cardiovascular pharmacology
DESCRIPTION
Cardiovascular PharmacologyTRANSCRIPT
Koss Allied Health Pharmacology 2010
CARDIOVASCULAR PHARMACOLOGY
HYPERTENSION (Diuretics) ANTI-LIPID DRUGS
Koss Allied Health Pharmacology 2010
ANTIHYPERTENSIVE DRUGS Introduction Worldwide, hypertensive disease is one of the most common and most serious concerns in medicine. It is estimated that between 25 and 45 million individuals suffer from hypertension in the United States alone. Although high blood pressure itself is relatively asymptomatic, hypertensive disease is the main contributor to other life threatening conditions such as stroke, heart failure, coronary artery disease and renal failure. Hypertensive patients are generally treated by pharmacological means. There is little doubt that effective treatment will greatly reduce the incidence of progressive cardiovascular and renal complications. In general terms hypertension is divided into arbitrary ranks of severity: being mild if diastolic pressure is 90-105 mm Hg, moderate at 105-120 mm Hg, and severe above 120 mm Hg. Blood pressure gradually increases as a normal consequence of the aging process. A sustained blood pressure in excess of 130 mm Hg requires immediate medical attention. In some patients, blood pressure can be lowered by decreasing sodium intake, by weight control and by exercise. About 10% of hypertensive patients have high blood pressure secondary to some known, underlying organic problem such as pheochromocytoma or renal disease. In these cases the underlying defect should be addressed. Patients with hypertension of unknown etiology are generally referred to as having "essential" hypertension (early investigators felt that the elevated blood pressure was "essential" to perfusion of the vital organs). The ultimate aim of anti-hypertensive therapy is to produce a sustained lowering of blood pressure by reducing total peripheral resistance or TPR (almost all hypertensive patients have normal cardiac output and elevated TPR). Although we are fortunate to have a wide variety of drugs available for therapy, the patient must continually take the medication for it to be effective. To achieve an effective response and patient compliance, the choice of agents must be individualized for each patient. Compliance by the patient to take drugs which have untoward side effects is one of the greatest problems you will encounter. Consequently, emphasis in this section will also concern common side effects of the anti-hypertensive agents. Polytherapy is the rule in anti-hypertensive therapy. One can often obtain the same degree of pressure reduction by using lower doses of several different classes of anti-hypertensive agents and thus minimize untoward effects seen with higher doses of a single drug. With the above factors in mind, we will focus on the mechanism of action and potential side effects of many of the most commonly used anti-hypertensive drugs.
Koss Allied Health Pharmacology 2010
Koss Allied Health Pharmacology 2010
DIURETICS Renal Anatomy & Physiology
Koss Allied Health Pharmacology 2010
Sites of action of Diuretic Drugs
Diuretic Drugs: Chlorothiazide [DIURIL] Furosemide [LASIX] Spironolactone [ALDACTANE]
Koss Allied Health Pharmacology 2010
Angiotensin Antagonists: Angiotensin Converting Enzyme (ACE) inhibitors: Lisinopril [PRINIVIL; ZESTRIL] Angiotensin Receptor Antagonists: Losartan [COZAAR]
Koss Allied Health Pharmacology 2010
ANTIHYPERTENSIVE DRUGS
MECHANISM OF
ACTION
DRUG CATEGORY
DRUGS
DIURETICS
Thiazides and related agents
Chlorothiazide (Diuril)
Loop Diuretics Furosemide (Lasix)
Potassium-sparing diuretics
Spironolactone (Aldactone)
SYMPATHOLYTIC DRUGS
Centrally acting agents
Clonidine (Catapres)
Beta-adrenoceptor antagonists
Propranolol (Inderal) Metoprolol (Lopressor) Atenolol (Tenormin)
Alpha-adrenoceptor antagonists
Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura)
Mixed antagonist (Alpha & Beta)
Labetalol (Normodyne, Trandate, Vescal)
DIRECT VASODILATORS
Arterial vasodilators
Minoxidil (Loniten)
Calcium antagonists
Amlodipine (Norvasc) Verapamil (Isoptin, Calan) Nifedipine (Procardia, Adalat) Diltiazem (Cardizem, Dilacor)
Arterial and venous vasodilators
Sodium nitroprusside (Nipride, Nitropress)
ANGIOTENSIN ANTAGONISTS
Converting enzyme inhibitors
Lisinopril (Prinivil, Zestril)
Angiotensin receptor antagonist
Losartan (Cozaar) Valsartin (Diovan)
Koss Allied Health Pharmacology 2010
ANTI-LIPID DRUGS Pathophysiology
Site of Action of Anti-Lipid Drugs
Inhibitor of VLDL secretion: Niacin (vitamin B3) Bile Acid-Binding Resins: Cholestyramine [QUESTRAN] Inhibitors of Cholesterol Synthesis (“statins”): Atorvastatin [LIPITOR] Simvastatin [ZOCOR} Inhibitor of Cholesterol Absorption: Ezetimibe [ZETIA] (plus simvastatin = vytorin)