Archive for the ‘ L3-Pharma HPT ’ Category

L3- Pharmacology of Hypertension

HYPERTENSION

PRIMARY  AHT

SECONDARY  AHT e.g. PHEOCHROMOCYTOMA & CON  Syndrome

HYPERTENSINOGENICS

•NEURAL  &  BEHAVIOURAL

•HUMORAL

•ENDOTHELIAL

•DIETARY

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THERAPEUTIC MARKERS

•BIOCHEMICAL

•DEMOGRAPHIC

•INDIVIDUAL

•GENETIC

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THERAPY OF HYPERTENSION

•LIFESTYLE  MODIFICATION

•DRUG THERAPY

ANTIHYPERTENSIVES

Commonly used:

•Diuretics

•B.B.

•Ca. Channel blockers

•A.C.E.I.

•AT II receptor blocker

Others:

•Direct  VD

•Central

•Alpha blockers

•Alpha+Beta  blockers

•Adr. N. Blockers

•5-HT antagonists

•Gang. Blockers

•K Channel oppeners

DIFFERENTIAL DRUG THERAPY

•CHILDHOOD

•PREGNANCY

•ELDERLY

•BLACKS

•OBESE

•RESISTANT  HYPERTENSION

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1- DIURETICS

LOOP   DIURETICS(Furosemide)

DISTAL  TUBULE  DIURETICS (Spironolacton)

Main Adverse Effects of Diuretics:

•Hypovolaemia

•Hyponatraemia

•Hypokalaemia

•Hyperkalaemia with Aldosterone antagonists (Spironolacton)

2-BETA-BLOCKERS

ANTIHYPERTENSIVE MECHANISMS OF BB

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BETA  BLOCKERS  MECHANISM

•-ve chronotropic  & inotropic  effects

•Suppression  of renin release

•Decreases the  central sympathetic outflow

•Gradual resetting reconditioning of baroreceptors

•Some B.B. are VD e.g. Dilevalol & Celiprolol

•May alter vascular PGs

•Decrease adrenergic release by presynaptic B2 block

ADVERSE EFFECTS  & PRECAUTIONS

HT.F

BRADYCARDIA

HYPOTENSION

BRONCHOSPASM

#  INSULIN

PERIPHERAL ISCHEMIA

HYPERKALAEMIA IN….

  1. NIGHTMARES
  2. DEPRESSION
  3. Inc. TRIGLYCERIDES
  4. Dec. HDL

DISEASE  DETER.  WITH SUDDEN ….

Contraindications &Precautions CCBs:

•HF

•A.V. block

•Sick sinus S.

•WPWS

•Low BP

•Unstable angina (Nif.

CALCIUM CHANNEL BLOCKERS

Adverse  effects of CCBs:

•HF aggravation

•Angina  ,, (Nif.)

•A.V. block

•Decrease glucose tolerance

•↓ flushing, nasal cong. & tinitus.

Contraindications &Precautions CCBs:

•HF

•A.V. block

•Sick sinus S.

•WPWS

•Low BP

•Unstable angina (Nif.

R-A system  Inhibitors

•Of  renin release (BB, Clonidine, alpha-methyl dopa)

•Renin inhibitors (Enalakrine & Pepstatin)

•ACEIs ( Captopril, Enalapril)

•Ang. II blockers (Saralasin, Losartan)

A C E I s

ANG. II  EFFECTS

AT1   EFFECTS:

•VC

•Supress renin release

•increase aldosterne

•increase Adr. Synthesis & release

•increase ADH

AT2  EFFECTS:

•Antiproliferation

•Apoptosis

•VD (Increase bradykinin)

CONTRAINDICATIONS OF  ACEIs

•HYPOTENSION

•ISCHEMIC  RENAL F.

•RENAL  A. STENOSIS

PRECAUTIONS OF  ACEIs

•TEST   DOSE

•+  DIURETICS

•FOLLOW UP OF CREATININE  &  K

ANG.  II  RECEPTOR BLOCKERS

•SARALASIN   T1/2        8 min.

•LOSARTAN  &VASARTAN ARE SELECTIVE AT2  BLOCKERS

•Induce  hyperkalaemia, hypotension

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VASODILATORS

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WHY PRAZOSIINE (SELECTVE α1 BLOCKER) & NOT PHENOXYBENZAMINE (α1 & α2 BLOCKERS) IN TREAMENT  OF essential  AHT ?

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CENTRALLY  ACTING  ANTI-AHT (CLONIDINE)

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POTASSIUM CHANNEL OPENERS (Cromakalim, Nicorandil ,Minoxidil)

Uses:

•AHT,  Angina

•BRONCHIAL  ASTHMA

•DYSMENORRHOEA

•ANTICONVULSANT

DRUGS  TO BE AVOIDED

•Sympathomimetics

•Steroids

•NSAIDs

•Oral Contraceptives

NEW  DRUG DEVELOPMENT THROUGH PHARMACOGENOMICS

HOW CAN GENETIC STUDIES HELP CLINICIANS  ?

•PREVENTION

•DRUG  RESPONSIVENESS (PHARMACOGENOMICS)

•TARGET ORGAN PROTECTION

COMBINED THERAPY RECOMMENDED INITIAL TREATMENT

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