angiotensin receptor blockers

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Angiotensin receptor blockers [ARB]

Angiotensin receptor blockers [ARBs]DR PADMAVATHI SASSOCIATE PROFESSOR - DEPT OF PHARMACOLOGY

Angiotensin antagonists

Angiotensin receptorsAT1VASCULAR S. M, MYOCARDIUMGPCR

VASOCONSTRICTIONCELL GROWTH IN HEART & ARTERIESSECRETION OF ALDOSTERONEPERIPHERAL SYM. ACTIVITY INCREASED

AT2 FOETUS, ADRENAL MEDULLA ADULTSGPCR

VASODILATATIONANTI-PROLIFERATIVEAPOPTOSIS

COMPETITIVE blockers

ARBs saRTANSLO SARTANCANDESARTANIRBESARTANVALSARTANOLMESARTANTELMISARTAN

MAJOR ADVERSE EFFECT DUE TO TREATMENT WITH ACE INHIBITORS

NOT SEEN WITH ARBS?

arbS VS Ace INHIBITORSDO NOT INTERFERE WITH DEGRADATION OF BRADYKININ COUGH IS RARE

COMPLETE INHIBITION OF AT1 RECEPTOR ACTIVATION

INDIRECT AT2 ACTIVATION

Individual drugsLOSARTAN HIGH FIRST PASS METABOLISM, NO DOSE ADJUSTMENT RENAL / LIVER DISEASE

CANDESARTAN NON COMPETITIVE ANTAGONISM

VALSARTAN ABSORPTION AFFECTED BY FOOD

OLMESARTAN NO DOSE ADJUSTMENTPRODRUG

ADVERSE EFFECTSHYPOTENSION

HYPERKALEMIA

TERATOGENECITY

USESHYPERTENSIONCONGESTIVE HEART FAILUREMYOCARDIAL INFARCTIONDIABETIC NEPHROPATHY

PREVENTS REMODELING

CONTRAINDICATION

Bilateral

CAN WE COMBINE

ARBS WITH ACE INHIBITORS?

THEORETICAL REASONSMORE COMPLETE SUPPRESSION OF RAS

ANGIOTENSIN II GENERATED BY ALTERNATE PATHWAYS BLOCKED BY ARBS

ACE INHIBITORS BRADYKININ RELATED VASODILATATION

ARBS COMPENSATORY RISE IN ANG II checked by ACEI

Direct Renin inhibitorALISKIREN

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