尊敬的 微信汇率:1円 ≈ 0.046166 元 支付宝汇率:1円 ≈ 0.046257元 [退出登录]
SlideShare a Scribd company logo
Dr. Haji Bahadar
Assistant Professor
Khyber Medical University-IPMS
Major diseases
 Hypertension
 Coronary heart disease
 Congestive heart failure/Heart failure
 Angina
 Heart Attack
Anti-hypertensive drugs
Blood pressure is the force exerted by blood against the
walls blood vessels.
Factors that determine the blood pressure:
1- Cardiac output (CO): Cardiac output is the volume of
blood the heart pumps per minute
2- Total peripheral resistance (PR).
3- Elasticity of the aorta and large arteries.
4- Blood volume and circulatory capacity.
BP = CO X PR
 What is afterload: Afterload is the
pressure against which the heart
works to eject blood during systole.
 What is preload: ??
Hypertension is defined as having a blood pressure higher than 140/ 90
mmHg
 Baroreceptors are pressure sensors. Their function
is to sense pressure changes.
 Baroreflex or baroreceptor reflex is a homeostatic
mechanisms that helps to maintain blood pressure at
nearly normal level.
 .
The renin-angiotensin system (RAS) plays an integral role in blood pressure
regulation
 1. Beta adrenergic blockers
 2. Diuretics
 3. Calcium channel blockers
 4. Angiotensin converting enzyme inhibitors
 5. Angiotensin receptor blockers
 7. Direct arterial vasodilators (self study)
 8. Drug used in hypertensive emergency
 Beta-blockers are drugs that bind to beta- receptors.
 These drugs block the binding of norepinephrine and
epinephrine to these receptors.
 Beta-blockers are sympatholytic drugs.
 β1-receptors are located commonly in the heart and
kidneys.
 β2- receptors are located mainly in the lungs,
gastrointestinal tract, liver, uterus, vascular smooth
muscle, and skeletal muscle.
 β3- adrenergic receptors are located in fat cells.
 Hypertension is associated with an increase
cardiac output. Beta-blockers decrease blood
pressure by reducing cardiac output.
• Hypertension in some patients is caused by
emotional stress, which causes enhanced
sympathetic activity. Beta-blockers can be very
effective in these patients.
↓ HR, ↓ Force of contraction, ↓ Cardiac Output
↓ β 1 mediated renin release from kidney
↓ sympathetic outflow
ISA:
selective (β1):
 Metoprolol
 Acebutolol
 Esmolol
 Atenolol
 Bisoprolol
 Betaxolol
 Non selective (β1 & β2):
Without ISA
 Propronolol,
 Sotalol ,
 Timolol
With ISA: Pindolol
With additional α
blocking property:
Labetolol
Carvedilol
 Bradycardia
 Hypotension
 atrioventicular (AV) nodal conduction
block. Beta-blockers are therefore
contraindicated in patients with sinus
bradycardia and partial AV block
 Bronchoconstriction can occur when non-selective
beta-blockers are given to asthmatic patients.
Therefore, non-selective beta-blockers are
contraindicated in patients with asthma or chronic
obstructive pulmonary disease.
 Bronchoconstriction occurs because sympathetic
nerves innervating the bronchioles normally activate
β2-adrenoceptors that promote bronchodilation.
 Beta-blockers can also mask the tachycardia that
serves as a warning sign for insulin-induced
hypoglycemia in diabetic patients; therefore, beta-
blockers should be used cautiously in diabetics.
 Heart: Blockade of beta1-receptors in the sino-
atrial node reduces heart rate (negative
chronotropic effect) and blockade of beta1-
receptors in the myocardium decrease cardiac
contractility (negative inotropic effect).
Cardiac Effects of beta blockers
Decrease contractility
(negative intropy)
Decrease heart rate
(negative chronotropy)
Decrease conduction velocity
(negative dromotropy)
 Kidney: Blockade of beta1-receptors inhibit the release of renin from
juxta-glomerular cells and thereby reduce the activity of the renin-
angiotensin-aldosterone system.
 Renin is a proteolytic enzyme that is released into
the circulation by the kidneys. Its release is
stimulated by:
 sympathetic nerve activation (acting through β1-
adrenoceptors)
 renal artery hypotension (caused by systemic
hypotension or renal artery stenosis)
 decreased sodium delivery to the distal tubules of
the kidney.
 The renin-angiotensin-aldosterone system (RAAS)
regulate blood volume and systemic vascular
resistance, which together influence cardiac
output and arterial pressure.
 There are three important components to this
system: 1) renin, 2) angiotensin, and 3)
aldosterone. Renin, which is released primarily by
the kidneys, stimulates the formation of
angiotensin in blood and tissues, which in turn
stimulates the release of aldosterone from the
adrenal cortex.
Angiotensin2 functions:
 Constricts resistance vessels increasing systemic
vascular resistance and arterial pressure
 Stimulates reabsorption.
 increase the release aldosterone, which in turn acts
on the kidneys to increase sodium and fluid retention
 Stimulates the release of vasopressin (antidiuretic
hormone, ADH) from the posterior pituitary, which
increases fluid retention by the kidneys
 Stimulates thirst centers within the brain
 Enhancing sympathetic adrenergic function
 Stimulates cardiac hypertrophy and vascular
hypertrophy.
 Benazepril
 Captopril
 Enalapril
 Fosinopril
 Lisinopril
 Moexipril
 Quinapril
 Ramipril
ACE inhibitors have the following actions:
 Dilate arteries and veins by blocking angiotensin II
formation
 Down regulate sympathetic activity
 Promote renal excretion of sodium and water
(natriuretic and diuretic effects) by blocking the
effects of angiotensin II in the kidney and by
blocking angiotensin II stimulation
of aldosterone secretion. This reduces blood
volume, venous pressure and arterial pressure.
 Inhibit cardiac remodeling associated with
chronic hypertension, heart failure, and myocardial
infarction.
In cardiology, ventricular remodeling (or cardiac remodeling) refers to
changes in the size, shape, structure, and function of the heart.
Angioedema
 Hypertension
 Heart Failure
 Diabetic and Nondiabetic Nephropathy
.
 Dry cough
 First-dose hypotension (due to vasodilatation)
 Angioedema: it is a serious type of skin reaction
that affects the skin layer and also the tissues
 Increased blood-potassium level (hyperkalemia)
 Patients with bilateral renal artery stenosis may
experience renal failure if ACE inhibitors are
administered. The reason is that the elevated
circulating and intrarenal angiotensin II in this
condition constricts the efferent arteriole more
than the afferent arteriole within the kidney, which
helps to maintain glomerular capillary pressure
and filtration. Removing this constriction by
blocking circulating and intrarenal angiotensin II
formation can cause an abrupt fall in glomerular
filtration rate.
 Renal artery stenosis is a narrowing
of arteries that carry blood to one or both of the
kidneys.
 Patients with renal artery stenosis, the kidneys
release large amounts of renin.
 High angiotensin II serve to maintain glomerular
filtration by two mechanisms: elevation of blood
pressure and constriction of efferent glomerular
arterioles.
 When ACE is inhibited, causing angiotensin II
levels to fall, the mechanisms that had been
supporting glomerular filtration fail, causing urine
production to drop
 Diuretics. Diuretics may intensify first-dose
hypotension. To prevent this interaction, diuretics
should be withdrawn 1 week prior to initiating ACE
inhibitor treatment
 ACE inhibitors increase the risk of hyperkalemia
caused by potassium supplements and
potassium-sparing diuretics
 Candesartan
 Irbesartan
 Losartan
 Olmesartan
 Telmisartan
 Valsartan
 These drugs have very similar effects
to angiotensin converting enzyme (ACE)
inhibitors and are used for the same indications
(hypertension, heart failure, post- myocardial
infarction).
A diuretic is any substance that promotes diuresis
(increased production of urine).
DIURETICS
Diuretics enhance the removal of sodium and water from
body through kidneys.
Ginger. ...
Parsley. ...
Caffeine
Types of diuretics
Thiazides: Hydrochlorothiazide, Chlorthalidone, indapamide
MOA:
these drugs Inhibit sodium-chloride transporter in the
distal tubule. This transporter normally reabsorbs about
5% of filtered sodium.
Loop diuretics: Furosemide (lasix), Torsemide, Bumetanide
MOA: Loop diuretics inhibit the sodium-potassium-chloride
co-transporter in the thick ascending limb. This transporter
normally reabsorbs about 25% of the sodium load.
Potassium-sparing diuretics: spironolactone and eplerenone.
Osmotic diuretics: Mannitol
 Hypertension
 Heart failure
 Pulmonary and systemic edema
 Amlodipine (Norvasc)
 Nimodifine (Nimotop)
 Felodipine.
 Isradipine.
 Nicardipine.
 Nifedipine (Adalat CC) Extended Release Tablets
 Nisoldipine
 Verapamil
 Calcium channel blockers decrease the amount of
calcium entering cardiac and smooth muscle cells
by blocking voltage-gated calcium channels.
 This causes blood vessels to relax and widen
(vasodilate), improves oxygen supply to the heart
 Calcium-channel blockers bind to L-type calcium channels
located on the vascular smooth muscle, cardiac myocytes, and
cardiac nodal tissue (sinoatrial and atrioventricular nodes).
 These channels are responsible for regulating the influx of
calcium into muscle cells, which in turn stimulates smooth
muscle contraction and cardiac myocyte contraction.
 In cardiac nodal tissue, L-type calcium channels play an
important role in pacemaker currents.
 Therefore, by blocking calcium entry into the cell, there is,
vasodilation,
 Decreased myocardial force generation (negative inotropy),
decreased heart rate (negative chronotropy),
 Decreased conduction velocity within the heart (negative
dromotropy),
 Flushing, headache, hypotension, edema and
reflex tachycardia
 Hypertension
 Angina
1. Anti hypertensive drugs.pptx what's hypertension

More Related Content

Similar to 1. Anti hypertensive drugs.pptx what's hypertension

Anti hypertensive drugs
Anti hypertensive drugsAnti hypertensive drugs
Anti hypertensive drugs
SyedSulaiman29
 
Drugs used for the Treatment of Heart failure
Drugs used for the Treatment of Heart failureDrugs used for the Treatment of Heart failure
Drugs used for the Treatment of Heart failure
netraangadi2
 
Week 5 Pharma
Week 5 PharmaWeek 5 Pharma
Week 5 Pharma
xtrm nurse
 
Antihypertensives | Classes of Drugs | Baro Receptor
Antihypertensives | Classes of Drugs | Baro ReceptorAntihypertensives | Classes of Drugs | Baro Receptor
Antihypertensives | Classes of Drugs | Baro Receptor
Chetan Prakash
 
cardiac medicine
cardiac medicinecardiac medicine
cardiac medicine
Pabitra Thapa
 
Heart failure
Heart failure Heart failure
Heart failure
Dr. Bushra Hasan Khan
 
HYPERTENSION - SLIDE SHARE PRESENTATION.
HYPERTENSION - SLIDE SHARE PRESENTATION.HYPERTENSION - SLIDE SHARE PRESENTATION.
HYPERTENSION - SLIDE SHARE PRESENTATION.
deepaannamalai16
 
Congestive heart failure
Congestive heart failure Congestive heart failure
Congestive heart failure
Ravi kumar
 
Antihypertensive drugs.pdf
Antihypertensive drugs.pdfAntihypertensive drugs.pdf
Antihypertensive drugs.pdf
AxmedXBullaale
 
Antihypertensive mbbs copy
Antihypertensive mbbs   copyAntihypertensive mbbs   copy
Antihypertensive mbbs copy
Divya Krishnan
 
Anti hypertensive drugs Biomedical science slideshare
Anti hypertensive drugs Biomedical science slideshareAnti hypertensive drugs Biomedical science slideshare
Anti hypertensive drugs Biomedical science slideshare
JersitaSherley
 
Inotropes and Vasopressors.pptx
Inotropes and Vasopressors.pptxInotropes and Vasopressors.pptx
Inotropes and Vasopressors.pptx
ashleycurtis23
 
Pathophysiology of hypertension
Pathophysiology of hypertensionPathophysiology of hypertension
Pathophysiology of hypertension
Anusha Rameshwaram
 
CARDIOVASCULAR PHARMACOLOGY.ppt
CARDIOVASCULAR PHARMACOLOGY.pptCARDIOVASCULAR PHARMACOLOGY.ppt
CARDIOVASCULAR PHARMACOLOGY.ppt
MulatuAsfaw
 
hypertension.pptx
hypertension.pptxhypertension.pptx
hypertension.pptx
NgulakehBlaise1
 
Hypertension Definition & management & types & treatment
Hypertension Definition & management & types & treatmentHypertension Definition & management & types & treatment
Hypertension Definition & management & types & treatment
Dr / Mohamed Ahmed
 
Hypertension and hypotension nature.pptx
Hypertension and hypotension nature.pptxHypertension and hypotension nature.pptx
Hypertension and hypotension nature.pptx
nxrg25985g
 
Hypertension (HTN)
Hypertension (HTN)Hypertension (HTN)
Hypertension (HTN)
BrahmjotKaur11
 
Congestive cardiac failure (CCF)
Congestive cardiac failure (CCF)Congestive cardiac failure (CCF)
Congestive cardiac failure (CCF)
VIGNESHROSS
 
Hypertension
HypertensionHypertension
Hypertension
Ratheeshkrishnakripa
 

Similar to 1. Anti hypertensive drugs.pptx what's hypertension (20)

Anti hypertensive drugs
Anti hypertensive drugsAnti hypertensive drugs
Anti hypertensive drugs
 
Drugs used for the Treatment of Heart failure
Drugs used for the Treatment of Heart failureDrugs used for the Treatment of Heart failure
Drugs used for the Treatment of Heart failure
 
Week 5 Pharma
Week 5 PharmaWeek 5 Pharma
Week 5 Pharma
 
Antihypertensives | Classes of Drugs | Baro Receptor
Antihypertensives | Classes of Drugs | Baro ReceptorAntihypertensives | Classes of Drugs | Baro Receptor
Antihypertensives | Classes of Drugs | Baro Receptor
 
cardiac medicine
cardiac medicinecardiac medicine
cardiac medicine
 
Heart failure
Heart failure Heart failure
Heart failure
 
HYPERTENSION - SLIDE SHARE PRESENTATION.
HYPERTENSION - SLIDE SHARE PRESENTATION.HYPERTENSION - SLIDE SHARE PRESENTATION.
HYPERTENSION - SLIDE SHARE PRESENTATION.
 
Congestive heart failure
Congestive heart failure Congestive heart failure
Congestive heart failure
 
Antihypertensive drugs.pdf
Antihypertensive drugs.pdfAntihypertensive drugs.pdf
Antihypertensive drugs.pdf
 
Antihypertensive mbbs copy
Antihypertensive mbbs   copyAntihypertensive mbbs   copy
Antihypertensive mbbs copy
 
Anti hypertensive drugs Biomedical science slideshare
Anti hypertensive drugs Biomedical science slideshareAnti hypertensive drugs Biomedical science slideshare
Anti hypertensive drugs Biomedical science slideshare
 
Inotropes and Vasopressors.pptx
Inotropes and Vasopressors.pptxInotropes and Vasopressors.pptx
Inotropes and Vasopressors.pptx
 
Pathophysiology of hypertension
Pathophysiology of hypertensionPathophysiology of hypertension
Pathophysiology of hypertension
 
CARDIOVASCULAR PHARMACOLOGY.ppt
CARDIOVASCULAR PHARMACOLOGY.pptCARDIOVASCULAR PHARMACOLOGY.ppt
CARDIOVASCULAR PHARMACOLOGY.ppt
 
hypertension.pptx
hypertension.pptxhypertension.pptx
hypertension.pptx
 
Hypertension Definition & management & types & treatment
Hypertension Definition & management & types & treatmentHypertension Definition & management & types & treatment
Hypertension Definition & management & types & treatment
 
Hypertension and hypotension nature.pptx
Hypertension and hypotension nature.pptxHypertension and hypotension nature.pptx
Hypertension and hypotension nature.pptx
 
Hypertension (HTN)
Hypertension (HTN)Hypertension (HTN)
Hypertension (HTN)
 
Congestive cardiac failure (CCF)
Congestive cardiac failure (CCF)Congestive cardiac failure (CCF)
Congestive cardiac failure (CCF)
 
Hypertension
HypertensionHypertension
Hypertension
 

More from Khyber medical university

12. EDEMA introduction and causes treatment
12. EDEMA introduction and causes treatment12. EDEMA introduction and causes treatment
12. EDEMA introduction and causes treatment
Khyber medical university
 
10. Antifungal drugs.pdf antifungal drugs classification and used
10. Antifungal drugs.pdf antifungal drugs classification and used10. Antifungal drugs.pdf antifungal drugs classification and used
10. Antifungal drugs.pdf antifungal drugs classification and used
Khyber medical university
 
9. Anti Malarial drugs.Anti malaria drugs
9. Anti Malarial drugs.Anti malaria drugs9. Anti Malarial drugs.Anti malaria drugs
9. Anti Malarial drugs.Anti malaria drugs
Khyber medical university
 
4. Anti Anginal.pdf What's anginal pectoris
4. Anti Anginal.pdf What's anginal pectoris4. Anti Anginal.pdf What's anginal pectoris
4. Anti Anginal.pdf What's anginal pectoris
Khyber medical university
 
CELL 1.pptxCell diffintion and function of cell and structure and types of cell
CELL 1.pptxCell diffintion and function of cell and structure and types of cellCELL 1.pptxCell diffintion and function of cell and structure and types of cell
CELL 1.pptxCell diffintion and function of cell and structure and types of cell
Khyber medical university
 
Lipids.pptx . Lipids and function of lipids and structure and types
Lipids.pptx .  Lipids and function of lipids and structure and typesLipids.pptx .  Lipids and function of lipids and structure and types
Lipids.pptx . Lipids and function of lipids and structure and types
Khyber medical university
 
Pharmacology II Chapter 5 ppt.pptx
Pharmacology II Chapter 5 ppt.pptxPharmacology II Chapter 5 ppt.pptx
Pharmacology II Chapter 5 ppt.pptx
Khyber medical university
 
Pharmacology II Chapter 1 ppt -.pptx
Pharmacology II Chapter 1 ppt -.pptxPharmacology II Chapter 1 ppt -.pptx
Pharmacology II Chapter 1 ppt -.pptx
Khyber medical university
 

More from Khyber medical university (8)

12. EDEMA introduction and causes treatment
12. EDEMA introduction and causes treatment12. EDEMA introduction and causes treatment
12. EDEMA introduction and causes treatment
 
10. Antifungal drugs.pdf antifungal drugs classification and used
10. Antifungal drugs.pdf antifungal drugs classification and used10. Antifungal drugs.pdf antifungal drugs classification and used
10. Antifungal drugs.pdf antifungal drugs classification and used
 
9. Anti Malarial drugs.Anti malaria drugs
9. Anti Malarial drugs.Anti malaria drugs9. Anti Malarial drugs.Anti malaria drugs
9. Anti Malarial drugs.Anti malaria drugs
 
4. Anti Anginal.pdf What's anginal pectoris
4. Anti Anginal.pdf What's anginal pectoris4. Anti Anginal.pdf What's anginal pectoris
4. Anti Anginal.pdf What's anginal pectoris
 
CELL 1.pptxCell diffintion and function of cell and structure and types of cell
CELL 1.pptxCell diffintion and function of cell and structure and types of cellCELL 1.pptxCell diffintion and function of cell and structure and types of cell
CELL 1.pptxCell diffintion and function of cell and structure and types of cell
 
Lipids.pptx . Lipids and function of lipids and structure and types
Lipids.pptx .  Lipids and function of lipids and structure and typesLipids.pptx .  Lipids and function of lipids and structure and types
Lipids.pptx . Lipids and function of lipids and structure and types
 
Pharmacology II Chapter 5 ppt.pptx
Pharmacology II Chapter 5 ppt.pptxPharmacology II Chapter 5 ppt.pptx
Pharmacology II Chapter 5 ppt.pptx
 
Pharmacology II Chapter 1 ppt -.pptx
Pharmacology II Chapter 1 ppt -.pptxPharmacology II Chapter 1 ppt -.pptx
Pharmacology II Chapter 1 ppt -.pptx
 

Recently uploaded

Ghaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your Doorstep
Ghaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your DoorstepGhaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your Doorstep
Ghaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your Doorstep
gragneelam30
 
Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...
Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...
Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...
wwefun9823#S0007
 
VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...
VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...
VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...
Reena callgirls
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
CentiUP
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
Rommel Luis III Israel
 
TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...
TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...
TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...
Donc Test
 
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in GoaCall Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
rajni kaurn06
 
6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx
6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx
6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx
baronofdestruction
 
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts AvailableCall Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
kmiss 1062#v08
 
Linga Mudra(Mark of Siva) generates excessive heat within the body
Linga Mudra(Mark of Siva) generates excessive heat within the bodyLinga Mudra(Mark of Siva) generates excessive heat within the body
Linga Mudra(Mark of Siva) generates excessive heat within the body
Karuna Yoga Vidya Peetham
 
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
aadeshkumar4448
 
💋Chandigarh Call Girls !! 740-46^34-175 !!— *Call "*Girls Service chandigar...
💋Chandigarh  Call Girls !! 740-46^34-175 !!—  *Call "*Girls Service chandigar...💋Chandigarh  Call Girls !! 740-46^34-175 !!—  *Call "*Girls Service chandigar...
💋Chandigarh Call Girls !! 740-46^34-175 !!— *Call "*Girls Service chandigar...
Reena callgirls
 
About CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdfAbout CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdf
CentiUP
 
ASSESSMENT OF THE EYE (2)-Health Assessment.pptx
ASSESSMENT OF THE EYE (2)-Health Assessment.pptxASSESSMENT OF THE EYE (2)-Health Assessment.pptx
ASSESSMENT OF THE EYE (2)-Health Assessment.pptx
Rommel Luis III Israel
 
COLD CREAM AND VANISHING CREAM, IP-I, PCI
COLD CREAM AND VANISHING CREAM, IP-I,  PCICOLD CREAM AND VANISHING CREAM, IP-I,  PCI
COLD CREAM AND VANISHING CREAM, IP-I, PCI
ssuser555edf
 
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPASunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
ssuser555edf
 
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
 Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F... Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F...
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
aadeshkumar4448
 
Seizure Nursing care plan with journal reference
Seizure Nursing care plan with journal referenceSeizure Nursing care plan with journal reference
Seizure Nursing care plan with journal reference
Google
 
CSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.pptCSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.ppt
vattakandyrahoof8
 
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.pptASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
Rommel Luis III Israel
 

Recently uploaded (20)

Ghaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your Doorstep
Ghaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your DoorstepGhaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your Doorstep
Ghaziabad Call Girls Service | 9711199171 | Housewife Ready 4x7 At Your Doorstep
 
Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...
Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...
Call Girls In Siliguri 👯‍♀️ 7339748667 🔥 Safe Housewife Call Girl Service Hot...
 
VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...
VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...
VIPP Mohali Call Girls Service ✅))7988336991((✅Cash Payment @cALL @gIRL Anjal...
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
 
TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...
TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...
TEST BANK For Bontrager's Textbook of Radiographic Positioning and Related An...
 
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in GoaCall Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
 
6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx
6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx
6.ENDODONTIC DIAGNOSIS AND RECENT MODALITIES.pptx
 
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts AvailableCall Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
Call Girls Kolkata 8824825030 Top Class Kolkata Escorts Available
 
Linga Mudra(Mark of Siva) generates excessive heat within the body
Linga Mudra(Mark of Siva) generates excessive heat within the bodyLinga Mudra(Mark of Siva) generates excessive heat within the body
Linga Mudra(Mark of Siva) generates excessive heat within the body
 
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...Kolkata Call Girls 🔝 7374876321 🔝   Top Escorts Service Experiences With Fore...
Kolkata Call Girls 🔝 7374876321 🔝 Top Escorts Service Experiences With Fore...
 
💋Chandigarh Call Girls !! 740-46^34-175 !!— *Call "*Girls Service chandigar...
💋Chandigarh  Call Girls !! 740-46^34-175 !!—  *Call "*Girls Service chandigar...💋Chandigarh  Call Girls !! 740-46^34-175 !!—  *Call "*Girls Service chandigar...
💋Chandigarh Call Girls !! 740-46^34-175 !!— *Call "*Girls Service chandigar...
 
About CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdfAbout CentiUP - Introduction and Products.pdf
About CentiUP - Introduction and Products.pdf
 
ASSESSMENT OF THE EYE (2)-Health Assessment.pptx
ASSESSMENT OF THE EYE (2)-Health Assessment.pptxASSESSMENT OF THE EYE (2)-Health Assessment.pptx
ASSESSMENT OF THE EYE (2)-Health Assessment.pptx
 
COLD CREAM AND VANISHING CREAM, IP-I, PCI
COLD CREAM AND VANISHING CREAM, IP-I,  PCICOLD CREAM AND VANISHING CREAM, IP-I,  PCI
COLD CREAM AND VANISHING CREAM, IP-I, PCI
 
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPASunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
Sunscreens, IP-I, Dr. M.N.CHISHTI, Asst Prof. Dept of Pharmaceutics, YBCCPA
 
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
 Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F... Bangalore Call Girls 💯Call Us 👉 9024918724 👈  Top Escorts Experiences With F...
Bangalore Call Girls 💯Call Us 👉 9024918724 👈 Top Escorts Experiences With F...
 
Seizure Nursing care plan with journal reference
Seizure Nursing care plan with journal referenceSeizure Nursing care plan with journal reference
Seizure Nursing care plan with journal reference
 
CSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.pptCSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.ppt
 
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.pptASSESSMENT OF THE EYE (1)-Health Assessment.ppt
ASSESSMENT OF THE EYE (1)-Health Assessment.ppt
 

1. Anti hypertensive drugs.pptx what's hypertension

  • 1. Dr. Haji Bahadar Assistant Professor Khyber Medical University-IPMS
  • 2.
  • 3. Major diseases  Hypertension  Coronary heart disease  Congestive heart failure/Heart failure  Angina  Heart Attack
  • 5. Blood pressure is the force exerted by blood against the walls blood vessels. Factors that determine the blood pressure: 1- Cardiac output (CO): Cardiac output is the volume of blood the heart pumps per minute 2- Total peripheral resistance (PR). 3- Elasticity of the aorta and large arteries. 4- Blood volume and circulatory capacity. BP = CO X PR
  • 6.  What is afterload: Afterload is the pressure against which the heart works to eject blood during systole.  What is preload: ??
  • 7. Hypertension is defined as having a blood pressure higher than 140/ 90 mmHg
  • 8.
  • 9.
  • 10.  Baroreceptors are pressure sensors. Their function is to sense pressure changes.  Baroreflex or baroreceptor reflex is a homeostatic mechanisms that helps to maintain blood pressure at nearly normal level.
  • 11.
  • 12.
  • 13.  . The renin-angiotensin system (RAS) plays an integral role in blood pressure regulation
  • 14.  1. Beta adrenergic blockers  2. Diuretics  3. Calcium channel blockers  4. Angiotensin converting enzyme inhibitors  5. Angiotensin receptor blockers  7. Direct arterial vasodilators (self study)  8. Drug used in hypertensive emergency
  • 15.  Beta-blockers are drugs that bind to beta- receptors.  These drugs block the binding of norepinephrine and epinephrine to these receptors.  Beta-blockers are sympatholytic drugs.  β1-receptors are located commonly in the heart and kidneys.  β2- receptors are located mainly in the lungs, gastrointestinal tract, liver, uterus, vascular smooth muscle, and skeletal muscle.  β3- adrenergic receptors are located in fat cells.
  • 16.
  • 17.  Hypertension is associated with an increase cardiac output. Beta-blockers decrease blood pressure by reducing cardiac output. • Hypertension in some patients is caused by emotional stress, which causes enhanced sympathetic activity. Beta-blockers can be very effective in these patients. ↓ HR, ↓ Force of contraction, ↓ Cardiac Output ↓ β 1 mediated renin release from kidney ↓ sympathetic outflow
  • 18. ISA: selective (β1):  Metoprolol  Acebutolol  Esmolol  Atenolol  Bisoprolol  Betaxolol  Non selective (β1 & β2): Without ISA  Propronolol,  Sotalol ,  Timolol With ISA: Pindolol With additional α blocking property: Labetolol Carvedilol
  • 19.  Bradycardia  Hypotension  atrioventicular (AV) nodal conduction block. Beta-blockers are therefore contraindicated in patients with sinus bradycardia and partial AV block
  • 20.
  • 21.  Bronchoconstriction can occur when non-selective beta-blockers are given to asthmatic patients. Therefore, non-selective beta-blockers are contraindicated in patients with asthma or chronic obstructive pulmonary disease.  Bronchoconstriction occurs because sympathetic nerves innervating the bronchioles normally activate β2-adrenoceptors that promote bronchodilation.  Beta-blockers can also mask the tachycardia that serves as a warning sign for insulin-induced hypoglycemia in diabetic patients; therefore, beta- blockers should be used cautiously in diabetics.
  • 22.
  • 23.  Heart: Blockade of beta1-receptors in the sino- atrial node reduces heart rate (negative chronotropic effect) and blockade of beta1- receptors in the myocardium decrease cardiac contractility (negative inotropic effect).
  • 24. Cardiac Effects of beta blockers Decrease contractility (negative intropy) Decrease heart rate (negative chronotropy) Decrease conduction velocity (negative dromotropy)
  • 25.
  • 26.  Kidney: Blockade of beta1-receptors inhibit the release of renin from juxta-glomerular cells and thereby reduce the activity of the renin- angiotensin-aldosterone system.
  • 27.  Renin is a proteolytic enzyme that is released into the circulation by the kidneys. Its release is stimulated by:  sympathetic nerve activation (acting through β1- adrenoceptors)  renal artery hypotension (caused by systemic hypotension or renal artery stenosis)  decreased sodium delivery to the distal tubules of the kidney.
  • 28.  The renin-angiotensin-aldosterone system (RAAS) regulate blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure.  There are three important components to this system: 1) renin, 2) angiotensin, and 3) aldosterone. Renin, which is released primarily by the kidneys, stimulates the formation of angiotensin in blood and tissues, which in turn stimulates the release of aldosterone from the adrenal cortex.
  • 29.
  • 30. Angiotensin2 functions:  Constricts resistance vessels increasing systemic vascular resistance and arterial pressure  Stimulates reabsorption.  increase the release aldosterone, which in turn acts on the kidneys to increase sodium and fluid retention  Stimulates the release of vasopressin (antidiuretic hormone, ADH) from the posterior pituitary, which increases fluid retention by the kidneys  Stimulates thirst centers within the brain  Enhancing sympathetic adrenergic function  Stimulates cardiac hypertrophy and vascular hypertrophy.
  • 31.  Benazepril  Captopril  Enalapril  Fosinopril  Lisinopril  Moexipril  Quinapril  Ramipril
  • 32. ACE inhibitors have the following actions:  Dilate arteries and veins by blocking angiotensin II formation  Down regulate sympathetic activity  Promote renal excretion of sodium and water (natriuretic and diuretic effects) by blocking the effects of angiotensin II in the kidney and by blocking angiotensin II stimulation of aldosterone secretion. This reduces blood volume, venous pressure and arterial pressure.  Inhibit cardiac remodeling associated with chronic hypertension, heart failure, and myocardial infarction. In cardiology, ventricular remodeling (or cardiac remodeling) refers to changes in the size, shape, structure, and function of the heart.
  • 34.  Hypertension  Heart Failure  Diabetic and Nondiabetic Nephropathy .
  • 35.  Dry cough  First-dose hypotension (due to vasodilatation)  Angioedema: it is a serious type of skin reaction that affects the skin layer and also the tissues  Increased blood-potassium level (hyperkalemia)
  • 36.
  • 37.  Patients with bilateral renal artery stenosis may experience renal failure if ACE inhibitors are administered. The reason is that the elevated circulating and intrarenal angiotensin II in this condition constricts the efferent arteriole more than the afferent arteriole within the kidney, which helps to maintain glomerular capillary pressure and filtration. Removing this constriction by blocking circulating and intrarenal angiotensin II formation can cause an abrupt fall in glomerular filtration rate.
  • 38.  Renal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys.
  • 39.  Patients with renal artery stenosis, the kidneys release large amounts of renin.  High angiotensin II serve to maintain glomerular filtration by two mechanisms: elevation of blood pressure and constriction of efferent glomerular arterioles.  When ACE is inhibited, causing angiotensin II levels to fall, the mechanisms that had been supporting glomerular filtration fail, causing urine production to drop
  • 40.  Diuretics. Diuretics may intensify first-dose hypotension. To prevent this interaction, diuretics should be withdrawn 1 week prior to initiating ACE inhibitor treatment  ACE inhibitors increase the risk of hyperkalemia caused by potassium supplements and potassium-sparing diuretics
  • 41.  Candesartan  Irbesartan  Losartan  Olmesartan  Telmisartan  Valsartan  These drugs have very similar effects to angiotensin converting enzyme (ACE) inhibitors and are used for the same indications (hypertension, heart failure, post- myocardial infarction).
  • 42. A diuretic is any substance that promotes diuresis (increased production of urine). DIURETICS Diuretics enhance the removal of sodium and water from body through kidneys. Ginger. ... Parsley. ... Caffeine
  • 43.
  • 44. Types of diuretics Thiazides: Hydrochlorothiazide, Chlorthalidone, indapamide MOA: these drugs Inhibit sodium-chloride transporter in the distal tubule. This transporter normally reabsorbs about 5% of filtered sodium. Loop diuretics: Furosemide (lasix), Torsemide, Bumetanide MOA: Loop diuretics inhibit the sodium-potassium-chloride co-transporter in the thick ascending limb. This transporter normally reabsorbs about 25% of the sodium load. Potassium-sparing diuretics: spironolactone and eplerenone.
  • 46.
  • 47.
  • 48.  Hypertension  Heart failure  Pulmonary and systemic edema
  • 49.  Amlodipine (Norvasc)  Nimodifine (Nimotop)  Felodipine.  Isradipine.  Nicardipine.  Nifedipine (Adalat CC) Extended Release Tablets  Nisoldipine  Verapamil
  • 50.  Calcium channel blockers decrease the amount of calcium entering cardiac and smooth muscle cells by blocking voltage-gated calcium channels.  This causes blood vessels to relax and widen (vasodilate), improves oxygen supply to the heart
  • 51.  Calcium-channel blockers bind to L-type calcium channels located on the vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue (sinoatrial and atrioventricular nodes).  These channels are responsible for regulating the influx of calcium into muscle cells, which in turn stimulates smooth muscle contraction and cardiac myocyte contraction.  In cardiac nodal tissue, L-type calcium channels play an important role in pacemaker currents.  Therefore, by blocking calcium entry into the cell, there is, vasodilation,  Decreased myocardial force generation (negative inotropy), decreased heart rate (negative chronotropy),  Decreased conduction velocity within the heart (negative dromotropy),
  • 52.
  • 53.  Flushing, headache, hypotension, edema and reflex tachycardia
  翻译: