These slides present directly acting arteriolar dilators i.e.cardiovascular drugs, their mechanism of action, pharmacological effects, pharmacokinetics, uses and precautions.
These slides present directly acting arteriolar dilators i.e.cardiovascular drugs, their mechanism of action, pharmacological effects, pharmacokinetics, uses and precautions.
There are two distinct goals of drug therapy in CHF.
Relief of congestion/ low cardiac output symptoms and restoration of cardiac performance.
Ionotropic agents, Vasodilators, Diuretics, BETA Blockers.
Arrest/reversal of disease progression and prolongation of survival.
ACE inhibitors, ARBs, Beta Blockers, Aldosterone Antagonists.
This presentation deals with the most common antihypertensive drugs used in our day-to-day practice. The common 4 ABCDs (Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretics)
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
This ppt describes the anti-arrhythmic drugs pharmacology and the treatment of various arrhythmias. Novel drugs in clinical trials and older drugs with repurposed formulations also have been included. Useful for MD Pharmacology residents as well as MBBS students.
There are two distinct goals of drug therapy in CHF.
Relief of congestion/ low cardiac output symptoms and restoration of cardiac performance.
Ionotropic agents, Vasodilators, Diuretics, BETA Blockers.
Arrest/reversal of disease progression and prolongation of survival.
ACE inhibitors, ARBs, Beta Blockers, Aldosterone Antagonists.
This presentation deals with the most common antihypertensive drugs used in our day-to-day practice. The common 4 ABCDs (Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretics)
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
This ppt describes the anti-arrhythmic drugs pharmacology and the treatment of various arrhythmias. Novel drugs in clinical trials and older drugs with repurposed formulations also have been included. Useful for MD Pharmacology residents as well as MBBS students.
Malignant hyperthermia is a potentially fatal hyperdynamic response due to pharmacogenetic abnormalities. This ppt gives a brief description of pathology and pharmacotherapy of malignant hyperthermia.
The ppt is made for undergraduate students to have a basic understanding on Corticosteroids and its role in all feilds of medicine. This is also useful to Postgraduate students
Gout is a type of inflammatory arthritis that causes permanent disability if left untreated. This presentation focuses on the important salient points we need to remember in Gout in all aspects - diagnosis, managment (both non-pharmacological and pharmacological approaches).
This presentation is useful to both MBBS and Postgraduate students of Pharmacology.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. • A 35-year-old man presents with a blood pressure of 150/95 mm Hg.
• He has been generally healthy, is sedentary, drinks several cocktails per day, and does not
smoke cigarettes.
• He has a family history of hypertension, and his father died of a myocardial infarction at
age 55.
• Physical examination is remarkable only for moderate obesity.
• Total cholesterol is 220 mg/dL
• High-density lipoprotein (HDL) cholesterol level is 40 mg/dL.
• Fasting glucose is 105 mg/dL.
• Chest X-ray is normal.
• Electrocardiogram shows left ventricular enlargement.
• How would you treat this patient?
2
3. 1. List the Classification of Anti-hypertensive drugs
2. Describe the pharmacological basis for their anti-
hypertensive action
3.List out the Advantages and limitations of combining
antihypertensives
4. List out the 1st line, 2nd line and 3rd line drugs used in
hypertension.
3
7. • THIAZIDES - Diuretic of choice for
have
similar efficacy.
• Enhance the effect of other
antihypertensive agents.
• Chlorthalidone has longer t1/2 - 48hrs
compared to hydrochlorothiazide (<
24 hours)
7
8. PHARMACOKINETICS:
• well absorbed from the intestine
• effect starts within one hour.
• distributed throughout the ECF and
are relatively concentrated in the
kidney.
• crosses the placental barrier.
• excreted in urine.
8
9. DRUGS PROPRIETAR
Y NAMES
INITIAL
ORAL
DOSAGE
DOSAGE
RANGE
ADVERSE
EFFECTS
COMMENTS
HYDROCHLORTHIAZIDE EZIDRIX,
MICROZIDE,
HYDRAZIDE
12.5 OR
25MG OD
12.5 - 50MG
OD
LOW DOSES
EFFECTIVE IN
MANY
PATIENTS
WITHOUR
METABOLIC
ABNORMALITI
ES,
METOLAZONE
MORE
EFFECTIVE IN
KIDNEY
DISEASE,
INDAPAMIDE
DOES NOT
ALTER SERUM
LIPID LEVELS
CHLORTHALIDONE THALITONE 12.5 OR
25MG OD
12.5 - 50MG
OD
METOLAZONE ZAROXOLYN 1.25 OR
2.5MG OD
1.25 - 5 MG
OD
INDAPAMIDE LOZOL,
DAPAMIDE
2.5MG OD 2.5 - 5MG
OD
USE:
antihypertensive in
diabetic patients
BENDROFLUMETHIAZIDE APRINOX
NEO
NACLEX
2.5MG OD 2.5 - 5MG
OD
9
10. • Potent, oral diuretic.
• Not recommended for long term Rx of hypertension
• Indicated in severe hypertension with CHF and renal
dysfunction.
• Indacrinone can be used in patients of gout because it
inhibits reabsorption of uric acid in the nephron (other loop
diuretics and thiazides cause hyperuricemia).
10
13. DRUGS PROPRIETA
RY NAMES
INITIAL
ORAL
DOSAGE
DOSAGE
RANGE
ADVERSE EFFECTS COMMENTS
FUROSEMIDE LASIX 20MG BD 40-320MG IN
2-3 DIVIDED
DOSES
SAME AS
THIAZIDES. BUT
HIGHER RISK OF
EXCESSIVE
DIURESIS AND
ELECTROLYTE
IMBALANCE,
INCREASES
CALCIUM
EXCRETION
SHORT DURATION OF
ACTION. SHOULD BE
RESERVED FOR
PATIENTS WITH
KIDNEY DISEASE OR
FLUID RETENTION.
POOR ANTI-
HYPERTENSIVE
ACTION.
ETHACRYNIC
ACID
EDECRIN 50MG OD 50-100MG
OD OR BD
BUMETANIDE 0.25 MG
BD
0.5 - 10 MG
IN 2 OR 3
DOSES
TORSEMIDE DEMADEX,
DYTOR
5MG OD 5 - 10 MG OD EFFECTIVE BLOOD
PRESSURE
MEDICATION AT LOW
DOSAGE
13
18. • Inhibition of renin decreases Angiotensin I and Angiotensin II levels
and hence produces a fall in BP
ALISKIREN: (Tekturna)
• Oral non-peptide drug
• It should not be used along with ACEI or ARBs or in pregnancy.
• Dosage Forms & Strengths:
1. Tablet - 150mg, 300mg
2. Oral pellets in capsules - 37.5mg
• Indications: Hypertension in adults and children ≥6 years
• Adverse effects: diarrhoea, abdominal pian, angioedema, headache
18
25. Contraindication for ACEI:
(1) Severe bilateral renal artery stenosis as they reduce GFR and may cause renal failure,
(2) Aortic stenosis,
(3) Coarctation of the aorta; and
(4) Pregnancy.
25
27. Status in Hypertension:
• Presently the first-line antihypertensives.
• ACE inhibitors are useful in the treatment of hypertension of all grades due to all causes.
• Addition of a diuretic potentiates their antihypertensive efficacy.
They are specially indicated as antihypertensives in:
a. Hypertension with left ventricular hypertrophy - because hypertrophy is gradually
reversed by ACE inhibitors.
b. Patients with diabetes mellitus - because ACE-I slow the development of nephropathy.
c. Renal diseases with hypertension - ACE inhibitors slow the progression of chronic renal
diseases like glomerulosclerosis.
d. Patients with co-existing IHD including post-MI patients.
e. In severe hypertension, they may be combined with other antihypertensives like β-
blockers, CCBs or diuretics
27
28. • block the AT1 receptors,
• Pharmacologic effects are similar to those of ACE inhibitors
• ARBs do not increase bradykinin levels.
• Used as first-line agents for the treatment of hypertension, especially in
patients with a compelling indication of diabetes, heart failure, or
chronic kidney disease.
• ARBs should not be combined with an ACE inhibitor for the treatment
of hypertension due to similar mechanisms and adverse effects.
• teratogenic
28
29. Special features of losartan:
– Produce active metabolite - 5-Carboxylic acid (E-3174) (active
metabolite; 40 times as potent as losartan in angiotensin II-blocking
activity)
– Has anti-platelet action due to competitive antagonism of TXA2.
– Mild uricosuric effect
Telmisartan has additional PPAR-δ agonistic activity. This activity can
help in patients with dysglycemia. Telmisartan is longest acting whereas
eprosartan is shortest acting ARB.
29
32. (1) Aldosterone antagonist: Spironolactone, eplerenone.
(2) Direct inhibitors of renal epithelial sodium
channels: Triamterene and Amiloride - They have no
anti-hypertensive action.
These drugs are combined with loop or thiazide diuretics
to prevent or correct hypokalemia.
32
44. CLEVIDIPINE
Clevidipine is a dihydropyridine L-type calcium channel blocker, highly selective
for vascular smooth muscle.
It reduces mean arterial blood pressure by decreasing systemic vascular resistance.
Used in patients with acute hypertension who cannot take drugs orally.
Pharmacokinetics:
• Onset: 2-4 minutes
• Protein Bound: 99.5%
• Metabolized in blood and extravascular tissues
• Half-Life: Initial 1 minute; terminal 15 minutes
• Excretion: Urine (63-74%); feces (7-22%)
Dosage forms:
Intra venous emulsion - 1–2 mg/hour IV infusion.
44
47. ADVERSE EFFECTS:
• Hepatic dysfunction
• Thiocyanate toxicity -
Prolonged administration of
sodium nitroprusside either in high doses
or in the presence of renal insufficiency.
This results in fatigue, anorexia,
nausea, vomiting, sweating, disorientation,
psychotic behavior and muscle twitching.
Larger doses may cause ataxia,
rigidity, convulsions and metabolic
acidosis.
• Nitrates have a synergistic effect with
vasodilator drugs and can lead to sudden
fall in BP and collapse.
47
48. PREVENTION OF TOXICITY:
• Administration of sodium
thiosulphate along with nitroprusside
prevents the accumulation of cyanide.
• Alternatively, hydroxocobalamin
may be given which combines with
cyanide to form cyanocobalamin
which is a nontoxic compound.
• Methaemoglobinaemia is also known
following infusion of nitroprusside. It
should be avoided in pregnancy.
48
49. Preparations and dosage of
hydralazine:
• Hydralazine hydrochloride tablets 10,
25, and 50 mg. Maximum dose 100 mg
daily.
• Dihydralazine sulphate 25 mg tablet.
• Injection 20 mg for IM/IV use.
49
50. AVAILABLE FORMS OF
NITROPRUSSIDE
• Sodium nitroprusside is supplied as 50
mg powder to be dissolved in 500 ml
of 5% dextrose in water, just prior to
administration.
• When it is exposed to light, it is
converted to cyanide; hence a brown
or black paper bag over the IV fluid
container is necessary.
• Translucent plastic tubing may need
taping.
• Only freshly prepared solution should
be used.
50
53. Fenoldopam:
It is a D1 dopamine receptor agonist, brings about dilation of
peripheral arteries and also loss of sodium.
It has a short t½ of 10 minutes and is given as an IV infusion.
USES:
Useful in hypertensive emergencies and postoperative
hypertension, particularly when there is impaired renal function.
Started with a low dose of 0.1 μg/kg/min, it is gradually increased
every 20 minutes till adequate response is attained. (maximum dose
1.6 μg/kg/min).
Adverse effects: include flushing, headache, palpitation and
hypotension. It should be avoided in patients with glaucoma since it
can raise the intraocular pressure.
Fenoldopam has efficacy similar to sodium nitroprusside but is devoid
of thiocyanate-related complications.
53
57. Peripheral vascular alpha-
receptors are of two types
• Postsynaptic α1 receptors
which are stimulatory in
nature; their activation causes
vasoconstriction and
•
which are
inhibitory in nature; their
activation inhibits NA release.
57
64. BETA BLOCKERS
• They are the first-line antihypertensive drugs in mild to moderate
hypertension with cardiac problems.
• β-blockers are effective and well-tolerated and are of special value in
patients who also have arrhythmias or angina.
• They should not be used alone.
• Suitable for combination with other antihypertensives, particularly
with drugs that cause tachycardia as their side effect (e.g.
vasodilators).
• Beta blockers are avoided in patients with peripheral arterial disease.
64
70. Pharmacological actions of clonidine:
Given IV it produces a transient hypertensive response followed by a prolonged fall in both
systolic and diastolic BP accompanied by bradycardia. Initial hypertensive effect is not seen
after its oral administration.
PHARMACOKINETICS:
Bioavailability: Immediate release (75-85%)
Protein bound: 20-40%
Duration: 6-10 hr.
Metabolism in Liver.
Elimination Half-life: 12-16 hr.
Excretion: Urine
70
85. A CASE SCENARIO...
• A 35-year-old man presents with a blood pressure of 150/95 mm Hg.
• He has been generally healthy, is sedentary, drinks several cocktails per day, and does not
smoke cigarettes.
• He has a family history of hypertension, and his father died of a myocardial infarction at
age 55.
• Physical examination is remarkable only for moderate obesity.
• Total cholesterol is 220 mg/dL
• High-density lipoprotein (HDL) cholesterol level is 40 mg/dL.
• Fasting glucose is 105 mg/dL.
• Chest X-ray is normal.
• Electrocardiogram shows left ventricular enlargement.
• How would you treat this patient?
85
86. CASE SCENARIO ANSWER
The patient has Joint National Committee stage 1
hypertension.
The strong family history suggests that this patient has
essential hypertension.
Need to do ECHO, LFT, RFT, Sr. electrolytes
Non-Pharmacological management - behavioral,
including dietary changes and aerobic exercise.
86
87. CONTD..
Thiazide diuretics in low doses are inexpensive, have relatively few
side effects, and are effective in many patients with mild hypertension.
Other first-line agents include angiotensin-converting enzyme
inhibitors, angiotensin receptor blockers, and calcium channel
blockers.
A single agent should be prescribed and the patient reassessed in a
month.
If a second agent is needed, one of the two agents should be a
thiazide diuretic. Once blood pressure is controlled, patients should be
followed periodically to reinforce the need for compliance with both
lifestyle changes and medications.
87