pharmacology of anti hypertensive agents[for bpt students]
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Antihypertensives
Dr.U.P.Rathnakar MD.DIH.PGDHM
Assistant Professor
Dept of Pharmacology
KMC, Mangalore
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Systolic blood pressure (SBP): isMaximum pressure recorded during
ventricular systole.Diastolic blood pressure (DBP):
Minimum pressure recorded duringventricular diastole.
BLOOD PRESSURE
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Category Blood Pressure (mmHg)Systolic Diastolic
Normal
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CLASSIFIC ATION ACE Inhibitors:
Captopril, enalapril, lisinopril,
Angiotensin-II-receptor antagonists:
Losartan, candesartan,
Calcium channel blockers:
Nifedipine SR, amlodipine, Diuretics
Hydrochlorothiazide, Furosemide, Amiloride, triamterene, spironolactone.
Sympatholytics
-Adrenergic blockers: Prazocin
-Adrenergic blockers: Propranolol, atenolol,
Vasodilators
Hydralazine, Na Nitroprusside
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Normal Regulation of
Blood Pressure
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TOTAL PERIPHERAL RESISTANCE
ACE Inhibitors, Angiotensin Receptor
Blockers (ARBS),
Vasodilators, -Adrenergic Blockers,
Cardiac output adrenergic receptor blocker
Blood volume and body sodium stores
Diuretics
Centrally acting
Clonidine
Renin Angiotensin System
ACE-I, ARBs
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Why treat HTN?
Multiple organ
damage heart,kidney, brain (CVA),
eyes
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Diuretics in
Hypertension
Thiazides-UsuallyusedFirst-line therapy
Mild to moderate HTCombined with
Amiloride
ADE?Other uses?
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-Blockers
Mechanism of action
ADE:Impotence, loss of libidoPrecipitation of asthmaLV dysfunction,Caution inDM
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Beta Blockers
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CALCIUM CHANNEL BLOCKERS
Amlodipine, Nifedipine (extended release),
felodipine verapamil, diltiazem
Block Ca2+
channels
arterial smoothmuscle relaxant action
Dilate coronary, cerebral and peripheral
arteries reduce total arterial resistance ADE:
Nifedipine immediate release:Reflextachycardia, Headache, Flushing, Peripheraledema
Verapamil and Diltiazem: Bradycardia
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ACE inhibitorsCaptopril, enalapril, lisinopril, ramipril
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ACE
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ACE inhibitorsCaptopril, enalapril, lisinopril, ramipril
Angiotensin receptors
ARB
ACE-I
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Dry cough
Hyper K+
Rashes
Post.Hypo
Fever
Adverse effects and Uses
Of ACE-IADE
USES
CHF
HTN
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Sodium nitroprusside
Use severe HTN, CHF as IV infusion
Nursing implication
Infusion should be protected from light and discarded after24 hrs
Discarded if colour changes to pale orange or dark brown
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Treatment strategies
Lifestyle modification- Weight reduction (BMI-18.5-24.9)
- Consume diet rich in fruits, vegetables
and low fat dietary product with a reducedcontent of saturated and total fat
- Restricted sodium intake (< 6g NaCl)
- Regular physical activity (30 min/day)
- Limit alcohol consumption