Antihypertensive Flashcards
Classification of antihypertensive drug
A.SYMPATHOLYTIC
1. Centrally acting
- a methyl dopa
- clonidine
2. Adrenergic neurone blocker
- resperine
3. Receptor blocker
I) B blocker
• Meteprolol
• Atenolol
• Nevibolol
• proponolol
• bisprolol
II) a blocker
• Parazosin
•Terazosin
III) Both a and B blocker
• carvedilol
• labetalol
B.Vasodilators
1. Arteriolar dilators
• minoxidil
• diazoxide
• hydralazin
2. Arteriovenous dilator
• Na nitroprusside
• Parazosin
• Terazosin
3. Ca+2 channel blocker
• vasoselective- Amlodipine, cilnidipine, nifedipine
• cardioselective- diltiazem,verapamil
4. ACE inhibitors
• Captopril
• Ramipril
• Perindopril
5. Angiotensin receptor blocker
• losartan potassium
• omelsartan
• valsartan
C. Diuretics
- hydrochlorothiazide, frusemide, indapamide, bumatanide, spironolactone
Antihypertensive drug safe in pregnancy
a methyl dopa
Nifedipine
Labetalol
Therapeutic approach of HTN
non pharmacological
•no added salt
• no stress
• mild exercise
• no smoking
• avoid fatty food
_ Pharmacological_
>mild
• diuretic or b blocker (proponolol)
• ACE inhibitor ( Ramipril)
• Ca +2 blocker ( Amlodipine)
>moderate
• diuretic and b blocker
• diuretic and ace inhibitors
>severe
• diuretic , b blocker and vasodilator
>malignant
• diuretic , b blocker and vasodilator
• ace inhibitors or Ca channel blocker
Therapeutic approach of HTN
non pharmacological
•no added salt
• no stress
• mild exercise
• no smoking
• avoid fatty food
_ Pharmacological_
>mild
• diuretic or b blocker (proponolol)
• ACE inhibitor ( Ramipril)
• Ca +2 blocker ( Amlodipine)
>moderate
• diuretic and b blocker
• diuretic and ace inhibitors
>severe
• diuretic , b blocker and vasodilator
>malignant
• diuretic , b blocker and vasodilator
• ace inhibitors or Ca channel blocker
Antihypertensive action of a methyl dopa
CNS: - noradrenaline secretion so no vasoconstriction so dcre bo
CVS: dcrs sympathetic discharge dcrs bp
Adverse effect of a methyl dopa
centrally
Sedation
Depression
Dry mouth
Heachache
Nightmare
Dcrs libido
Galactorhoea
Gynecomastia
EPS
Peripherally
Bradycardia
Sinus arrhythmia
Hepatotoxicity
Thrombocytopenia
Leucopenia
Hemolytic anaemia
Classify beta blockers
A)according to selectivity
Selective B1 blocker
Atenolol
Meteprolol
Bisoprolol
Nevibolol
Acebutolol
Esmolol
**No selective B2 blockers*$
Propranolol
Nadolol
Timolol
Sotalol
B) according to intrinsic sympathomimetic activity
Pindolol
Acebutalol
Labetalol
Celiprolol
C)according to membrane stabilizing activity
A) msa beta blocker
Meteprolol
Acebutolol
Proponolol
Pindolol
Non MSA B blocker
Timolol
Nadolol
Sotalol
Indication of propanolol
“happy gets champ”
HTN
Angina
Post MI
Pheochromocytoma
Glaucoma
Essential tremor
Cardiac arrhythmia
Headache
Anxiety
Migraine (prophylaxis)
Adverse effects of proponolol
Hypotension
Bradycardia
Heart block
Cardiac failure
Bronchospasm
Hyperglycemia
Dislipidemia
Sexual interference
Cold extremities
Contraindications of proponolol
Cardiac failure
Heart block
Hypotension
Bronchial asthma
Diabetes
Why propranolol is contraindicated in diabetes
1)It inhibits the beta blocker of pancreas so insulin is not released so hyperglycemia occurs and there is no correction of diabetes and corrects the symptoms
2) If hypoglycemia occurs the symptoms which includes sweating anxiety palpitation will be corrected and patients will go into hypoglycemia shock with no symptoms
Antihypertensive action of atenolol
In heart acts on B¹ and inhibit chronotropic and inotropic action dcrs CO n BP
** KIDNEY**
Decrease renin release no aldosterone dcrs bld vol Drs bp
Indication of ace inhibitors or ARB
HTN
HTN with Dm, LVH, MI
Indication of ace inhibitors or ARB
HTN
HTN with Dm, LVH, MI
Adverse effects of ace inhibitors
Dry cough
Angioneuratic oedema
Skin rash
Hypotension
Hyperkalemia
Hepatotoxicity
Glycosuria
Neutropenia
Contraindications of ACE inhibitors
Bilateral renal artery stenosis
Acute renal failure
Pregnancy (2nd n 3rd trimester)
Systolic pressure< 100 mmHg
Proponolol vs atenolol
non selective n selective
Lipid soluble n no
Can cross BBB n no
Has CNS no CNS effects
Cause bronchoconstriction n no
Not safe in dm n safe
Dislipidemia n no
Timolol in glaucoma
BInds with B2 receptor in ciliary muscle
Dcrs release of aqueous humor
Dcrs intraocular pressure
Correct of glaucoma
Parazosin indication
HTN With atherosclerosis
Peripheral vascular disease
Pheochromocytoma
Causalgia
CCF
Benign prostate hyperplasia
Mitral or vulvur aortic insufficiency
Adverse effect of Parazosin
Heachache
Postural hypotension
Dizziness
Flushing
Failure of ejaculation
Antihypertensive action of Parazosin
It binds with a receptors of veins and artery it causes veno and vasodilation
Decreases blood pressure
Drugs involved in renin angiotensin aldosterone system
B blocker (mape)
Ace inhibitors
ARB
Direct renin inhibitors: Aliskiron
Adverse effect of arb
Teratogenicity
Hyperkalemia
Hypotension
Headache
Acute renal failure
Rash
Weakness
Indication of Ca channel/ Amlodipine
HTN
Angina
Cardiac arrhythmia
HTN with bronchial asthma
Systemic sclerosis
Raynaud’s phenomenon
Migraine
Adverse effects of Ca channel blocker
Ankle oedema
Hypotension
Bradycardia
Head ache
Dizziness
Heart block
Av block
Cough
Gum hyperplasia
Contraindications of Ca channel blocker
Bradycardia
Liver disease
Av block
CCF
Heart block
Hypotension
Amlodipine vs losartan potassium
Ca channel n ARB
Causes reflective tachycardia n bradycardia
Used in BA n no
Not used in dm n use
Causes ankle oedema n no
