antihypertensives and diuretics WIP

hypertension chart

antihypertensive drugs

• Adrenergic drugs
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers
• Diuretics
• Vasodilators
• Direct renin inhibitors

adrenergic drugs subcategories

• α2-Receptor agonists (central)
• α1-Receptor blockers (peripheral)
• β-Receptor blockers (peripheral)
• Combination α1- and β-receptor blockers (peripheral

clonidine and methyldopa

centrally sympatholytic stimulate a-receptors in CNS to inhibit vasoconstriction → reduced peripheral resistance

decrease norepinephrine prod

stim a2d adrenergic receptors thus reducing renin activity in the kidneys

result in decreased BP

a2 receptor agonist AE

Sodium and water retention
Edema
Drowsiness
Dizziness
Hypotension
Impotence
Bradycardia
Depression

peripherally acting a1-blockers

doxazosin, prazosin, and terazosin
Decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in vasodilation and decreased B/P
Dilate arteries and veins
α1-Blockers also increase urinary flow rates and decrease outflow
obstruction by preventing smooth muscle contractions in the bladder neck and urethra.
Use: benign prostatic hyperplasia (BPH)
Maintain renal blood flow
Treat hypertension

peripherally acting A1 blockers

Orthostatic hypotension
Reflex tachycardia
Sodium and water retention
Edema
Weight gain

beta blockers

-olol

beta blockers

ß- Adrenergic blockers inhibit response to ß-Adrenergic stimulation thus decreasing cardiac output
Block the release of catecholamines (epinephrine and norepinephrine) – decreasing heart rate and B/P; decrease the workload of the heart and decrease oxygen demands

beta blocker indications

Angina, dysrhythmias, hypertension,
migraine headaches, prevention of
myocardial infarction, and glaucoma
Carvedilol and metoprolol
- Used in heart failure once the patient
has been stabilized with ACE inhibitor and
diuretic therapy

beta blocker AE

Bradycardia
Hypotension
Bronchospasm
Weakness, fatigue
Dizziness

ACE inhibitors

Often used as first-line drugs for HF and hypertension
May be combined with a thiazide diuretic or a calcium channel blocker.

-pril

ACE inhibitor MoA

Inhibit ACE, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II
Angiotensin II is a potent vasoconstrictor and causes aldosterone secretion from the adrenal glands.

Block ACE, thus preventing the formation of angiotensin II
Prevent the breakdown of the vasodilating substance bradykinin
Ability to decrease SVR (a measure of afterload) and preload
Can stop the progression of left ventricular hypertrophy
Lower BP

ACE inhibitor indications

Hypertension
HF (drug used either alone or in combination with diuretics or other drugs)
Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective)
Renal protective effects in patients with diabetes

ACE inhibitor MoA

ACE: converts angiotensin I (formed through the
action of renin) to angiotensin II
Angiotensin II: potent vasoconstrictor that induces
aldosterone secretion by the adrenal glands
Aldosterone: stimulates sodium and water
resorption, which can raise BP
Renin–angiotensin–aldosterone system
ACE Inhibitors thus lower BP.

ACE inhibitor primary effects

Cardiovascular and renal
BP: reduce BP by decreasing SVR
HF:
Prevent sodium and water resorption by inhibiting aldosterone
secretion
Diuresis: decreases blood volume and return to the heart
Decreases preload, or the left ventricular end-diastolic volume
Decreases work required of the heart

ACE inhibitors cardioprotective effects

ACE inhibitors decrease SVR (a measure of afterload) and preload.
Used to prevent complications after MI
Ventricular remodeling: left ventricular hypertrophy, which is sometimes seen after MI
Have been shown to decrease morbidity and mortality in patients with HF
Drugs of choice for hypertensive patients with HF

ACE Inhibitors: Renal Protective Effects

Reduce glomerular filtration pressure
Cardiovascular drugs of choice for patients with diabetes
Reduce proteinuria
Standard therapy for diabetic patients to prevent the progression of diabetic nephropathy

ACE Inhibitors: Adverse Effects

Fatigue, dizziness, headache, impaired taste
Mood changes
First-dose hypotensive effect
Possible hyperkalemia
Dry, nonproductive cough, which reverses when therapy is
stopped
Angioedema: rare but potentially fatal
Others
Do not use NSAIDS with ACE Inibitors