Drug Therapy of Hypertension

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<p>Diapositiva 1</p> <p> 2. (AntiHypertensive Drugs)2.1 (Diuretics) 2.2 (Sympathoplegic agents) 2.3 (Direct acting vasodilators)2.4 </p> <p>The control of blood pressureIntroduction</p> <p>The sympathetic nervous systemThe renin-angiotensin-aldosterone system</p> <p>Heart</p> <p>KidneyPostcapillary venulesPrecapillary arterioles</p> <p>32.1 (Diuretics) Hydrochlorothiazide (HCTZ), Furosemide , Spironolactone BP 10-15 mm.Hg</p> <p>HCTZfurosemidespironolactone</p> <p> BP HCTZ loop diuretics furosemide potassium-sparings spironolactone thiazide loop diuretic ()2.2 (Sympathopagic agents)2.2.1 Centrally actings2.2.2 (Ganglion-blocking agents)2.2.3 (Adrenergic neurone blockings)2.2.4 (Adrenergic receptor antagonists) ** -blocker 2.2.1 Centrally actings Clonidine, Methyldopa () Clonidine 2 adrenergic receptor imidazoline receptor - (severe) </p> <p>Methyldopa 2 adrenergic receptor CNS peripheral vascular resistance cardiac out put : (vertigo), (sedative), (nightmares), (depression), (tremor) (rigidity) </p> <p>2.2.2 (Ganglion-blocking agents)trimethaphan ()/ nicotinic receptor postganglionic neuron sympathetic parasympathetic : sympathetic neuron postural hypotention, parasympathetic effect </p> <p>2.2.3 (Adrenergic neurone blockings) Guanethidine, Reserpine () Guanethidine norepinephrine cardiac out put : postural hypotension, </p> <p>Reserpine : NE vesicle NE, DA cardiac out put reserpine : , , , , </p> <p>2.2.4 (Adrenergic receptor antagonists) 1. ( antagonists) prazosin, terazosin, doxazosin ()/ 1 receptor blocker antagonist : sodium ions </p> <p>prazosinterazosin</p> <p>2. ( antagonists) Propranolol, Nadolol (1 2 ) Atenolol, Metoprolol (1): 1 receptor cardiac out put &gt;&gt;&gt; 1 receptor &gt;&gt; (renin- angiotensin)</p> <p>Propranolol</p> <p>Atenolol (direct vasodilators) (ischemic heart disease) </p> <p> (bradycardia) (dizziness) (fatigue) (insomnia) (loss of libido)</p> <p> (asthma) ** insulin </p> <p>2.3 (Direct acting vasodilator) Direct acting vasodilators: Hydralazine, Minoxidil, Sodium nitroprusside (calcium channel blockers) Nifedipine</p> <p>Hydralazine</p> <p>Minoxidil</p> <p>Sodium nitroprusside </p> <p>Nifedipine Hydralazine, minoxidil ,diazoxide Sodium nitroprusside : hydralazine , minoxidil, (hypertensive emergencies): sodium nitropusside, diazoxide minoxidil </p> <p>Hydralazine : ( 6 ) lupus-like syndrome (ischemic heart disease) (angina), </p> <p>Minoxidyl diazoxide : (edema), (hirsutism)Sodium nitropusside : cyanide metabolic acidosis, (arrhythmia), </p> <p>Diazoxide : sodium ions (hyperglycemia) (Calcium channel blockers)Verapamil, Diltiazem, Nifedipine,Amlodipine , Felodipine/ voltage operated calcium channel calcium ions </p> <p>Verapamil</p> <p>Diltiazem</p> <p>Nifedipine</p> <p>Amlodipine verapamil, diltiazem, nifedipine verapamil supraventricular tachyarrhythmia verapamil nicardipine, felodipine</p> <p> (cardiac arrest), , , , (peripheral edema) ( sodium ions )2.4 2.4.1 (Angiotensin converting enzyme inhibitors ; ACE inhibitors)Captopril, Enalapril, Lisinopril, Benazepril</p> <p>EnalaprilCaptopril angiotensin II angiotensin converting enzyme angiotensin I angiotensin II bradykinin () pheripheral vascular resistance </p> <p>Mechanism of action</p> <p> ischemic heart disease (diabetic neuropathy) protein urea </p> <p> ** (dry cough) hyperkalemia potassium-sparing NSAIDs ACE inhibitors NSAIDs prostaglandin bradykinin</p> <p>2.4.2 / (Angiotensin II receptor blockers ; ARBs)Losartan, Valsartan, Irbesartan ()/ angiotensin receptor (AT1 receptor) bradykinin renin angiotensin ACE inhibitors</p> <p> ACE inhibitors</p>