The document provides an overview of various anti-hypertensive drugs, including their classifications, mechanisms of action, uses, and side effects. It covers calcium channel blockers, ACE inhibitors, ARBs, and hydralazine, detailing their effects on blood pressure and specific conditions. Key points include the importance of monitoring for side effects and contraindications associated with these medications.
The document provides an overview of various anti-hypertensive drugs, including their classifications, mechanisms of action, uses, and side effects. It covers calcium channel blockers, ACE inhibitors, ARBs, and hydralazine, detailing their effects on blood pressure and specific conditions. Key points include the importance of monitoring for side effects and contraindications associated with these medications.
The document provides an overview of various anti-hypertensive drugs, including their classifications, mechanisms of action, uses, and side effects. It covers calcium channel blockers, ACE inhibitors, ARBs, and hydralazine, detailing their effects on blood pressure and specific conditions. Key points include the importance of monitoring for side effects and contraindications associated with these medications.
The document provides an overview of various anti-hypertensive drugs, including their classifications, mechanisms of action, uses, and side effects. It covers calcium channel blockers, ACE inhibitors, ARBs, and hydralazine, detailing their effects on blood pressure and specific conditions. Key points include the importance of monitoring for side effects and contraindications associated with these medications.
• Hypertension: elevated BP > 120/80 mmhg in at least 2 occasions
Anti-Hypertensives
• Hypertension: elevated BP > 120/80 mmhg in at least 2 occasions
• Hypertensive urgency: BP > 180/120 mmhg without end organ damage • Hypertensive emergency: BP > 180/120 mmhg with end organ damage Anti-Hypertensives
• Blood pressure: SBP/DBP e.g., 120/80 mmhg
• SBP: depends mainly on SV (volume of blood pumped by the heart/beat) • DBP: depends mainly on TPR (depends mainly on diameter of blood vessels) • Other factor affecting BP: Blood volume (hypervolemia increases BP) • Regulation of blood pressure: 1- Renin Angiotensin aldosterone system 2- Baroreceptors Source: Osmosis Anti-Hypertensives Anti-Hypertensives – Calcium channel blockers
• Uses: - Both types are used in: HTN by ↓↓ COP and ↓↓ TPR. Angina by ↓↓ cardiac work and ↓↓ loads on heart (see later). - DHPs only: Raynaud’s phenomenon. Nimodipine: SAH to prevent cerebral vasospasm. Clevidipine: IV administration in malignant HTN. - Non-DHPs only: They are used mainly to treat atrial flutter and fibrillation (↓↓ HR). Anti-Hypertensives – Calcium channel blockers Anti-Hypertensives – Calcium channel blockers
• Main S/Es: - Constipation and gingival hyperplasia. - DHPs: Flushing, ↓↓ BP and edema. - Non-DHPs: Bradycardia and AV block. - Verapamil leads to ↑↑ prolactin. بميل وادلدق - Reflex tachycardia: prevented by BB.
• Main drug interaction:
- Non DHP + BB = Severe bradycardia up to heart block Anti-Hypertensives – ACEi
• Names: pril - Captopril - Enalapril - Ramipril • Mechanism: - ↓↓ ACE, so ↓↓ AT II formation causing : ↓↓ Aldosterone secretion. VD (mainly in efferent arteriole of nephron). • Key effect: - Decrease breakdown of bradykinin - Bradykinin accumulation mainly in lungs & airways - Bradykinin is a proinflammatory mediator - Decreased GFR due to VD of efferent arteriole - Increased Renin due to loss of negative feedback Anti-Hypertensives – ACEi
• Names: pril - Captopril - Enalapril - Ramipril • Mechanism: - ↓↓ ACE, so ↓↓ AT II formation causing : ↓↓ Aldosterone secretion. VD (mainly in efferent arteriole of nephron). • Key effect: - Decrease breakdown of bradykinin - Bradykinin accumulation mainly in lungs & airways - Bradykinin is a proinflammatory mediator - Decreased GFR due to VD of efferent arteriole - Increased Renin due to loss of negative feedback Anti-Hypertensives – ACEi
• Uses: - HTN and HF especially in diabetic patients. (prevent diabetic nephropathy) - One of the best drugs in HF patients. Prevent cardiac remodeling (has mortality benefit) • Main S/Es: CATCH - Cough (dry) and Angioedema: Due to bradykinin, substance P and prostaglandin accumulation. - Teratogenic: renal anomalies. - Creatinine rise: ↓↓ GFR (due to dilatation of efferent arteriole) - Hyperkalemia: due to decreased aldosterone (Mainly in pts with RF or taking other drugs causing hyperkalemia - Hypotension (first dose effect). Anti-Hypertensives – ACEi
• Uses: - HTN and HF especially in diabetic patients. (prevent diabetic nephropathy) - One of the best drugs in HF patients. Prevent cardiac remodeling (has mortality benefit) • Main S/Es: CATCH - Cough (dry) and Angioedema: Due to bradykinin accumulation. - Teratogenic: renal anomalies. - Creatinine rise: ↓↓ GFR (due to dilatation of efferent arteriole) - Hyperkalemia: due to decreased aldosterone (Mainly in pts with RF or taking other drugs causing hyperkalemia - Hypotension (first dose effect). Anti-Hypertensives – ACEi
• Names: sartan - Losartan - Candesartan - Valsartan. • Mechanism: - Block AT receptors preventing action of AT II with same effects of ACEIs, but no accumulation of bradykinin. • Key Use: - Alternative to ACEi in case of severe S/E e.g. dry cough • Main S/Es: All except cough & angioedema !! Anti-Hypertensives – Hydralazine
• Mechanism: - ↑↑ cGMP causing activation of MLCP. - Dephosphorylation of myosin causing smooth muscle relaxation - VD blood vessels • Uses: Safe in pregnancy (REMEMBER: H, L, A) - HTN: VD ➔ ↓↓ TPR. - HF: ↓↓ Afterload. • Main S/Es: - Reflex ↑↑ HR: might precipitate angina (Prevented by co-administration of BB) - Drug-induced lupus (manifestations like SLE caused by drugs associated with positive anti-histone Abs). - Dilator: Headache, Edema (due to overactive renin angiotensin system) - Edema is prevented by coadministration of diuretics
