathetic inhibitors, calcium channel blockers, and vasodilators. It describes the mechanisms of action, pharmacological effects, drug interactions, and side effects of common antihypertensive drugs from each class such as hydrochlorothiazide, captopril, propranolol, nifedipine, and hydralazine. The document provides an overview of classifications, treatment approaches, and management of hypertension using different antihypertensive drug classes and combinations.
Hypertension (HTN), also known as high blood pressure, is defined as a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg. It is a major cause of heart disease and stroke. The renin-angiotensin-aldosterone system (RAAS) regulates blood pressure and fluid balance and dysregulation of this system is implicated in the majority of hypertension cases. Management involves lifestyle modifications like diet, exercise, weight loss and reducing sodium intake as well as pharmacological therapy with medications that target the RAAS or lower blood pressure directly. The goal of treatment is to lower blood pressure below 140/90 mmHg.
Electrophysiology of Heart & Drugs Affecting Renin Angiotensin System Monika Bhardwaj
The document discusses cardiac electrophysiology and the renin-angiotensin system. It describes how cardiac myocytes in the sinoatrial and atrioventricular nodes can generate impulses, and how these impulses propagate through specialized conducting tissue. It also details the actions of angiotensin II, including its effects on vasoconstriction, sodium reabsorption, and aldosterone secretion. Common drugs for manipulating the renin-angiotensin system are also summarized, such as ACE inhibitors like lisinopril and angiotensin receptor blockers like losartan.
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.
The document discusses the renin-angiotensin system (RAS) and drugs that affect it. RAS regulates blood pressure and electrolyte balance through the actions of angiotensin II, which is produced from renin and angiotensin converting enzyme. Angiotensin II causes vasoconstriction, sodium retention, and other effects. Drugs like ACE inhibitors and angiotensin receptor blockers inhibit parts of the RAS pathway to lower blood pressure. Captopril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and sodium retention.
1. Angiotensin converting enzyme inhibitors (ACEIs) block the conversion of angiotensin I to angiotensin II, inhibiting the renin-angiotensin system.
2. ACEIs are used to treat hypertension, congestive heart failure, myocardial infarction, diabetic nephropathy, and scleroderma renal crisis.
3. Common adverse effects of ACEIs include hypotension, cough, and hyperkalemia. ACEIs are contraindicated in pregnancy and bilateral renal artery stenosis due to risks of hypotension, renal failure, and fetal complications.
A presentation hypertension
(what blood pressure is, what is hypertension, what are the risk factors of hypertension, how is it managed?) and other related knowledge on hypertension
This document discusses the pathophysiology, clinical presentation, diagnosis and management of coronary artery disease and angina. It describes how atherosclerosis can lead to decreased oxygen supply or increased oxygen demand, resulting in myocardial ischemia and chest pain. The goals of treatment are to relieve symptoms, slow atherosclerosis, and reduce the risk of blood clots. Various drug classes are discussed including nitrates, beta-blockers, calcium channel blockers, ivabradine and ranolazine. Their mechanisms of action, pharmacological effects, uses, and side effects are summarized. The management of unstable angina and myocardial infarction is also outlined.
Scientific Research Methodology introduction.pdfCharlesSsekawu
Scientific Research Methodology introduction.RESEARCH METHODOLOY
DR. VAISHALI PAGAIRA 3
Unit-I
Research: Research comprises defining and redefining problems, formulating hypothesis or
suggested solution; collecting, organizing and evaluating data, making deductions and reaching
conclusions and carefully testing the conclusions to determine whether they fit the f ormulating
hypothesis. The manipulation of things, concepts or symbols for the purpose of generalizing to
extend , correct or verify knowledge, whether that knowledge aids in construction of theory or in
the practice of an art.
Research in simple terms refers to search for knowledge. It is a scientific and systematic
search for information on a particular topic or issue. It is also known as the art of scientific
investigation. Several social scientists have defined research in different ways.
In the Encyclopedia of Social Sciences, D. Slesinger and M. Stephension (1930) defined
research as “the manipulation of things, concepts or symbols for the purpose of generalizing to
extend, correct or verify knowledge, whether that knowledge aids in the construction of theory or
in the practice of an art”.
Research Methods Vs Methodology:
Research methods include all those techniques/methods that are adopted for conducting research.
Thus, research techniques or methods are the methods that the researchers adopt for conducting
the research studies. On the other hand, research methodology is the way in which research
problems are solved systematically. It is a science of studying how research is conducted
scientifically. Under it, the researcher acquaints himself/herself with the various steps generally
adopted to study a research problem, along with the underlying logic behind them. Hence, itis
not only important for the researcher to know the research techniques/ methods, but also the
scientific approach called methodology.
What is the definition of research methodology?
The process used to collect information and data for the purpose of making business decisions.
The methodology may include publication research, interviews, surveys and other research
techniques, and could include both present and historical information.
RESEARCH METHODOLOY
DR. VAISHALI PAGAIRA 4
Research methodology is a term that basically means the science of how research is done
scientifically. It is a way to systematically and logically solve a problem, help us understand the
process not just the product of research, and analyzes methods in addition to the information
obtained by them.
What are the types of research methodology?
Basic research
Applied Research
Problem oriented research
Problem solving
Quantitative Research
Qualitative Research
Research Problem: A research problem is a statement about an area of concern, a condition to
be improved, a difficulty to be eliminated, or a troubling question that exists in scholarly
literature, in theory, or in practice that points to the need for meaningful understanding
INTRODUCTION TO PHARMACY LAW AND REGULATIONSCharlesSsekawu
This document provides definitions and explanations of key terms related to pharmacy laws. It discusses the differences between laws and morality as well as rules and regulations. It also outlines the bodies responsible for pharmacy practice in Uganda, the laws governing it, and categories of pharmaceutical industries in the country. Sources of law are categorized into material sources, which include legislation, precedent, customary law, and conventional law, as well as historical and formal sources.
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 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 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
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 discusses antihypertensive drugs used to treat hypertension. It begins by defining hypertension and classifying it based on blood pressure levels. It then describes the normal regulation of blood pressure via baroreceptor reflexes and the renin-angiotensin-aldosterone system. The rest of the document is spent classifying and describing the mechanisms and effects of major classes of antihypertensive drugs, including diuretics, vasodilators, drugs affecting the sympathetic nervous system, beta-blockers, and others. Adverse effects and clinical uses are provided for many individual 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 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 outlining its pathophysiology, including potential mechanisms like the renin-angiotensin-aldosterone system. It then classifies antihypertensive drugs and provides examples in each category, describing their mechanisms of action. The categories discussed are centrally acting drugs, adrenergic receptor blockers, vasodilators, drugs blocking the renin-angiotensin-aldosterone axis like ACE inhibitors and angiotensin receptor blockers, calcium channel blockers, and diuretics. Specific drugs like clonidine, prazosin, and hydrochlorothiazide are explained in more detail.
This document summarizes various classes of antihypertensive drugs including diuretics, sympatholytic agents, adrenergic receptor blockers, direct vasodilators, calcium channel blockers, angiotensin converting enzyme inhibitors, and their mechanisms of action, therapeutic uses, and side effects. It also provides guidelines on the management of hypertension including recommendations for first-line drugs for mild or moderate vs. severe hypertension as well as considerations for special populations and hypertensive emergencies.
This document discusses various types of antihypertensive drugs including diuretics, renin-angiotensin system inhibitors, sympathetic inhibitors, calcium channel blockers, and vasodilators. It describes the mechanisms of action, pharmacological effects, drug interactions, and side effects of common antihypertensive drugs from each class such as hydrochlorothiazide, captopril, propranolol, nifedipine, and hydralazine. The document provides an overview of classifications, treatment approaches, and management of hypertension using different antihypertensive drug classes and combinations.
Hypertension (HTN), also known as high blood pressure, is defined as a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg. It is a major cause of heart disease and stroke. The renin-angiotensin-aldosterone system (RAAS) regulates blood pressure and fluid balance and dysregulation of this system is implicated in the majority of hypertension cases. Management involves lifestyle modifications like diet, exercise, weight loss and reducing sodium intake as well as pharmacological therapy with medications that target the RAAS or lower blood pressure directly. The goal of treatment is to lower blood pressure below 140/90 mmHg.
Electrophysiology of Heart & Drugs Affecting Renin Angiotensin System Monika Bhardwaj
The document discusses cardiac electrophysiology and the renin-angiotensin system. It describes how cardiac myocytes in the sinoatrial and atrioventricular nodes can generate impulses, and how these impulses propagate through specialized conducting tissue. It also details the actions of angiotensin II, including its effects on vasoconstriction, sodium reabsorption, and aldosterone secretion. Common drugs for manipulating the renin-angiotensin system are also summarized, such as ACE inhibitors like lisinopril and angiotensin receptor blockers like losartan.
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.
The document discusses the renin-angiotensin system (RAS) and drugs that affect it. RAS regulates blood pressure and electrolyte balance through the actions of angiotensin II, which is produced from renin and angiotensin converting enzyme. Angiotensin II causes vasoconstriction, sodium retention, and other effects. Drugs like ACE inhibitors and angiotensin receptor blockers inhibit parts of the RAS pathway to lower blood pressure. Captopril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and sodium retention.
1. Angiotensin converting enzyme inhibitors (ACEIs) block the conversion of angiotensin I to angiotensin II, inhibiting the renin-angiotensin system.
2. ACEIs are used to treat hypertension, congestive heart failure, myocardial infarction, diabetic nephropathy, and scleroderma renal crisis.
3. Common adverse effects of ACEIs include hypotension, cough, and hyperkalemia. ACEIs are contraindicated in pregnancy and bilateral renal artery stenosis due to risks of hypotension, renal failure, and fetal complications.
A presentation hypertension
(what blood pressure is, what is hypertension, what are the risk factors of hypertension, how is it managed?) and other related knowledge on hypertension
This document discusses the pathophysiology, clinical presentation, diagnosis and management of coronary artery disease and angina. It describes how atherosclerosis can lead to decreased oxygen supply or increased oxygen demand, resulting in myocardial ischemia and chest pain. The goals of treatment are to relieve symptoms, slow atherosclerosis, and reduce the risk of blood clots. Various drug classes are discussed including nitrates, beta-blockers, calcium channel blockers, ivabradine and ranolazine. Their mechanisms of action, pharmacological effects, uses, and side effects are summarized. The management of unstable angina and myocardial infarction is also outlined.
Similar to anti hypertensive pharmacology.pptx (20)
Scientific Research Methodology introduction.pdfCharlesSsekawu
Scientific Research Methodology introduction.RESEARCH METHODOLOY
DR. VAISHALI PAGAIRA 3
Unit-I
Research: Research comprises defining and redefining problems, formulating hypothesis or
suggested solution; collecting, organizing and evaluating data, making deductions and reaching
conclusions and carefully testing the conclusions to determine whether they fit the f ormulating
hypothesis. The manipulation of things, concepts or symbols for the purpose of generalizing to
extend , correct or verify knowledge, whether that knowledge aids in construction of theory or in
the practice of an art.
Research in simple terms refers to search for knowledge. It is a scientific and systematic
search for information on a particular topic or issue. It is also known as the art of scientific
investigation. Several social scientists have defined research in different ways.
In the Encyclopedia of Social Sciences, D. Slesinger and M. Stephension (1930) defined
research as “the manipulation of things, concepts or symbols for the purpose of generalizing to
extend, correct or verify knowledge, whether that knowledge aids in the construction of theory or
in the practice of an art”.
Research Methods Vs Methodology:
Research methods include all those techniques/methods that are adopted for conducting research.
Thus, research techniques or methods are the methods that the researchers adopt for conducting
the research studies. On the other hand, research methodology is the way in which research
problems are solved systematically. It is a science of studying how research is conducted
scientifically. Under it, the researcher acquaints himself/herself with the various steps generally
adopted to study a research problem, along with the underlying logic behind them. Hence, itis
not only important for the researcher to know the research techniques/ methods, but also the
scientific approach called methodology.
What is the definition of research methodology?
The process used to collect information and data for the purpose of making business decisions.
The methodology may include publication research, interviews, surveys and other research
techniques, and could include both present and historical information.
RESEARCH METHODOLOY
DR. VAISHALI PAGAIRA 4
Research methodology is a term that basically means the science of how research is done
scientifically. It is a way to systematically and logically solve a problem, help us understand the
process not just the product of research, and analyzes methods in addition to the information
obtained by them.
What are the types of research methodology?
Basic research
Applied Research
Problem oriented research
Problem solving
Quantitative Research
Qualitative Research
Research Problem: A research problem is a statement about an area of concern, a condition to
be improved, a difficulty to be eliminated, or a troubling question that exists in scholarly
literature, in theory, or in practice that points to the need for meaningful understanding
INTRODUCTION TO PHARMACY LAW AND REGULATIONSCharlesSsekawu
This document provides definitions and explanations of key terms related to pharmacy laws. It discusses the differences between laws and morality as well as rules and regulations. It also outlines the bodies responsible for pharmacy practice in Uganda, the laws governing it, and categories of pharmaceutical industries in the country. Sources of law are categorized into material sources, which include legislation, precedent, customary law, and conventional law, as well as historical and formal sources.
1) The document discusses the key processes of memory: encoding, storage, and retrieval. It describes how information moves from sensory memory to short-term memory and then (through elaborative rehearsal) into long-term memory.
2) It then discusses several theories of forgetting, including decay, interference, retrieval-based forgetting, and storage-based forgetting. It also mentions motivated or purposeful forgetting, such as Freud's concept of repression.
3) The document questions how much we can truly intentionally forget or trust recovered memories of things like childhood trauma that were supposedly repressed.
This document discusses several approaches to breaking bad news to patients in a compassionate manner. It outlines the ABCDE and SPIKES protocols which involve preparing in advance, building a therapeutic environment, clearly communicating the news, dealing with reactions, encouraging emotions, setting up privacy, assessing understanding, inviting discussion, providing knowledge, addressing emotions, and creating a strategy and summary. The document emphasizes breaking news directly but gently, using plain language, allowing silence, validating emotions, and providing follow up support to empower patients during difficult conversations.
1) Learning involves acquiring relatively permanent changes in behavior through experience. It can occur through classical conditioning, operant conditioning, and cognitive learning.
2) Classical conditioning pairs a neutral stimulus with an unconditioned stimulus to elicit a conditioned response. Operant conditioning uses reinforcement and punishment to modify voluntary behaviors. Cognitive learning focuses on mental processes like latent learning and observational learning.
3) Key principles of learning include reinforcement, punishment, shaping, extinction, generalization, and discrimination. Learning theories are applied to understand behaviors and design treatment programs.
Description of body fluids compartments.pptxCharlesSsekawu
The document describes the different body fluid compartments and their composition. It discusses:
- The two main fluid compartments - intracellular fluid (ICF) and extracellular fluid (ECF). ECF includes interstitial fluid, plasma, and other specialized fluids.
- The major ions found in ICF (K+) and ECF (Na+, Cl-, HCO3-), and their important functions.
- Other specialized body fluids like lymph, milk, cerebrospinal fluid, amniotic fluid, aqueous humor, sweat, and tears - their composition and roles.
- The lymphatic system which drains interstitial fluid back to blood and transports fats and immune cells.
The document describes the cardiac cycle and its key events. The cardiac cycle consists of systole, when the heart contracts and pumps blood, and diastole, when the heart relaxes and fills with blood. Each cycle takes approximately 0.8 seconds. Systole includes the isometric contraction, when pressure rises but volume does not change, and the ejection period, when blood is pumped out. Diastole includes isometric relaxation as pressure falls, followed by three filling phases - rapid, slow, and last rapid filling due to atrial contraction. The document provides details on the timing and mechanics of each phase of the cardiac cycle.
The document summarizes the anatomy and physiology of the heart. It describes the location of the heart in the thoracic cavity surrounded by the pericardium. It outlines the four chambers of the heart - right and left atria and ventricles - and explains the pulmonary and systemic circulation circuits. Key structures like the septa that divide the chambers, valves that ensure one-way blood flow, and coronary arteries and veins are also summarized. The layers of the heart - epicardium, myocardium and endocardium - and the internal structures such as trabeculae and papillary muscles are briefly outlined.
A 65-year-old woman presented to the emergency department with nausea, vomiting, and diarrhea one day after starting a new medication. Based on her symptoms and recent medication initiation, the physician determined she was experiencing an adverse drug reaction. Laboratory tests were ordered to confirm the diagnosis and identify the culprit medication so it could be discontinued.
The document describes the anatomy and physiology of the heart. It discusses the location of the heart within the thoracic cavity. It outlines the four chambers of the heart - the right and left atria and ventricles. It describes the pulmonary and systemic circuits that transport blood to and from the lungs and body. The layers of the heart - epicardium, myocardium, and endocardium - are defined. Key internal structures like the septa that divide the chambers and the four heart valves that ensure one-way blood flow are also summarized.
The renal system consists of paired kidneys, ureters, urinary bladder, and urethra. The kidneys filter waste from the blood to produce urine and regulate electrolyte, acid-base, and fluid balance. The functional unit of the kidney is the nephron, which filters blood in the renal corpuscle and reabsorbs or secretes substances along the renal tubule to form urine. Urine passes through collecting ducts, ureters, bladder, and urethra for excretion from the body.
The heart is located in the thoracic cavity, surrounded by the pericardium. It has four chambers - right and left atria which receive blood, and right and left ventricles which pump blood out. The heart has two circulation circuits - pulmonary circulation transports blood to and from the lungs, while systemic circulation transports oxygenated blood to the body. It has four valves that ensure one-way blood flow - tricuspid, pulmonary, mitral and aortic valves. Contraction of the heart muscles pumps blood through the heart and major arteries.
The document discusses the anatomy and physiology of the liver and gallbladder. It describes the lobular structure of the liver made up of hepatic lobules containing hepatocytes and portal triads. It also discusses the biliary system including the gallbladder and bile ducts. Key functions of the liver mentioned include metabolism, storage, synthesis of proteins and bile, and detoxification. The gallbladder stores and concentrates bile released from the liver. Jaundice and types of hepatitis are also summarized.
This document provides an overview of the digestive system, including the anatomy and physiology of the digestive tract and its organs. It describes the layers of the digestive tract wall and discusses the nerve supply, including the enteric and autonomic nervous systems. The functions of the digestive system and the organs of the gastrointestinal tract are outlined. Details are provided on the structure and layers of the stomach wall, as well as the glands and secretions of the stomach, including the composition and functions of gastric juice.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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4. Types of
Hypertension
Essential
A disorder of unknown
origin affecting the
Blood Pressure
regulating mechanisms
Secondary
Secondary to other
disease processes
****************************************************
5.
6. Treatment – Why?
Symptomatic treatment is Mandatory:
Damage to the vascular epithelium, paving the
path for atherosclerosis or nephropathy due
to high intra-glomerular pressure
Increased load on heart due to high BP can
cause CHF
Hypertension, even asymptomatic needs
treatment
7. Normal Blood Pressure Regulation
Hydraulic equation:
Blood Pressure = Cardiac output (CO) X
Resistance to passage of blood
through precapillary arterioles (PVR)
Physiologically CO and PVR is
maintained minute to minute by –
arterioles (1) postcapillary venules (2)
and Heart (3)
Kidney is the fourth site – volume of
intravascular fluid
Baroreflex, humoral mechanism and
renin-angiotensin- aldosterone system
regulates the above 4 sites
Local agents like Nitric oxide
In hypertensives – Baroreflex and
renal blood-volume control system –
set at higher level
All antihypertensives act via
interfering with normal mechanisms
10. The Renal response
Long-term blood pressure control – by controlling
blood volume
Reduction in renal pressure - intrarenal redistribution
of pressure and increased absorption of salt and
water
Decreased pressure in renal arterioles and
sympathetic activity – renin production – angiotensin
II production
Angiotensin II:
Causes direct constriction of renal arterioles
Stimulation of aldosterone synthesis – sodium
absorption and increase in intravascular blood volume
11.
12.
13. Antihypertensive Drugs
Diuretics:
Thiazides: Hydrochlorothiazide, chlorthalidone, Indapamide
High ceiling: Furosemide, Torsemide, Ethacrynic acid
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
14. 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
15. 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
16.
17. Diuretics
Drugs causing net loss of Na+ and water in urine
Mechanism of antihypertensive action:
Initially: diuresis – depletion of Na+ and body fluid
volume – decrease in cardiac output
Subsequently after 4 - 6 weeks, Na+ balance and CO
is regained by 95%, but BP remains low!
Q: Why? Answer: reduction in total peripheral
resistance (TPR) due to deficit of little amount of Na+
and water (Na+ causes vascular stiffness)
Similar effect is seen with sodium restriction (low
sodium diet)
18.
19. Thiazide diuretics – adverse effects
Adverse Effects:
Hypokalaemia – muscle pain and fatigue
Hyperglycemia: Inhibition of insulin release due to K+
depletion (proinsulin to insulin) – precipitation of
diabetes
Hyperlipidemia: rise in total LDL level – risk of stroke
Hyperurecaemia: inhibition of urate excretion
Sudden cardiac death – tosades de pointes
(hypokalaemia)
All the above metabolic side effects – higher doses (50
– 100 mg per day)
But, its observed that these adverse effects are
minimal with low doses (12.5 to 25 mg) - Average fall
in BP is 10 mm of Hg
20. Thiazide diuretics – current status
Effects of low dose:
No significant hypokalaemia
Low incidence of arrhythmia
Lower incidence of hyperglycaemia, hyperlipidemia and
hyperuricaemia
Reduction in MI incidence
Reduction in mortality and morbidity
JNC recommendation:
JNC recommends low dose of thiazide therapy (12.5 – 25
mg per day) in essential hypertension
Preferably should be used with a potassium sparing diuretic
as first choice in elderly
If therapy fails – another antihypertensive but do not
increase the thiazide dose
Loop diuretics are to be given when there is severe
hypertension with retention of body fluids
21. Diuretics
K+ sparing diuretics:
Thiazide and K sparing diuretics are combined
therapeutically – DITIDE (triamterene + benzthiazide)
is popular one
Modified thiazide: indapamide
Indole derivative and long duration of action (18 Hrs) –
orally 2.5 mg dose
It is a lipid neutral i.e. does not alter blood lipid
concentration, but other adverse effects may remain
Loop diuretics:
Na+ deficient state is temporary, not maintained round
–the-clock with no effect on t.p.r
Used only in complicated cases – CRF, CHF marked
fluid retention cases
25. 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
27. 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
28. Angiotensin-II
What are the ill effects on chronic ?
Volume overload and increased t.p.r
Cardiac hypertrophy and remodeling
Coronary vascular damage and remodeling
Hypertension – long standing will cause ventricular
hypertrophy
Myocardial infarction – hypertrophy of non-infarcted
area of ventricles
Renal damage
Risk of increased CVS related morbidity and mortality
ACE inhibitors reverse cardiac and vascular
hypertrophy and remodeling
29. Angiotensin-II – Pathophysiological
Roles
1. Mineraocorticoid secretion
2. Electrolyte, blood volume and pressure homeostasis: Renin is
released when there is changes in blood volume or pressure
or decreased Na+ content
Intrarenal baroreceptor pathway – reduce tension in the afferent
glomerular arterioles by local production of Prostaglandin –
intrarenal regulator of blood flow and reabsorption
Low Na+ conc. in tubular fluid – macula densa pathway – COX-2
and nNOS are induced – release of PGE2 and PGI2 – more renin
release
Baroreceptor stimulation increases sympathetic impulse – via
beta-1 pathway – renin release
Renin release – increased Angiotensin II production –
vasoconstriction and increased Na+ and water reabsorption
Long term stabilization of BP is achieved – long-loop negative
feedback and short-loop negative feedback mechanism
3. Hypertension
4. Secondary hyperaldosteronism
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
37. 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.
38. ACE inhibitors – other uses
Hypertension
Congestive Heart Failure
Myocardial Infarction
Prophylaxis of high CVS risk subjects
Diabetic Nephropathy
Schleroderma crisis
39. 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
40. 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
41. 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
42. 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
43. 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
44. 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
45. 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
46. 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
47. 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)
49. 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
50. 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
51. 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
52. 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.
53. 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
54. 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
55. 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.
56. 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
Read it yourself
58. Treatment of Hypertension: 7
classification
Categories
BP Systolic Diastolic
Normal >120 <80
Prehypertension 120-139 80-89
Stage1 149-159 90-99
Stage2 >160 >100
Risk factors
1. Age above 55 and 65 in
Men and Woman
respectively
2. Family History
3. Smoking
4. DM and Dyslipidemia
5. Hypertension
6. Obesity
7. Microalbuminuria
61. Treatment of Hypertension – General
principles
Stage I:
Start with a single most appropriate drug with a low
dose. Preferably start with Thiazides. Others like beta-
blockers, CCBs, ARBs and ACE inhibitors may also be
considered. CCB – in case of elderly and stroke
prevention. If required increase the dose moderately
Partial response or no response – add from another
group of drug, but remember it should be a low dose
combination
If not controlled – change to another low dose
combination
In case of side effects lower the dose or substitute with
other group
Stage 2: Start with 2 drug combination – one should
be diuretic
62. Treatment of Hypertension –
combination therapy
In clinical practice a large number of patients require
combination therapy – the combination should be
rational and from different patterns of haemodynamic
effects
Sympathetic inhibitors (not beta-blockers) and
vasodilators + diuretics
Diuretics, CCBs, ACE inhibitors and vasodilators +
beta blockers (blocks renin release)
Hydralazine and CCBs + beta-blockers (tachycardia
countered)
ACE inhibitors + diuretics
3 (three) Drug combinations:
CCB+ACE/ARB+diuretic; CCB+Beta blocker+
diuretic; ACEI/ARB+ beta blocker+diuretic
63. Treatment of Hypertension.
Never combine:
Alpha or beta blocker and clonidine - antagonism
Nifedepine and diuretic synergism
Hydralazine with DHP or prazosin – same type of
action
Diltiazem and verapamil with beta blocker –
bradycardia
Methyldopa and clonidine
Hypertension and pregnancy:
No drug is safe in pregnancy
Avoid diuretics, propranolol, ACE inhibitors, Sodium
nitroprusside etc
Safer drugs: Hydralazine, Methyldopa, cardioselective
beta blockers and prazosin
64. Hypertensive Emergencies
Cerebrovascular accident or head injury with high BP
Left ventricular failure with pulmonary edema due to
hypertension
Hypertensive encephalopathy
Angina or MI with raised BP
Acute renal failure with high BP
Eclampsia
Pheochromocytoma, cheese reaction and clonidine withdrawal
Drugs:
Sodium Nitroprusside (20-300 mcg/min) – dose titration and
monitoring
GTN (5-20 mcg/min) – cardiac surgery, LVF, MI and angina
Esmolol (0.5 mg/kg bolus) and 50-200mcg/kg/min - useful in
reducing cardiac work
Phentolamine – pheochromocytoma, cheese reaction nd clonidine
withdrawal (5-10 mg IV)
65. Desirable to know/learn
Classification of Antihypertensive
Antihypertensive mechanisms: Diuretics, ACE
inhibitors, ARBs, Beta-blockers, alpha-blockers,
CCBs, Vasodilators and central sympatholytics
Present status of above mentioned group of Drugs
Common Adverse effects of above groups of Drugs
Pharmacotherapy of Hypertension
Pharmacotherapy of hypertensive emergencies
Preparation and dosage of commonly used drugs of
above mentioned groups