Pharmacology - Midterms
It is a sustained, reproducible inc in BP that could lead to cardiovascular problem, renal dse; blindness
Hypertension
It is the most common dse
Hypertension
What are the combination of several abnormalities that causes HTN?
What kind of HTN when Pt in whom no specific cause of HTN?
essential hypertension
What are the specific causes of HTN?
normal control of BP - short term
baroreceptor reflex
normal control of BP - long term
kidneys
possible mechanism in essential hypertension
<12 mm systolic; <80 mmHg diastolic
Normal BP
120-129 systolic; <80 mmHg diastolic
Elevated BP
130 - 139 systolic or 80-89 mmHg
Stage 1 Hypertension
> 140 systolic; > 90 mmHg diastolic
Stage 2
6 Major Categories of Drugs for HTN
It decreases the plasma fluid volume @ kidneys
DIURETICS
It decreases sympathetic influence on: heart &/or peripheral vasculature @ various sites w/in sympathetic division of ANS?
SYMPATHOLYTIC DRUGS
It lower vasuclar resistance by directly vasodilating @ peripheral vessels?
VASODILATORS
These are ACE inhibitory - prevents conversion of nagiotensin I to angiotensin II receptor blockers.
inhibition of renin-angiotensin system
These dec vascular smooth-mm cxn, dec myocardial force; rate of cxn
calcium channel blockers
MOA: inc formation and excretion fo renal, and inc renal excretion of water; sodium; dec fluid volume lowers blood pressure
diuretics
what are the 3 classification of diuretics?
It act primarily on early portion of DCT of nephron; inhibit sodium reabsorption
thiazide diuretics
it act primarily on ascending limb of loob of Henle, which inhibits reabsorption of sodium; chloride thus prevents reabsorption of water
loop diuretics
this prevents secretion into the distal tubule
potassium sparring
diuretic drugs used to treat HTN
loop diuretics for HTN
potassium-sparring diuretics
what are the adverse effect of diuretics?
it is the increase in sympathetic activity may be an underlying factor in essential htn, can be classified according to where and how they interrupt sympathetic activity
sympatholytic drugs
it is the mainstay in treatment of HTN, well tolerated by most pt, incidence of side effects are low
beta blockers
this exerts primary effect on heart; dec HR; force of myocardia cxn; general dec sympathetic tone
often complement effects of other anti-HTN
beta blockers - sympatholytic drugs
what are the 4 theories of beta blocker - sympatholytic drugs?
specific agents of beta blockers - sympatholytic drugs
beta blockers - selective for beta 1 receptors (cardioselective)
beta blocker - which are partial agonists, intrinsic sympathomimetic activity
pinodolol, acebutolol
beta blocker - which are membrane stabilizing activity
labetalol, propranolol
beta blocker - which are peripheral vasodilator and cardiac beta blockade
labetalol, newer beta blockers
what are the adverse effects of beta blocker - sympatholytic drugs
this blocks alpha 1 adrenergic receptor on vascular smooth mm, ability to improve blood lipid profiles and produce favorable effect on glucose metabolism; insulin resistance
alpha blockers - sympatholytic drugs
indication for mild to moderate HTN, which acts directly to tissues - mediate inc BP, peripheral vasculature
alpha blockers - sympatholytic drugs
can also be used to treat the symptoms of
benign prostatic
hypertrophy as they
decrease
sympathetic-mediated
contraction of smooth muscle located
in
the prostate gland
alpha blockers - sympatholytic drugs
specific agents: alpha blockers - sympatholytic drugs
what are the adverse effects of alpha blocker - sympatholytic drugs
this is an adverse effect of alpha blocker when peripheral vascular
resistance
falls d/t the effects of these drugs,
the
baroreceptor reflex often responds
by generating a
compensatory
inc in HR
reflex tachycardia
this is an adverse effect of alpha blocker wherein blockade of
alpha-1 receptors in
peripheral arteries and veins
often
promotes pooling of blood in the LE
when a patient
stands up
orthostatic HOTN
this are drugs that inhibit release of norepinephrine from
presynaptic
terminals of peripheral adrenergic neurons
may
be used effectively in some individuals
with hypertension
presynaptic adrenergic inhibitors
MOA: : prevent normal physiologic release of
norepinephrine from
postganglionic
sympathetic neurons
presynaptic adrenergic inhibitors
what are the specific agents of presynaptic adrenergic inhibitors?
This only drug in presynaptic adrenergic inhibitors that is
still
used commonly in the United States
to treat hypertensio
reserpine
adverse effects of presynaptic adrenergic inhibitors
this drug inhibit sympathetic discharge from
brainstem which are
similar to alpha 2 agonists; decrease sympathetic outflow
centrally acting agents
specific agents of centrally acting
adverse effect of centrally acting agents
these are drugs that block synaptic transmission @autonomic ganglia
will dramatically; effectively reduce BP by
dec systemic
sympathetic activity
ganglionic blockers
essentially nicotinic cholinergic
antagonists, w/c block
transmission @the
junction between presynaptic
and
postsynaptic neurons in sympathetic and
parasympathetic pathways
ganglionic blockers
most of such drugs are no longer
available clinically because of
intolerable
toxicities related to their primary action
ganglionic blockers
MOA:
1. block synaptic transmission at
autonomic
ganglia
2. decrease sympathetic activity
3.
nicotinic cholinergic antagonists - between
pre and postsynaptic
neurons of both
divisions
ganglionic blockers
what is the indication of ganglionic blockers?
hypertensive crisis
what are the specific agents of ganglionic blockers?
what are the adverse effect of ganglionic blockers?
these are drugs that directly vasodilate the
peripheral
vasculature will produce an
antihypertensive effect by
decreasing
peripheral vascular resistance
vasodilators
these drugs exerts inhibitory effect: vascular smooth-mm cells, inhibit smooth mm cxn by inc intracellular production of 2nd messengers and also inc amounts of cGMP, inhibit fxn of contractile process in vascular smooth-mm cell - leading to vasodilation
vasodilators
MOA:
1. vasodilates peripheral vasculature
2. inhibits
smooth muscle contraction due to
increased 2nd messengers (cyclic GMP)
vasodilators
specific agents of vasodilators
adverse effect of vasodilators
this is an adverse effect of vasodilators whi often occurs because
the baroreceptor
reflex attempts to compensate for the
fall
in vascular resistance that these
drugs produce
reflex tachycardia
involves several endogenous components
that help regulate
vascular tone an
regulate sodium and water balance in the
body
angiotensin converting enzyme inhibitors
an enzyme produced primarily in the
kidneys; when blood pressure
falls, renin
is released from the kidneys into the
systemic circulation
renin
a peptide that is produced by the liver and
circulates
continually in the bloodstream
angiotensinogen
MOA: inhibits enzyme that converts
angiotensin 1 to angiotensin
2
(renin-angiotensin system)
angiotensin converting enzyme inhibitors
it is an indication of mild to moderate HTN; used alone of in combination
angiotensin converting enzyme inhibitors
what are the advantages of angiotensin converting enzyme inhibitors?
specific agents of angiotensin converting enzyme inhibitors?
what are the adverse effect of angiotensin converting enzyme inhibitors
these are drugs recognized as being beneficial in the treatment of
essential HTN where calcium appears to play a role in activating the
contractile element in
smooth muscle
calcium channel blockers
MOA:
1. Blocks calcium entry into vascular
smooth muscle
cell
2. Decreased vascular resistance
3. Tends to decrease
HR and myocardial
contractile force
calcium channel blockers
specific agents of calcium channel blockers
Adverse Effects of calcium channel blockers