Hypertension is defined as systolic blood pressure over 140 mm Hg or diastolic over 90 mm Hg. It can be primary or secondary, with primary/essential hypertension accounting for 90-95% of cases in adults.
Antihypertensive drugs work by decreasing peripheral artery tone, reducing cardiac output, and diminishing circulating blood volume. Major classes include diuretics, adrenoblockers, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers. Calcium channel blockers work by blocking calcium channels in blood vessel walls, relaxing vessels and lowering blood pressure. They are effective for controlling hypertension and its symptoms.
Systemic hypertension is a long-lasting increase in blood pressure. Primary (essential) hypertension has no known cause, while secondary hypertension is caused by another underlying disease. According to guidelines, the prevalence of hypertension increases with age, affecting over 60% of those over 70 years old. The JNC 7 classification simplified earlier systems, categorizing blood pressure into four levels of severity. Higher blood pressure levels correspond to greater risk of cardiovascular diseases like heart failure and stroke. Antihypertensive treatment can significantly reduce this risk by lowering blood pressure. Evaluation of hypertensive patients considers lifestyle factors, risks, and screening for related diseases to guide treatment.
New pharmocological agents in the management of angina nicorandilJerin Kuruvilla
Nicorandil is a potassium channel activator used to treat angina. It works by dilating both epicardial coronary arteries through its nitrate-like properties as well as peripheral coronary arterioles through potassium channel activation. This dual mechanism of action decreases myocardial oxygen demand and increases supply. Nicorandil has been shown to be effective in treating stable and unstable angina, improving outcomes in acute myocardial infarction when administered before reperfusion, and preventing the no-reflow phenomenon during percutaneous coronary intervention. It provides cardioprotection through ischemic preconditioning with a good safety profile.
Pulmonary hypertension is defined as a mean pulmonary arterial pressure of at least 25 mm Hg. It can be caused by various conditions and is classified accordingly. Idiopathic pulmonary hypertension has no known cause. It presents with dyspnea and right heart failure. Diagnosis involves right heart catheterization showing elevated pulmonary pressures. Treatment includes diuretics, vasodilators like calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostanoids, and sometimes atrial septostomy or lung transplantation for severe cases refractory to medical therapy. Prognosis depends on factors like functional status, hemodynamics, and response to treatment.
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
This document discusses hyponatremia, defined as a sodium level below 135 mEq/L. It describes the fluid compartments in the body under normal conditions and with hyponatremia. Causes of hyponatremia include excessive water intake, syndrome of inappropriate antidiuretic hormone secretion, and liver or kidney failure. Symptoms range from nausea and vomiting to seizures and coma. Severe hyponatremia below 115 mEq/L may warrant emergency treatment to correct the sodium level by no more than 1 mEq/L/hour. The document provides extensive details on the causes, diagnosis, and treatment of hyponatremia.
This document provides an overview of hypertension including its diagnosis, management, and treatment. It defines hypertension and classifies blood pressure levels. Lifestyle factors and common causes of primary and secondary hypertension are discussed. Target organ damage from hypertension is described along with clinical manifestations. Treatment involves lifestyle modifications and medication including diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and ARBs. Factors influencing medication choice and treatment failure are also summarized.
This document discusses antiarrhythmic drugs, their mechanisms of action, indications, and side effects. It covers the Vaughan-Williams classification system for antiarrhythmic drugs (Classes I-IV) and describes examples from each class such as quinidine, amiodarone, beta blockers, calcium channel blockers, and others. The mechanisms by which these drugs treat arrhythmias include blocking sodium, potassium, or calcium channels or suppressing automaticity. Adverse effects and considerations for use are also outlined.
Systemic hypertension is a long-lasting increase in blood pressure. Primary (essential) hypertension has no known cause, while secondary hypertension is caused by another underlying disease. According to guidelines, the prevalence of hypertension increases with age, affecting over 60% of those over 70 years old. The JNC 7 classification simplified earlier systems, categorizing blood pressure into four levels of severity. Higher blood pressure levels correspond to greater risk of cardiovascular diseases like heart failure and stroke. Antihypertensive treatment can significantly reduce this risk by lowering blood pressure. Evaluation of hypertensive patients considers lifestyle factors, risks, and screening for related diseases to guide treatment.
New pharmocological agents in the management of angina nicorandilJerin Kuruvilla
Nicorandil is a potassium channel activator used to treat angina. It works by dilating both epicardial coronary arteries through its nitrate-like properties as well as peripheral coronary arterioles through potassium channel activation. This dual mechanism of action decreases myocardial oxygen demand and increases supply. Nicorandil has been shown to be effective in treating stable and unstable angina, improving outcomes in acute myocardial infarction when administered before reperfusion, and preventing the no-reflow phenomenon during percutaneous coronary intervention. It provides cardioprotection through ischemic preconditioning with a good safety profile.
Pulmonary hypertension is defined as a mean pulmonary arterial pressure of at least 25 mm Hg. It can be caused by various conditions and is classified accordingly. Idiopathic pulmonary hypertension has no known cause. It presents with dyspnea and right heart failure. Diagnosis involves right heart catheterization showing elevated pulmonary pressures. Treatment includes diuretics, vasodilators like calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostanoids, and sometimes atrial septostomy or lung transplantation for severe cases refractory to medical therapy. Prognosis depends on factors like functional status, hemodynamics, and response to treatment.
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
This document discusses hyponatremia, defined as a sodium level below 135 mEq/L. It describes the fluid compartments in the body under normal conditions and with hyponatremia. Causes of hyponatremia include excessive water intake, syndrome of inappropriate antidiuretic hormone secretion, and liver or kidney failure. Symptoms range from nausea and vomiting to seizures and coma. Severe hyponatremia below 115 mEq/L may warrant emergency treatment to correct the sodium level by no more than 1 mEq/L/hour. The document provides extensive details on the causes, diagnosis, and treatment of hyponatremia.
This document provides an overview of hypertension including its diagnosis, management, and treatment. It defines hypertension and classifies blood pressure levels. Lifestyle factors and common causes of primary and secondary hypertension are discussed. Target organ damage from hypertension is described along with clinical manifestations. Treatment involves lifestyle modifications and medication including diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and ARBs. Factors influencing medication choice and treatment failure are also summarized.
This document discusses antiarrhythmic drugs, their mechanisms of action, indications, and side effects. It covers the Vaughan-Williams classification system for antiarrhythmic drugs (Classes I-IV) and describes examples from each class such as quinidine, amiodarone, beta blockers, calcium channel blockers, and others. The mechanisms by which these drugs treat arrhythmias include blocking sodium, potassium, or calcium channels or suppressing automaticity. Adverse effects and considerations for use are also outlined.
This document discusses resistant hypertension. It defines resistant hypertension as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, including a diuretic. It notes that resistant hypertension affects 10-20% of hypertensive patients and is associated with increased risk of cardiovascular events. The document outlines various causes of resistant hypertension including primary factors, secondary causes like obstructive sleep apnea and primary aldosteronism, and lifestyle and medication factors that can contribute. It provides guidance on evaluating and managing patients with resistant hypertension through lifestyle changes, medication optimization, and consideration of device therapies if needed.
Vasopressin receptor antagonist and therapeutic potentialDr Amit Mittal
Vasopressin receptor antagonists work by blocking vasopressin receptors and have therapeutic potential. Vasopressin is a hormone that acts on kidneys to increase water permeability and on blood vessels to cause vasoconstriction. There are three main types of vasopressin receptors: V1a, V1b, and V2. Vasopressin receptor antagonists include conivaptan, tolvaptan, and lixivaptan which are used to treat hyponatremia associated with congestive heart failure and cirrhosis by selectively blocking the V2 receptor. Relcovaptan is a V1a selective antagonist being studied for Raynaud's disease and dys
Polypill for primary and secondary preventions of cardiovascularBhaswat Chakraborty
This document discusses cardiovascular diseases (CVDs) and strategies for primary and secondary prevention. It summarizes that CVDs are caused by risk factors like hypertension, diabetes, smoking, obesity, and high cholesterol. Modifying these risk factors can prevent CVDs. The document outlines that a polypill containing multiple drugs can provide primary prevention by lowering risk factors. Studies on Cadila Pharmaceuticals' polypill product Polycap found it reduced blood pressure and LDL cholesterol similarly to the individual drugs. Polycap was also found to have no drug interactions and preserve the bioavailability of components, establishing its potential for CVD prevention.
Hypertension is defined as high blood pressure with a systolic reading of 140 mmHg or higher or a diastolic reading of 90 mmHg or higher. It can be caused by primary or secondary factors. Primary hypertension makes up 90-95% of cases and has contributing lifestyle factors like increased sodium intake, obesity, lack of exercise, and excessive alcohol consumption. Secondary hypertension is caused by an underlying medical condition. Treatment involves lifestyle modifications like diet, exercise, weight loss and lowering sodium intake as well as medication to control blood pressure. The goal of treatment is to reduce cardiovascular risk by maintaining a blood pressure reading under 140/90 mmHg or under 130/80 mmHg for those with diabetes or kidney disease.
This document provides guidelines for the diagnosis of primary aldosteronism, pheochromocytoma, Cushing's syndrome, renal artery stenosis, and evaluating young hypertension. It outlines recommended screening tests and confirmatory tests for each condition. Screening tests include ARR for primary aldosteronism, plasma and urine metanephrines for pheochromocytoma, and various cortisol tests for Cushing's syndrome. Confirmatory tests include saline infusion testing, AVS and subtype evaluation for primary aldosteronism and imaging, genetic testing for pheochromocytoma. The source is then localized for ACTH dependent Cushing's syndrome. Renal artery stenosis is screened for using duplex ultrasound
Sepsis & septic shock an updated managementahad80a
1) Sepsis and septic shock are systemic inflammatory responses to infection that can lead to organ dysfunction and death. The management involves recognizing the condition, administering antibiotics and fluids, controlling the infection source, and providing supportive organ care.
2) Diagnostic criteria include signs of infection along with dysregulated inflammatory response and organ dysfunction. Management goals within 3-6 hours include antibiotics, fluid resuscitation, lactate measurement, vasopressors for hypotension, and in some cases steroids and glucose control.
3) Common infection sites include the lungs, urinary tract, abdomen, and intravenous lines. Antibiotics should have appropriate spectrum and be given quickly based on likely pathogens. Other supportive therapies
HYPERTENSION introduction, recommendations for accurate measurements of BP, evaluation of patient with hypertension, management of patient with hypertension, resistant hypertension, hypertensive crisis, hypertensive emergencies
DPP-4 inhibitors work by inhibiting the DPP-4 enzyme, which normally breaks down the incretin hormones GLP-1 and GIP. By inhibiting DPP-4, GLP-1 levels are increased for longer after meals. This helps lower blood sugar levels by stimulating insulin secretion, suppressing glucagon secretion, and slowing gastric emptying. DPP-4 inhibitors are used to treat type 2 diabetes, either alone or in combination with other drugs like metformin. They improve glycemic control as measured by HbA1c levels and have benefits like weight neutrality and low risk of hypoglycemia. However, some studies have found possible links between DPP-4 inhibitors and side effects like pancreatitis
This document defines essential hypertension and provides a classification of blood pressure levels according to the JNC-7 report. It also outlines the causes, initial investigations, complications, and treatment of hypertension. Hypertension is classified as normal, prehypertensive, or hypertensive stage 1 or 2 based on systolic and diastolic blood pressure levels. Lifestyle modifications and drug treatments including diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers are recommended depending on the hypertension stage. Hypertensive crisis requires urgent treatment with intravenous drugs to lower blood pressure and prevent complications affecting the heart, brain, kidneys, and other organs.
WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
This case report describes a nearly fatal case of amlodipine poisoning in an 11-month old infant. The infant received 6 doses of 15mg of amlodipine which was mistakenly dispensed instead of amoxicillin. Within hours, the infant developed vomiting, lethargy, bradycardia, respiratory distress, and hypotension. Laboratory tests showed hyperglycemia, electrolyte abnormalities, and elevated liver enzymes. The infant was treated with insulin, calcium gluconate, ionotropes, and peritoneal dialysis. The infant's condition gradually improved and was discharged after 10 days. The authors conclude that hyperinsulinemia therapy is beneficial in treating calcium channel blocker toxicity and
This document discusses electrolyte disorders and provides details on hyponatremia and hypernatremia. It defines hyponatremia as a low serum sodium level caused by an excess of body water relative to sodium. The document outlines the major causes of hyponatremia including excessive water intake that cannot be excreted. It also describes the initial evaluation and treatment of hyponatremia based on volume status and urine osmolality. Hypernatremia is defined as a high serum sodium level caused by a deficit of body water relative to sodium, usually due to water loss and impaired access to water. The major causes and treatment approaches for hypernatremia are also summarized.
Hypertension, or high blood pressure, is a common cardiovascular disease defined by elevated blood pressure in the arteries. It is categorized based on systolic and diastolic blood pressure readings into prehypertension, stage 1 hypertension, stage 2 hypertension, and stage 3 hypertension. There are many risk factors that can contribute to hypertension, and it is classified as either essential or secondary hypertension. Treatment involves use of several classes of antihypertensive drugs, including diuretics, sympatholytics, beta blockers, calcium channel blockers, ACE inhibitors, and others. These drugs work to lower blood pressure through various mechanisms like reducing fluid volume, decreasing sympathetic nervous system activity, blocking adrenoreceptor sites, and inhibiting the renin
Hypertension is a major health problem affecting 25% of adults and 50% of those over 60. It causes dangerous complications like heart attack, heart failure, stroke, and renal failure. The causes are mostly unknown except for 5% of secondary cases. Lifestyle modifications like reduced salt and fat intake, weight loss, exercise, and stopping smoking are beneficial for reducing blood pressure and complications. There are several classes of antihypertensive drugs that work through different mechanisms like reducing blood volume and pressure, blocking nerve signals, dilating blood vessels, and inhibiting hormone systems. The choice of drugs depends on individual patient factors and risks.
Slidedeck of the presentation I gave during the East by Southwest conference, co-organized by the Division of Nephrology (UNM) and the Renal and Electrolyte Division (UPMC)
This document provides information on antihypertensive drugs. It defines hypertension as elevated blood pressure and discusses its classification. The mechanisms involved in hypertension development include increased heart rate, stroke volume, cardiac output, peripheral vascular resistance, and vasoconstriction. Antihypertensive drug classes include those that inhibit the renin-angiotensin-aldosterone system, sympathetic nervous system, calcium channels, and drugs that cause vasodilation or diuresis. Specific drug mechanisms and examples from each class are described along with their advantages and adverse effects in summarizing the pharmacology of antihypertensive treatment options.
This document discusses the pharmacotherapy of dyslipidemias. It defines key terms related to lipids and lipoproteins. It then describes the different types of cholesterol and triglycerides, lipoprotein transport pathways, causes of dyslipidemias, and consequences of abnormal lipid levels. The main drug classes for treating dyslipidemias are discussed, including statins, bile acid sequestrants, fibrates, nicotinic acid, ezetimibe, and CETP inhibitors. Treatment is based on lipid levels and cardiovascular risk assessment. Lifestyle modifications including diet and exercise are also an important part of management.
Hypertension, or high blood pressure, is a major global health issue. It is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Risk factors include age, family history, stress, obesity, alcohol, sodium intake and lack of exercise. Complications can include heart disease, stroke, kidney disease and eye damage if left untreated. Treatment involves lifestyle changes like diet, exercise and weight loss as well as medications that lower blood pressure such as diuretics, ACE inhibitors, calcium channel blockers and beta blockers. Nurses play an important role in educating patients about hypertension management.
This document provides information on the diagnosis and management of hypertension. It defines hypertension as blood pressure greater than 140/90 mmHg. It describes the types and causes of hypertension, including essential (95% of cases, no identifiable cause) and secondary (underlying cause such as renal or endocrine issues). Target organ damage from uncontrolled hypertension includes effects on the heart, brain, kidneys, and retina. Lifestyle modifications and medication are used to treat hypertension with the goals of reducing blood pressure below 140/90 mmHg to prevent cardiovascular events. Common classes of antihypertensive medications discussed include diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
This document provides an overview of hypertensive emergencies and their treatment. It defines hypertensive emergency as an acute elevation in blood pressure of 180/120 mmHg or higher associated with end organ damage. Common causes include hypertensive encephalopathy, stroke, heart attack, aortic dissection, eclampsia, and kidney failure. Intravenous drugs like metoprolol, esmolol, and labetalol are recommended for initial treatment to lower blood pressure while avoiding hypotension. Targets for lowering blood pressure depend on the specific end organ involved. The document provides detailed guidance on evaluating and managing different hypertensive emergencies.
Hypertension, or high blood pressure, is defined based on average readings from multiple visits. It is classified by the WHO into normal, prehypertension, and stages 1 and 2 hypertension. Primary hypertension has no identifiable cause while secondary hypertension has identifiable underlying causes. Complications arise from damage to blood vessels and target organs like the brain, heart, kidneys, and eyes. Treatment involves lifestyle modifications and medications like diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers. Care must be taken with anesthesia as patients can experience exaggerated blood pressure changes in response to stimuli. Antihypertensive medications should generally be continued during surgery.
The drug that is absolutely contraindicated in pregnancy is losartan, an angiotensin II receptor blocker (ARB). While all antihypertensives should be used cautiously in pregnancy, ARBs like losartan are contraindicated due to the risk of fetal harm, including the possibility of fetal death. Atenolol, methyldopa, nifedipine and propranolol can be used in pregnancy with appropriate monitoring by an obstetrician. The answer is B.
This document discusses resistant hypertension. It defines resistant hypertension as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, including a diuretic. It notes that resistant hypertension affects 10-20% of hypertensive patients and is associated with increased risk of cardiovascular events. The document outlines various causes of resistant hypertension including primary factors, secondary causes like obstructive sleep apnea and primary aldosteronism, and lifestyle and medication factors that can contribute. It provides guidance on evaluating and managing patients with resistant hypertension through lifestyle changes, medication optimization, and consideration of device therapies if needed.
Vasopressin receptor antagonist and therapeutic potentialDr Amit Mittal
Vasopressin receptor antagonists work by blocking vasopressin receptors and have therapeutic potential. Vasopressin is a hormone that acts on kidneys to increase water permeability and on blood vessels to cause vasoconstriction. There are three main types of vasopressin receptors: V1a, V1b, and V2. Vasopressin receptor antagonists include conivaptan, tolvaptan, and lixivaptan which are used to treat hyponatremia associated with congestive heart failure and cirrhosis by selectively blocking the V2 receptor. Relcovaptan is a V1a selective antagonist being studied for Raynaud's disease and dys
Polypill for primary and secondary preventions of cardiovascularBhaswat Chakraborty
This document discusses cardiovascular diseases (CVDs) and strategies for primary and secondary prevention. It summarizes that CVDs are caused by risk factors like hypertension, diabetes, smoking, obesity, and high cholesterol. Modifying these risk factors can prevent CVDs. The document outlines that a polypill containing multiple drugs can provide primary prevention by lowering risk factors. Studies on Cadila Pharmaceuticals' polypill product Polycap found it reduced blood pressure and LDL cholesterol similarly to the individual drugs. Polycap was also found to have no drug interactions and preserve the bioavailability of components, establishing its potential for CVD prevention.
Hypertension is defined as high blood pressure with a systolic reading of 140 mmHg or higher or a diastolic reading of 90 mmHg or higher. It can be caused by primary or secondary factors. Primary hypertension makes up 90-95% of cases and has contributing lifestyle factors like increased sodium intake, obesity, lack of exercise, and excessive alcohol consumption. Secondary hypertension is caused by an underlying medical condition. Treatment involves lifestyle modifications like diet, exercise, weight loss and lowering sodium intake as well as medication to control blood pressure. The goal of treatment is to reduce cardiovascular risk by maintaining a blood pressure reading under 140/90 mmHg or under 130/80 mmHg for those with diabetes or kidney disease.
This document provides guidelines for the diagnosis of primary aldosteronism, pheochromocytoma, Cushing's syndrome, renal artery stenosis, and evaluating young hypertension. It outlines recommended screening tests and confirmatory tests for each condition. Screening tests include ARR for primary aldosteronism, plasma and urine metanephrines for pheochromocytoma, and various cortisol tests for Cushing's syndrome. Confirmatory tests include saline infusion testing, AVS and subtype evaluation for primary aldosteronism and imaging, genetic testing for pheochromocytoma. The source is then localized for ACTH dependent Cushing's syndrome. Renal artery stenosis is screened for using duplex ultrasound
Sepsis & septic shock an updated managementahad80a
1) Sepsis and septic shock are systemic inflammatory responses to infection that can lead to organ dysfunction and death. The management involves recognizing the condition, administering antibiotics and fluids, controlling the infection source, and providing supportive organ care.
2) Diagnostic criteria include signs of infection along with dysregulated inflammatory response and organ dysfunction. Management goals within 3-6 hours include antibiotics, fluid resuscitation, lactate measurement, vasopressors for hypotension, and in some cases steroids and glucose control.
3) Common infection sites include the lungs, urinary tract, abdomen, and intravenous lines. Antibiotics should have appropriate spectrum and be given quickly based on likely pathogens. Other supportive therapies
HYPERTENSION introduction, recommendations for accurate measurements of BP, evaluation of patient with hypertension, management of patient with hypertension, resistant hypertension, hypertensive crisis, hypertensive emergencies
DPP-4 inhibitors work by inhibiting the DPP-4 enzyme, which normally breaks down the incretin hormones GLP-1 and GIP. By inhibiting DPP-4, GLP-1 levels are increased for longer after meals. This helps lower blood sugar levels by stimulating insulin secretion, suppressing glucagon secretion, and slowing gastric emptying. DPP-4 inhibitors are used to treat type 2 diabetes, either alone or in combination with other drugs like metformin. They improve glycemic control as measured by HbA1c levels and have benefits like weight neutrality and low risk of hypoglycemia. However, some studies have found possible links between DPP-4 inhibitors and side effects like pancreatitis
This document defines essential hypertension and provides a classification of blood pressure levels according to the JNC-7 report. It also outlines the causes, initial investigations, complications, and treatment of hypertension. Hypertension is classified as normal, prehypertensive, or hypertensive stage 1 or 2 based on systolic and diastolic blood pressure levels. Lifestyle modifications and drug treatments including diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers are recommended depending on the hypertension stage. Hypertensive crisis requires urgent treatment with intravenous drugs to lower blood pressure and prevent complications affecting the heart, brain, kidneys, and other organs.
WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
This case report describes a nearly fatal case of amlodipine poisoning in an 11-month old infant. The infant received 6 doses of 15mg of amlodipine which was mistakenly dispensed instead of amoxicillin. Within hours, the infant developed vomiting, lethargy, bradycardia, respiratory distress, and hypotension. Laboratory tests showed hyperglycemia, electrolyte abnormalities, and elevated liver enzymes. The infant was treated with insulin, calcium gluconate, ionotropes, and peritoneal dialysis. The infant's condition gradually improved and was discharged after 10 days. The authors conclude that hyperinsulinemia therapy is beneficial in treating calcium channel blocker toxicity and
This document discusses electrolyte disorders and provides details on hyponatremia and hypernatremia. It defines hyponatremia as a low serum sodium level caused by an excess of body water relative to sodium. The document outlines the major causes of hyponatremia including excessive water intake that cannot be excreted. It also describes the initial evaluation and treatment of hyponatremia based on volume status and urine osmolality. Hypernatremia is defined as a high serum sodium level caused by a deficit of body water relative to sodium, usually due to water loss and impaired access to water. The major causes and treatment approaches for hypernatremia are also summarized.
Hypertension, or high blood pressure, is a common cardiovascular disease defined by elevated blood pressure in the arteries. It is categorized based on systolic and diastolic blood pressure readings into prehypertension, stage 1 hypertension, stage 2 hypertension, and stage 3 hypertension. There are many risk factors that can contribute to hypertension, and it is classified as either essential or secondary hypertension. Treatment involves use of several classes of antihypertensive drugs, including diuretics, sympatholytics, beta blockers, calcium channel blockers, ACE inhibitors, and others. These drugs work to lower blood pressure through various mechanisms like reducing fluid volume, decreasing sympathetic nervous system activity, blocking adrenoreceptor sites, and inhibiting the renin
Hypertension is a major health problem affecting 25% of adults and 50% of those over 60. It causes dangerous complications like heart attack, heart failure, stroke, and renal failure. The causes are mostly unknown except for 5% of secondary cases. Lifestyle modifications like reduced salt and fat intake, weight loss, exercise, and stopping smoking are beneficial for reducing blood pressure and complications. There are several classes of antihypertensive drugs that work through different mechanisms like reducing blood volume and pressure, blocking nerve signals, dilating blood vessels, and inhibiting hormone systems. The choice of drugs depends on individual patient factors and risks.
Slidedeck of the presentation I gave during the East by Southwest conference, co-organized by the Division of Nephrology (UNM) and the Renal and Electrolyte Division (UPMC)
This document provides information on antihypertensive drugs. It defines hypertension as elevated blood pressure and discusses its classification. The mechanisms involved in hypertension development include increased heart rate, stroke volume, cardiac output, peripheral vascular resistance, and vasoconstriction. Antihypertensive drug classes include those that inhibit the renin-angiotensin-aldosterone system, sympathetic nervous system, calcium channels, and drugs that cause vasodilation or diuresis. Specific drug mechanisms and examples from each class are described along with their advantages and adverse effects in summarizing the pharmacology of antihypertensive treatment options.
This document discusses the pharmacotherapy of dyslipidemias. It defines key terms related to lipids and lipoproteins. It then describes the different types of cholesterol and triglycerides, lipoprotein transport pathways, causes of dyslipidemias, and consequences of abnormal lipid levels. The main drug classes for treating dyslipidemias are discussed, including statins, bile acid sequestrants, fibrates, nicotinic acid, ezetimibe, and CETP inhibitors. Treatment is based on lipid levels and cardiovascular risk assessment. Lifestyle modifications including diet and exercise are also an important part of management.
Hypertension, or high blood pressure, is a major global health issue. It is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Risk factors include age, family history, stress, obesity, alcohol, sodium intake and lack of exercise. Complications can include heart disease, stroke, kidney disease and eye damage if left untreated. Treatment involves lifestyle changes like diet, exercise and weight loss as well as medications that lower blood pressure such as diuretics, ACE inhibitors, calcium channel blockers and beta blockers. Nurses play an important role in educating patients about hypertension management.
This document provides information on the diagnosis and management of hypertension. It defines hypertension as blood pressure greater than 140/90 mmHg. It describes the types and causes of hypertension, including essential (95% of cases, no identifiable cause) and secondary (underlying cause such as renal or endocrine issues). Target organ damage from uncontrolled hypertension includes effects on the heart, brain, kidneys, and retina. Lifestyle modifications and medication are used to treat hypertension with the goals of reducing blood pressure below 140/90 mmHg to prevent cardiovascular events. Common classes of antihypertensive medications discussed include diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
This document provides an overview of hypertensive emergencies and their treatment. It defines hypertensive emergency as an acute elevation in blood pressure of 180/120 mmHg or higher associated with end organ damage. Common causes include hypertensive encephalopathy, stroke, heart attack, aortic dissection, eclampsia, and kidney failure. Intravenous drugs like metoprolol, esmolol, and labetalol are recommended for initial treatment to lower blood pressure while avoiding hypotension. Targets for lowering blood pressure depend on the specific end organ involved. The document provides detailed guidance on evaluating and managing different hypertensive emergencies.
Hypertension, or high blood pressure, is defined based on average readings from multiple visits. It is classified by the WHO into normal, prehypertension, and stages 1 and 2 hypertension. Primary hypertension has no identifiable cause while secondary hypertension has identifiable underlying causes. Complications arise from damage to blood vessels and target organs like the brain, heart, kidneys, and eyes. Treatment involves lifestyle modifications and medications like diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers. Care must be taken with anesthesia as patients can experience exaggerated blood pressure changes in response to stimuli. Antihypertensive medications should generally be continued during surgery.
The drug that is absolutely contraindicated in pregnancy is losartan, an angiotensin II receptor blocker (ARB). While all antihypertensives should be used cautiously in pregnancy, ARBs like losartan are contraindicated due to the risk of fetal harm, including the possibility of fetal death. Atenolol, methyldopa, nifedipine and propranolol can be used in pregnancy with appropriate monitoring by an obstetrician. The answer is B.
This document discusses drug treatment for hypertension. It begins by defining hypertension and classifying it by severity based on systolic and diastolic blood pressure readings. The causes of primary and secondary hypertension are explained. Blood pressure regulation involves the renin-angiotensin system and is controlled by both short-term mechanisms like the autonomic nervous system and long-term mechanisms like fluid volume regulation. The major classes of antihypertensive drugs are described including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and others. Lowering blood pressure reduces risks of heart disease, stroke, kidney failure and other complications. Treatment involves lifestyle modifications and drug therapy tailored to a patient's risk level.
This document discusses antihypertensive agents used to treat hypertension. It describes different categories of agents including adrenergic agents, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and vasodilators. For each category, it covers mechanisms of action, examples of medications, therapeutic uses, and potential side effects. It emphasizes the importance of monitoring blood pressure during therapy and avoiding abruptly stopping medications.
This document discusses antihypertensive agents used to treat hypertension. It describes different categories of agents including adrenergic agents, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and vasodilators. For each category, the document outlines mechanisms of action, examples of medications, therapeutic uses, and potential side effects. It emphasizes the importance of monitoring blood pressure during therapy and avoiding abruptly stopping medications.
Nearly 1/3 of Indians have high blood pressure, with urban rates higher than rural. Only 25% of rural and 42% of urban hypertensive Indians are aware of their condition, and even fewer (25% rural, 38% urban) are receiving treatment. Lifestyle modifications like weight loss, following a DASH diet, reducing sodium, increasing physical activity, and limiting alcohol can all help to lower blood pressure. Medical management involves drug classes that target the renin-angiotensin system, calcium channels, adrenergic receptors, and vasodilation to control blood pressure. The goal of treatment is to prevent complications through achieving and maintaining a blood pressure under 140/90 mmHg.
This document discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
The document discusses hypertension, including its definition, classification, epidemiology, types, etiology, pathophysiology, clinical presentation, diagnosis, and management. Hypertension is defined as elevated blood pressure above 140/90 mmHg and can be essential or secondary. Common types include essential, secondary, white coat, and isolated systolic hypertension. Lifestyle modifications and medications are used to treat hypertension, with drug classes including diuretics, ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and others. The goal of treatment is to control blood pressure and reduce long term health risks.
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
Adrenergic antagonists are drugs that inhibit the function of adrenergic receptors. There are two main groups - alpha adrenergic blockers and beta adrenergic blockers. Alpha blockers relax smooth muscles in blood vessels and the prostate gland, and are used to treat high blood pressure, BPH, and other conditions. Beta blockers are used to treat high blood pressure, angina, arrhythmias, heart failure, and migraine by blocking the effects of epinephrine and slowing the heart rate. Common alpha blockers discussed are prazosin, tamsulosin, and terazosin, while common beta blockers include propranolol, metoprolol, and aten
Antihypertensive drugs and hypertension managementAnas Indabawa
This document discusses antihypertensive drugs and hypertension management. It begins with an introduction to hypertension and outlines types of hypertension like primary or essential hypertension. It then discusses risk factors, diagnosis, and management of hypertension including both non-pharmacological lifestyle changes and various classes of pharmacological treatments. Specific drug classes are explained like ACE inhibitors, calcium channel blockers, diuretics, and others. The document also covers hypertension during pregnancy and hypertensive emergencies. It concludes with precautions for using antihypertensive drugs.
The document discusses hypertension, including its definition, causes, classification, and treatment options. It defines hypertension as a sustained blood pressure over 140/90 mmHg and discusses how it damages blood vessels. It classifies blood pressure and lists the etiology and risk factors of hypertension. The major sections cover the principles of treatment, classification of antihypertensive drugs including diuretics, sympatholytic agents, and vasodilators.
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 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.
Hypertension is also known as high blood pressure. There are mainly two type of blood pressure i.e. systolic and another one is diastolic . The hypertension are categories into two parts that is primary hypertension and secondary hypertension. People are suffering from 3 stage during the condition of hypertension. There are following agents are used to treat hypertension like calcium channel blockers, ACE inhibitors, beta blocker, alpha + beta blockers these are commonly used.
This document discusses hypertension and classifications of blood pressure. It then summarizes various categories of antihypertensive agents including their mechanisms of action, examples of medications, therapeutic uses, and side effects. Nursing implications are provided around monitoring blood pressure during therapy, ensuring proper administration of medications, and lifestyle education to support treatment.
Advance therapy in hypertension... jyoti..pptJyoti Sharma
This document discusses hypertension and its treatment. It begins by defining hypertension and describing its various classifications and categories based on systolic and diastolic blood pressure readings. It then discusses the effects of hypertension on the body and the mechanisms involved, including the renin-angiotensin system. Causes of resistant hypertension and classifications of oral antihypertensive agents are provided. The document concludes by outlining investigations into new therapies for hypertension, such as guanylate cyclase stimulators, prostacyclin receptor agonists, endothelin receptor blockers, and endothelial nitric oxide synthase couplers.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
The ability to recreate computational results with minimal effort and actionable metrics provides a solid foundation for scientific research and software development. When people can replicate an analysis at the touch of a button using open-source software, open data, and methods to assess and compare proposals, it significantly eases verification of results, engagement with a diverse range of contributors, and progress. However, we have yet to fully achieve this; there are still many sociotechnical frictions.
Inspired by David Donoho's vision, this talk aims to revisit the three crucial pillars of frictionless reproducibility (data sharing, code sharing, and competitive challenges) with the perspective of deep software variability.
Our observation is that multiple layers — hardware, operating systems, third-party libraries, software versions, input data, compile-time options, and parameters — are subject to variability that exacerbates frictions but is also essential for achieving robust, generalizable results and fostering innovation. I will first review the literature, providing evidence of how the complex variability interactions across these layers affect qualitative and quantitative software properties, thereby complicating the reproduction and replication of scientific studies in various fields.
I will then present some software engineering and AI techniques that can support the strategic exploration of variability spaces. These include the use of abstractions and models (e.g., feature models), sampling strategies (e.g., uniform, random), cost-effective measurements (e.g., incremental build of software configurations), and dimensionality reduction methods (e.g., transfer learning, feature selection, software debloating).
I will finally argue that deep variability is both the problem and solution of frictionless reproducibility, calling the software science community to develop new methods and tools to manage variability and foster reproducibility in software systems.
Exposé invité Journées Nationales du GDR GPL 2024
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
Remote Sensing and Computational, Evolutionary, Supercomputing, and Intellige...University of Maribor
Slides from talk:
Aleš Zamuda: Remote Sensing and Computational, Evolutionary, Supercomputing, and Intelligent Systems.
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Inter-Society Networking Panel GRSS/MTT-S/CIS Panel Session: Promoting Connection and Cooperation
https://www.etran.rs/2024/en/home-english/
The use of Nauplii and metanauplii artemia in aquaculture (brine shrimp).pptxMAGOTI ERNEST
Although Artemia has been known to man for centuries, its use as a food for the culture of larval organisms apparently began only in the 1930s, when several investigators found that it made an excellent food for newly hatched fish larvae (Litvinenko et al., 2023). As aquaculture developed in the 1960s and ‘70s, the use of Artemia also became more widespread, due both to its convenience and to its nutritional value for larval organisms (Arenas-Pardo et al., 2024). The fact that Artemia dormant cysts can be stored for long periods in cans, and then used as an off-the-shelf food requiring only 24 h of incubation makes them the most convenient, least labor-intensive, live food available for aquaculture (Sorgeloos & Roubach, 2021). The nutritional value of Artemia, especially for marine organisms, is not constant, but varies both geographically and temporally. During the last decade, however, both the causes of Artemia nutritional variability and methods to improve poorquality Artemia have been identified (Loufi et al., 2024).
Brine shrimp (Artemia spp.) are used in marine aquaculture worldwide. Annually, more than 2,000 metric tons of dry cysts are used for cultivation of fish, crustacean, and shellfish larva. Brine shrimp are important to aquaculture because newly hatched brine shrimp nauplii (larvae) provide a food source for many fish fry (Mozanzadeh et al., 2021). Culture and harvesting of brine shrimp eggs represents another aspect of the aquaculture industry. Nauplii and metanauplii of Artemia, commonly known as brine shrimp, play a crucial role in aquaculture due to their nutritional value and suitability as live feed for many aquatic species, particularly in larval stages (Sorgeloos & Roubach, 2021).
hematic appreciation test is a psychological assessment tool used to measure an individual's appreciation and understanding of specific themes or topics. This test helps to evaluate an individual's ability to connect different ideas and concepts within a given theme, as well as their overall comprehension and interpretation skills. The results of the test can provide valuable insights into an individual's cognitive abilities, creativity, and critical thinking skills
Or: Beyond linear.
Abstract: Equivariant neural networks are neural networks that incorporate symmetries. The nonlinear activation functions in these networks result in interesting nonlinear equivariant maps between simple representations, and motivate the key player of this talk: piecewise linear representation theory.
Disclaimer: No one is perfect, so please mind that there might be mistakes and typos.
dtubbenhauer@gmail.com
Corrected slides: dtubbenhauer.com/talks.html
2. Hypertension is defined as a systolic blood
pressure (sBP) of 140 mm Hg or more, or a diastolic
blood pressure (dBP) of 90 mm Hg or more
Hypertension may be PRIMARY, which may develop as
a result of environmental or genetic causes, or
SECONDARY, which has multiple etiologies,
including renal, vascular, and endocrine causes.
Primary or essential hypertension accounts for 90-95%
of adult cases, and secondary hypertension
accounts for 2-10% of cases.
3. Arterial hypertension
Primary (essential) hypertension: in 20-40%
patients with boundary arterial hypertension
(neurocirculatory dystonia of hypertensive type,
diagnosed on the basis of three times fixed within a
week SBP up to 159 mmHg, DBP up to 94 mmHg
without the signs of target organs damage the nervous
system, the heart, the eye, the kidneys)
Secondary – symptomatic (vascular: dilatation of
the renal artery as a result of renal diseases, etc.;
initially humoral: pheochromocytoma, Cushing’s
disease, etc.)
The correct choice of hypotensive therapy
depends on knowledge of etiology, basic links of
arterial hypertension pathogenesis being an
object of medicinal influence!
4. Hypertension is a major health problem, especially be
cause it has no symptoms.
Many people have hypertension without knowing it.
Hypertension is more common in men than woman
and in people over the age of 65 than in younger
persons.
Hypertension is serious because people with the
condition have a higner risk for heart disease and other
medical problems than people with normal blood
pressure:
arteriosclerosis, also called atherosclerosis
heart attack, stroke, kidney damage.
Serious complications can be avoided
by getting regular blood
pressure checks and treating hyper-
tension as soon as it is diagnosed.
5.
6. Changing our lifestyle can go a long way toward
controlling high blood pressure.
Doctor may recommends eat a healthy diet with less
salt, exercise regularly, quit smoking and maintain a
healthy weight. But sometimes lifestyle changes aren't
enough.
In addition to diet and exercise, doctor may recommend
to the patients medication to lower blood pressure.
7. Our blood pressure treatment goal depends
on how healthy we are.
Blood pressure treatment goals*
*Although 120/80 mm Hg or lower is the ideal blood
pressure goal, doctors are unsure if you need treatment
(medications) to reach that level.
Less than150/90 mm Hg If you're a healthy adult age 60 or
older
Less than140/90 mm Hg If you're a healthy adult younger
than age 60
Less than140/90 mm Hg If you have chronic kidney
disease, diabetes or coronary artery disease or are at
high risk of coronary artery disease
8. Antihypertensive (hypotensive)
drugs
The action of these drugs is directed upon
decrease of the peripheral artery tone,
reduction of the cardiac output and
diminution of the circulating blood
volume,
which are the main links of the arterial
hypertension pathogenesis.
9. Clinical classification of antihypertensive
drugs
І. Drugs of main group (First-Line
Treatment for Hypertension):
Diuretics
Adrenoblockers
ACE-inhibitors
Angiotensin ІІ receptor blockers
Calcium channels blockers
II. Drugs of supplemental group
Agonists of central α2-аdrenoreceptors
Sympatolytics
Myotropic antispasmodics
Agonists of imidasoline (І1) receptors
Ganglion blockers
10. Transition Page
Neurotropic drugs;
Myotropic drugs
Сa++ channel blockers
K+ channel activators
Agents which influence upon the renin-
angiotensin system
Agents who influence upon the sodium
and water balance (diuretics)
Classification of
hypotensive drugs according to
the mechanism of action
11. 1. Drugs with central action (decrease the tone of
vasomotor center)
а) Sedatives (Natrii bromidum, extr. Valerianae,
b) Hypnotics (Phenobarbitalum)
c) Neuroleptics (Aminazinum)
d) Tranquilizers (Sibasonum, Gidazepamum)
e) Central α2-adrenoreceptor activators (Clophelinum,
Methyldopa)
i) Activators of central imidazoline receptors
(Moxonidinum)
I. Neurotropic drugs(acts on the different
parts of nervous system)
12.
13. Clophelinum
Causes central action on the vasomotor
center of medulla oblongata
Stimulates α2-adrenoreceptors
Decreases sympathetic vasoconstrictor
impulsation to the peripheral vessels
Decreases rennin secretion
The beginning of the effect - after 30-60 min (per os),
maximal effect – after 2-4 hours, duration of the effect
– 8 hours.
After i.v. introduction the beginning of the effect will
be after 3-5 min.
14. Indications for usage:
orally - for the systematic treatment of arterial
hypertension.
i.v. - to arrest hypertensive crisis.
Side effects:
«Withdrawal syndrome» - rapid increasing of
BP after sudden cessation of the drug
dry mouth, drowsiness, lethargy
Ortostatic collapse
Dyspeptic disorders
N.B! This drug potentiates effects of different
drugs with depressive effect on the CNS (alcohol)
15.
16. Mechanism of action:
• Central agonist of imidazoline receptors, localized in vasomotor
center. Can decrease their influence on blood vessels and
myocardium. Inhibits sympathetic nervous system activity and blood
pressure
• Doesn’t influence on α2-adrenoreceptors (doesn’t cause dry mouth
and sedative effect).
• Doesn’t influence cardiac output, doesn’t cause bradycardia
Indications for use:
Arterial hypertension (in case of effectiveless of ACE-inhibitors, β-
adrenoblockers and Са++ -channel blockers
Side effects
Dry mouth, dizziness, asthenia, somnolence
Contraindications
Bradycardia (< 50 /min), AV-blockade
Acute and chronic heart failure
Childrens, breast feedings
Hypersensitivity
Moxonidinum
17. Neurotropic drugs with peripheral
neurotropic action
1) ganglion blockers (Benzohexonium,
Pentaminum, Hygronium)
2) sympatholytics (Octadinum, Reserpinum)
3) adrenoblockers
a) α-adrenoblockers - (Prazosinum,
Doxazosinum)
b) β-adrenoblockers – (Propranololum,
Atenolol, Metoprolol, Nebivolol)
c) α-β–adrenoblockers – (Labetalol,
Celiprolol, Carvedilol)
19. Beta-adrenoblockers
Mechanism of action – blockade of β1-
adrenoreceptors of myocardium, decreasing of cardiac
output, reduction of renin secretion, lowering of the
vasornotor centre tone, that leads to the dilation of vessels
They ere used most commonly for the
systematic treatment of the arterial
hypertension.
Alfa-adrenoblockers
Mechanism of action – blockade of α-
adrenoreceptors of peripheral vessels,
decreasing of the BP owing to the dilation of
peripheral arteries.
21. Beta-adrenoblockers
Block of β-
receptors of the
juxta-glomerular
apparatus of the
kidney
Block of β-
receptors of
the vessels
Central
links of
sympathetic
Block of β-
receptors of
the heart
renin
secretion
tone of
peripheral
vessels
Hypotension
force and
heart rate
stroke and
cardiac output
myocardial
demands in O2
Antianginal
automaticity,
conductivity
and excitability
of myocardium
Antiarrythmic
25. III.Vasodilators with myotropic action
(myotropic drugs).
1) Calcium channel blockers - Nifedipine, Felodipine,
Amlodipine
2) Potassium channels activators - Minoxidil, Diazoxlde
3) Agents which release nitric oxide (NO) - Natrium
nitroprusside
4) Miscellaneous drugs - Dibazolum, No-spa, Papaverinum,
Masnesium sulfas
IV. Agents who influence upon the
sodium and water balance
(diuretics) - Dichlothiazidum, Furosemide,
Triamterene, Spironolactone
26. • apressin (hydralasin), activators
of potassium channels, vasotropic
calcium channel blockers, etc.
Arterial:
•papaverine, drotaverine
(no-spa), α-adrenoblockers,
ganglion blockers, nitrates
(sodium nitroprusside), etc.
Arterial and
venous:
Myotropics (vasodilatators)
Majority of myotropic drugs are intended for hypertensive crisis
arrest and additional therapy in the arterial hypertonia complex
treatment!
27. Calcium channel blockers (Nifedipinum,
Felodipinum, Amlodipinum).
The mechanism of action is blockade of Ca++
channels of blood vessel myocyte membranes,
that leads their relaxation and to the dilation of
the peripheral vessels.
are the most specific correctors of increasing
vascular resistance during arterial
hypertension
block the Ca++ ions flow
dilate blood vessels and decrease BP
cause antiarrythmic effect
cause antiischemic (antianginal) effect
28. Classification of calcium channel blockers
I type – cardiotropic (phenylalkylamine derivates)
•1 generation – verapamil,
•2 generation – hallopamil, etc.
II type - vasotropic
General action: dihydropyridine derivates –
•1 generation – nifedipine (cordafen);
•2 generation –nicardipine, etc.
•Cerebrovasotropic – diphenylpiperasine derivates
•1 generation – cinnarizine (stugerone);
•2 generation – flunarizine, as well as nimodipine
III type – mixed (benzothiazine derivates)
•1 generation – diltiazem
•2 generation – clentiazem
29. Peculiarities of hypotensive effect of
calcium channel blockers
Systolic BP and DBP
+ Moderate diuretic action
Blood flow to vital organs (the heart, the brain, the
kidneys), microcirculation
Hypertrophy of the left ventricle
ABP proportional to the dose, in therapeutic doses
have a slight influence to normal ABP, do not cause
orthostatic phenomena
I generation – ABP variability + reflex tachycardia
II generation – maximal antihypertensive effect of
retarding forms of I generation of all the calcium
blockers develops after 2-4 week therapy without
pause; amlodipine – after 4-8 weeks
30. DOSAGE AND TOXICITY OF THE CALCIUM
INFLUX-BLOCKING DRUGS
Drug Onset of
action
Plasma
half-life
Dose Toxicity
Verapamil
(Isoptin)
< 1,5 min after
i.v., 30 min after
oral
administration
6 hours 75 – 150
mg/kg i.v. 80 –
160 mg every
8 hours orally
Hypotension,
myocardial
depression, heart
failure, dependent
edema
Nifedipine
(Adalat)
< 1 min after i.v.,
<3 min after
sublingual,
< 20 min after
oral
administration
4 hours 3 – 10 mg/kg
i.v.; 10 – 40
mg every 8
hours orally
Hypotension,
dizziness, flushing,
nausea,
constipation,
dependent edema
Diltiazem < 3 min after i.v.,
> 30 min after
oral
administration
3 – 4
hours
75 – 150
mg/kg i.v.; 30
– 80 mg every
6 hours orally
Hypotension,
dizziness, flushing,
bradycardia
31.
32.
33. Myotropic drugs
1. Potassium channels activators (Minoxidil,
Nicorandil)
2. Nitrogen oxide (NO) donators – (Natrii
nitroprussidum)
Cause potent, fast and short effect (5-15 min).
Use by transfusions in cause of severe
hypertensive crises, lung edemas, acute heart
faulure
3. Myotropic spasmolytics (Dibasolum, No-
spa, Papaverini hydrochloridum, Magnesium
sulfas)
34. Myotropic drugs (Dibazolum, No-spa,
Papaverini hydrochloridum)
The mechanism of action - inhibition of enzyme
phosphodiesterase. This leads to blocks of the
Ca++ influx into the cells. Smooth muscles of blood
vessels relax, and BP decreases.
35.
36. Magnesii sulfas (25% - 10 ml)
After parenteral introduction:
- hypotensive,
- vasodilative
- sedative
- anticonvulsive
- tocolytic
- Myorelaxing
- hypnotic
- suppress breathing center
Mechanism of action. Magnesium is physiological antagonist of calcium,
blocks intake of Са++ throw presynaptic membrane. Relaxes
smooth musculature, decreases BP
Effects starts after i.v. introduction- immediately and after 0,5-1 hour
after i.m. introduction.
Duration of action after i.v. – 30 min, after i.m. – 3-4 hours.
After oral inrtoduction:
- bile-expelling
- laxative
37. Drugs influence the renin-
angiotensine system
Captoprilum
Enalaprilum
Lisinoprilum
Ramiprilum
Fosinoprilum
Moexiprilum
Perindoprilum
Blockators of
angiotenzine II
receptors
Angiotensin-
converting
enzyme inhibitors
Losartanum
Valsartanum
Irbesartanum
Candesartanum
38. Mechanism of action
Inhibition of "angiotensin-converting enzyme”, decrease of
angoitensin II creation, that leads to vasodilation,
reduction of aldosterone release and, as a result of
this, decrease of BP.
Promote the accumulation of bradykinin, prostaglandins E2,
I2, which cause significant vasodilating action.
Do not change the cardiac output and the heart rate.
They are used
systematic treatment of arterial hypertension (renal origin)
chronic heart failure (as they decrease the cardiac afterload).
ACE-inhibitors (Captoprilum, Enalaprilum)
Dry cough
Hypotension (after first dose)
Gustatory disorders
Allergic reaction
Tachycardia
Side-effects:
39.
40. systematic treatment of the arterial
hypertension.
Angiotensin receptor blockers (Losartan,
Valsartan, Candesartan)
Mechanism of action
blockade of the AT1-angiotensin receptors, that
leads to elimination of all angiotensin effects
(including vasoconstriction and increase of the
aldosterone release).
Usage
Side-effects
headache, vertigo, allergic reactions.
41.
42. Mechanism of the antihypertensive action :
1) increased excretion of water causes decrease of
the circulating blood volume;
2) amplification of Na+ ion excretion leads to
decrease of vascular tone as a result of reduction
of excitability of the vessel smooth muscles;
3) decrease of the perivascular fluid amount leads to
the reduction of the peripheral blood vessel tone;
4) diuretics potentiate the action of other
antihypertensive drugs
Diuretics – Dichlothiazidum,
Furosemidum, Triamteren, Spironolacton
43. Diuretics - these are the drugs which promote the
excretion of sodium, chlorine ions and water with the urine
out from the organism.
The most effective in elderly patients;
Use in patients with edemas;
Use in patients with concomitant cardiac pathology;
Use in patients with concomitant renal failure
Thiaside diuretics
Loop diuretics
К+-sparing diuretics
Hydrochlorothiazidum
Indapamidum
Furosemidum
Torasemidum
Acidum etacrуnicum
Spironolactonum
Triamterenum
44.
45. Improvement the effectiveness
of treatment due to:
Influence on different
pathogenic links of drugs
with different mechanisms
of action
Potentiation the effects
duration of action
freacvency of side
effects due to usage of
lower doses of each
component
Rational combine pharmacotherapy
of arterial hypertension
47. Classification of the hypotension
drugs according to the clinical
usage:
І. Drugs for arrest the hypertensive
crisis:
Magnesii sulfas
Clophellinum
Dibasolum
Furosemidum
II. Drugs for treatment of hypertonic
disease
adrenoblockers, ACE-inhibitors,
Ca++ antagonists, diuretics
i.m., i.v.
orally
48. Adrenomimetics:
Drugs increasing the cardiac stroke volume
and the vascular tone: Adrenaline, Ephedrine
Drugs that increase chiefly the vascular
tone:
Noradrenaline, Mesatone;
Dopaminotropics: Dopamine
Glucocorticoids – Hydrocortisone, Prednisolone
Mineralocorticoids - DOXA
Peripheral vasoconstrictors - Angioteninamide
Analeptics: Caffeine, Cordiamine
Аdaptogens – drugs of Eleuterococcus, Ginseng,
etc.