13- anti - HPN

b. Aliskiren

b. Aliskiren

1. blocks renin enzyme

   a. Captopril

   b. Aliskiren

   c. Candesartan

   d. Ramipril

d. Mannitol

2. Potassium-sparing diuretics, except

   a. Amiloride

   b. Triamterene

   c. Sprinolactone

   d. Mannitol

b. Torsemide

3. Example of loop diuretic

   a. HCTZ

   b. Torsemide

   c. Sprinolactone

   d. Chlorthalidone

c. Thiazide diuretics

4. Na+/Cl- symporter blockers

   a. Loop diuretics

   b. Potassium-sparing diuretic

   c. Thiazide diuretics

   d. osmotic diuretics

b. nimodipine

5. DOC for subarachnoid hemorrhage

   a. amlodipine

   b. nimodipine

   c. verapamil

   d. diltiazem

HYPERTENSION

Blood Pressure is too high

Systolic

pressure of blood vessel where the heart contracts or beats

Diastolic

pressure of blood vessel where the heart rests in beats

• Systolic: 120

• Diastolic: 80

normal blood pressure:

• Systolic: 140-159

• Diastolic: 90-99

Stage 1 Hypertension:

• Systolic: >160

• Diastolic: >100

Stage 2 Hypertension:

• Hydralazine: Vasodilator | Inhibits PRV 

• Beta-Blockers: (-) HR, Contractility, Renin Secretion

• Aliskerin: (-) Renin Secretion

• ACE-I: (-) ACE enzymers

• SARTANS/ARBS: (-) Angiotensin Receptors

• Diuretics: Decrease Blood Volume

Drugs classification for Antihypertension

decrease Na excretion

Diuretics MOA:

• Loop

• Thiazides

• K-Sparing

Types of Diuretics drugs:

Loop Diuretics

• HPN w/ Kidney Problem

• High natriuretic effect

• Has Kaliuretic effect

Thiazides Diuretics

• Most frequently used for HPN

• Moderate natriuretic effect

• Has Kaliuretic effect

High CO & high total Peripheral Vascular Resistance

Problem w/ hypertension

K-Sparing Diuretics

• Combined with thiazide/loop to prevent hypokalemia

• Low natriuretic effect

• No Kaliuretic effect

Thiazides Diuretics

• MOA: Inhibit the Na/Cl symporter (early distal tubules)

• Effects: Low Na, K, Mg, Ca, Cl

• S/E: Hypokalemia, Hyperglycemia, Hyperuricemia, Hyperlipidemia, Hypercalcemia

• HCTZ

• Chlorthalidone

• Indapamide

Thiazides Direutics:

Decrease blood volume → dec BP

Thiazides in short term effects have the ability to decrease what?

Decrease Na in smooth muscles → dec BP

Thiazides in long term effects have the ability to decrease what?

• Hypokalemia, Hyperglycemia, Hyperuricemia, Hyperlipidemia, Hypercalcemia

S/E of Thiazides

High-Ceiling Diuretics

Loop Diuretics is also known as

inhibit the Na+ ,K+ ,2Cl− symporter in the ascending limb of the loop of Henle

MOA of Loop Diuretics

Loop Diuretics

• Effects: Low Na, K, Mg, Ca, Cl

• Uses: HPN + renal impairement, Pulmonary edema (Furosemide); CHF, Hypercalcemia

• Alternative if the px can’t tolerate the activity of thiazides

Furosamide, Torsemide, Bumetanide, Ethacrynic acid

Examples of loop direutics

Ototoxicity

A/E of Ethacrynic acid

combined w/ other drugs to lower BP

MOA of K-Sparing Diuretics

• Amiloride & Triamterene

• Spironolactone & Eplerenone

K-Sparing Diuretics:

Amiloride & Triamterene

a K-Sparing Diuretics that blocks Na+ - channel

Spironolactone & Eplerenone

a K-Sparing Diuretics that blocks mineralocorticoid receptor (↓Na+ reabsorption, ↑K+ secretion)

Spironolactone

• Use: hyperaldosteronism

• S/E: gynecomastia, impotence

• Carbonic anhydrase inhibitors (Acetazolamide, Dorzolamide)

• Osmotic Diuretics (Mannitol, Glycerol)

Other Diuretics

Acetazolamide, Dorzolamide

Tx for altitude sickness, anti-glaucoma

Mannitol, Glycerol

Mx of high intracranial pressure after cerebral accident

Mannitol

An osmotic diuretic that inhibits the toxicity of anti-neoplastic called platinum

α-Adrenoceptor Antagonists (α1-blockers)

not recommended for the initial treatment of HPN but can be added to other drugs when blood pressure is not adequately controlled

• doxazosin,

• prazosin &

• terazosin

α1-blockers:

Reflex tachycardia, Fluid Retention, Orthostatic Hypotension *(first-dose syncope)

S/E of α1-blockers:

Tachycardia

Beta Blockers + Doxazosin = can be treated for what condition?

Fluid Retention

Diuretics + Doxazosin = can be treated for what condition?

Blockade of cardiac β1-receptors (Results: Low HR, contractility, renin secretion)

MOA of β-Adrenoceptor Antagonists (BETABLOCKERS)

β-Adrenoceptor Antagonists

• Uses: HPN + CVD (Myocardial ischemia, arrhythmia, HF)

• S/E: fatigue, vivid dreams, low exercise capacity

• METOPROLOL

• ATENOLOL

Selective- B1blockers:

• PROPRANOLOL

• NADOLOL

• LABETALOL

• CARVEDILOL

Non-Selective-blockers:

LABETALOL

a Non-Selective-blocker that is used for HPN and safe for pregnant

• clonidine,

• guanfacine,

• methyldopa

Centrally-Acting Drugs (Alpha-2-agonist):

Methyldopa

• Centrally-Acting Drugs (Alpha-2-agonist)

• Methyldopa → Methy NE (active)

• Safe for pregnant

sedation, Coomb’s-positive hemolytic anemia (Methyldopa)

S/E of Centrally-Acting Drugs (Alpha-2-agonist):

ACE inhibitors

MOA: blocks Angiotensin I → Angiotensin II

Aliskiren

MOA: blocks Renin (Angiotensinogen → Angiotensin I)

• Catopril (has –SH group),

• Fasinopril,

• Ramipril,

• Enalapril (Enalaprilat)

Ex of ACE inhibitors:

ACE Inhibitors

• Use: HPN + diabetic nephropathy

• 1st line in HF (also sartans)

Hyperkalemia , Fetal injury (teratogenic) , Dry cough

A/E of ACE Inhibitors

• Losartan,

• Candesartan

Angiotensin Receptor Blockers:

Hyperkalemia, fetal injury, NO dry cough

S/E of Angiotensin Receptor Blockers:

VASODILATORS

• USE: HPN + KIDNEY DISEASE

• NOT GIVEN TO HEART FAILURE

• Dihydropiridines (Nifedipine, Amlodipine, Nimodipine)

• Non- dihydropiridines (Verapamil, Diltizem)

Calcium Channel Blockers (CCBs):

Dihydropiridines

a CCB that relaxes vascular smooth muscle

Non- dihydropiridines

a CCB that decrease HR & CO

• Nifedipine

• Amlodipine

• Nimodipine

Dihydropiridines’ drugs:

• Verapamil

• Diltizem

Non- dihydropiridines’ drugs:

Nimodipine

DOC for Subarachnoid Hermorrhage

Hydralazine

• Vasodilator that is safe for pregnant

• S/E: Reflex Tachcardia, SLE, Fluid Retention

Minoxidil

S/E: Reflex Tachcardia, Hypertrichosis, Fluid Retention

Diazoxide

Tx for insulinoma

Nitroprusside

Tx for HPN crisis

CN Toxicity

Nitroprusside’s S/E:

Na Thiosulfate

Mx for CN Toxicity

Fenoldopam

(+) Dopamine-1 = vasodilation, in Kidney: relaxation afferent/efferent arterioles

ARBs

Blocks angiotensin II receptor