Anti Hypertensive Drugs Flashcards
Classification of anti hypertensive drugs
SYMPATHOLYTIC DRUGS
VASODILATORS
DIURETICS
Classification of anti hypertensive drugs
SYMPATHOLYTIC DRUGS
VASODILATORS
DIURETICS
SYMPATHOLYTIC drugs are
CENTRALLY ACTING
ADRENERGIC NEURON RECEPTOR BLOCKERS
RECEPTOR BLOCKERS
Centrally acting drugs are
Alpha methyldopa
Clonidine
Adrenergic drugs are
Reserpine
Receptor blockers are
Beta blockers
Alpha blockers
Both beta and alpha blockers
Beta blockers are
Atenolol
Meteprolol
Nevibilol
Bisprolol
Propanolol
Alpha blockers
Prazosin
Terazosin
Alpha blockers used in BEP
Alfazosin
Tamsulosin
Both Alpha and beta blockers
Carvedilol
Labetalol
Vasodilators are
Arteriolar dilators
Arteriovenous dilators
Ca++ channel blockers
ACE inhibitors
Angiotensin receptor blockers
Arteriolar dilators
Minoxidil
Diazoxide
Hydralazin
Arteriovenous dilators
Terazosin
Prazosin
Na nitroprusside
Ca++ channel blockers (ine)
Amlodipine
Clinidipine
Nifedipine
Diltiazem
Verapamil
ACE inhibitors (pril)
Ramipril
Perindopril
Captopril
ARB (tan. )
Losartan potassium
Olmesartan
Valsartan
Diuretics
Hydrochlorothiazide
Frusemide
Indapamide
Bumatanide
Spironolactone
Safe in pregnancy anti hypertensive drugs
Labetalol
Alpha methyldopa
Nifedipine
Pharmacological approach
Mild HTN = AC+ C + D or B
Moderate = D +B or AC +D
Severe = D+ B + Vasodilators
Malignant = D+B+ VD + C or Ace
A/E of methyldopa
Central =
Sedation
Headache
Depression
Dry mouth
Nightmare
Gyanomastia
Decreased libido
Galactorrhea
EPS
Decreased libido
Peripheral =
Bradycardia
Sinus arrest
Hepatotoxicity
Hemolytic anemia
Leucopenia
Thrombocytopenia
Catergorization of beta blockers
Acc to receptor selectivity
Acc to intrinsic sympathomimetic activity
Acc to membrane stabilizing activity
Selective b blockers cardio selective
atenolol
Metoprolol
Bisoprolol
Acebutolol
Esmolol
Nebivolol
Non selective beta blockers
Propanolol
Timolol
Nadolol
Sotalol
Nadolol
Acc to intrinsic symapathomimetic activity
Pindolol
Acebutolol
Labetolol
Celiprolol
Acc to membrane stabilising activity
MSA beta blockers = Propanolol Acebutolol metoprolol pindolol
Non MSA beta blockers = timolol nadolol sotalol
Categorization of ca++ channel blockers
Acc to chemical structure
Acc to selectivity
Ca channel Acc to chemical structure
Phenyl alkylamine = Verapamil
Benzothiazepine = Diltiazem
Dihydropryridine = nifedipine amlodipine nimodipine nicardipine
Acc to selectivity
Cardio selective Verapamil Diltiazem
Vessoselective Amlodipine Nifidipine Nimodipine Nicardipine
Pharmacological action of propanol
CVS = decrease HR , FC , A-V conduction , O2 consumption
Respiratory = Bronchospasm
Eye = decrease IOP
Kidney = decrease renin release
CNS = insomnia tremor restlessness
Peripheral vessel = cold extremity due to vasoconstriction
Metabolism = increase TG hyperglycemia
M/A of Propanolol
HEART
(-) chronotropic action (decrease HR)
(-) inotropic action ( decrease FC)
Decrease CO
Decrease BP
VMC
Decrease sympathetic discharge
(-) vasoconstriction
Decrease BP
Kidney
Decrease renin release
Decrease aldosterone secretion
Decrease blood volume
Decrease BP
Indications of Propanolol
HTN
Angina
Cardiac arrhythmia
Post MI
Hyperthyroidism
Pheochromocytoma
Anxiety
Headache
Migraine
Essential tremor
Glaucoma
A/E of Propanolol
Bradycardia
Hypotension
Heart block
Cardiac failure
Bronchospasm
Dsylipidemia
Hyperglycemia
Cold extremity
Sexual interference
Contraindications of Propanolol
Cardiac failure
Heart block
Bronchial asthma
DM
Bradycardia
Hypotension
Propanolol contraindications in DM
(-) release of insulin and blocks B cells of pancreas
If development of hypoglycaemia with symptom of anxiety palpitations sweating Propanolol will correct these above symptoms ; so patient will go to hypoglycaemic shock without any symptoms of hypoglycaemia
Propanolol contraindications in DM
(-) release of insulin and blocks B cells of pancreas
If development of hypoglycaemia with symptom of anxiety palpitations sweating Propanolol will correct these above symptoms ; so patient will go to hypoglycaemic shock without any symptoms of hypoglycaemia
Atenolol is safer than Propanolol
Only B1 blocker so act on heart and decrease BP BUT Propanolol is both B1 and B2 blocker and decrease BP with more adverse effects
Can’t cross BBB so no CNS effect
No effects on B2 receptor so Safe in bronchial asthma and DM
Less chance of dyslipidemia
Prazosin Alpha 1 blocker pharmacological action
CVS = decrease Bp
Others= eye miosis
GIT = diarrhoea
Ejaculatory failure
Flushing
Increase RBF
Prazosin Alpha 1 blocker pharmacological action
CVS = decrease Bp
Others= eye miosis
GIT = diarrhoea
Ejaculatory failure
Flushing
Increase RBF
Indications of Prazosin
HTN with atherosclerosis
Pheochromocytoma
PVD
CCF
Mitral or aortic valvular insufficiency
BPH
Causalgia
A/E of Prazosin
POSTURAL HYPOTENSION
Failure of ejaculation
Diarrhoea
Flushing
Headache
Anti hypertensive role of Prazosin
Alpha 1 receptor block in vein and arteriole
Vaso and vasodilation
Decrease BP
Renin angiotensin aldosterone axis drugs
ACE inhibitors ( angiotensin converting enzyme = peptidyl dipeptidase )
ARB
Beta blockers
Direct renin inhibitor = Aliskiron
Indications of ACE inhibitors
HTN
HTN with DM
HTN with LVH
HTN with MI
A/ E of ace inhibitors
DRY COUGH ( due to bradykinin )
Hypotension
Hyperkelemia
Skin rash
Angioneuratic oedema
Glycosuria
Neutopenia
Hepatotoxicity
Contradindicaruons of ace
ARF
Systolic Bp= less than 100mm Hg
Bilateral renal artery stenosis
Pregnancy
How ace cause postural hypotension
No vasoconstriction
Venodilation
Decrease sympathetic discharge
Postural hypotension
So should be taken at bed time
Indications of Amlodipine
HTN
Angina
Cardiac arrhythmia
HTn with br asthma
Raynaud’s phenomenon
Migraines prophylaxis
Systemic sclerosis
A/E of Amlodipine
ANKLE OEDEMA ( except clindipine )
Hypotension
Bradycardia
Headache
Dizziness
Flushing
Palpitation
Cough / wheeze
Contraindications of Amlodipine
Bradycardia
Hypotension
Heart block
A - V block
CCF
Liver disease
Heart block
Constipation
Gum hyperplasia
