1. Anti Hypertensive

2. Anti Hypertensive Types of HTN: Alternate HTN. Mild HTN (DBP 91 -104 MMHg). Moderate HTN (DBP 105 -114 MMHg). Severe HTN (DBP < 115 MMHg without End organ damage). Malignant HTN (DBP < 115 MMHg with end organ damage). Systolic HTN (syst BP < 160MMHg(

3. ANTI HYPERTENSIVE THERAPY Diuretics:- 4 major groups • Carbonic anhydrase inhibitors (prox. Tubules) 2. Loop Diuretics Dose • Bumetanide (Bumex) 0.5 – 5 mg • Ethacrynic acid (Edecrin) 25 – 100 mg • Furosemide (Lasix) 40 – 480 mg

4. 3. Thiazides and Related Sulfonamide Comp. • Chlorothiazide (Diuril) 125 – 500 mg • Cyclothiazide (Anhydron) 0.5 – 2mg • Hydrochlorothiazide (Esidrix) 12.5 – 50 mg • Polythiazide (Renese) 1 – 4 mg • Methylclothiazide (Enduron) 2.5 – 5 mg • Bendroflumethiazide (Naturetin) 2.5 – 5 mg • Benzthiazide (Aquatag) 12.5 – 50 mg • Triclormethiazide (Metahydrin) 1 – 4 mg

5. Sulfonamide Compounds • Chlorthalidone (Hygroton) 12.5 -50 mls • Indapamide (Lozol) 2 – 5 mg • Metolazone (Zaroxolyn) 1 - 10 mg • Quinethazone (Hydromox) 25 – 100 mg 4. Potassium – Sparing Agents • Spironolactone (Aldactone) 25 – 100 mg • Amiloride (Midamor) 5 – 10 mg • Triamterene (Dyrenium) 50 – 100 mg

6. MECHANISMS BY WHICH CHRONIC DIURETIC THERAPY MAY LEAD TO VARIOUS COMPLICATIONS Diuretic therapy Renal reabsorption of Na (and Mg) Hypomagnesemia Hyponatremia Saluresis and dluresis Plasma volume Cardiac output Renal blood flow PRA Postural hypotension GFR Aldosterone Pre-renal Proximal Distal Ca++ Kaliuresis azotemia reabsorption reabsorption uric acid calcium Hypokalemia Hyper – cholesterolemia Hyperuricemia Hypercalcemia Glucose tolerance

7. Dosage and Choice of Agent Mild & Moderate HTN: • With serum creatinine > 2 mg/dL • With serum creatinine < 2 mg/dL

8. Side Effects • Hypolemia • Use small dose of diuretics. • Use moderately long acting (12–18 hours). • Restrict Na+ intake. • Increase dietary K+ intake. • Restrict use of laxative. • Combined Thiazide with K+ sparing agent.

9. Side Effects (cont.) 2. Hyponatremia 3. Hypomagnesemia 4. Hyperuricemia 5. Hypercholesterolemia 6. Hypercalcemia 7. Hyperglycemia 8. Impotence 9. Use of NSAIDs

10. Adrenergic Inhibitors: • Peripheral Inhibitors: • Reserphine • Guanethidine (Ismelin) • Guanadrel (Hylorel) • Bethanidine (Tenathan) • Central Inhibitors: • Methyldopa (Aldomet) • Clonidine (Catapres)

11. * A- Receptor Blockers: • a1- Receptor • Doxazosin ( Cardura) • Prazosin (Minipress) B. a1 and a2- Receptors • Phentolamine (Regitine) • Phenoxybenzamine (Dibenzyline)

12. * B- Receptor Blockers • Acebutolol (Sectral) • Atenolol (Ternomin) • Betaxolol (Kerlone) • Metoprolol (Lopressor) • Nadolol (Corgard) • Penbutolol (Levatol) • Pindolol (Visken) • Propranolol (Inderal)

13. Beta-adrenoceptor blocking drugs Nonselective selective with alpha-blocking activity - + - + Labetalol ISA ISA ISA ISA Bucindolol Carvedilol NadololPindolol Atenolol Acebutolol Propranolol Carteolol Esmolol (Practolol) Timolol Penbutolol Metoprolol Celiprolol Sotalol Alprenolol Bevantolol Tertalolol Oxprenolol Bisoprolol Dilevalol Betaxolol

14. VASODILATORS Direct: • Hydralazine A < V • Minoxidil A < V • Nitroproside A < v • Diazoxide A < V • Nitroglycerin V < A • Calcium Blockers A < V • Converting Enz. Inh. A < V • Alpha Blockers A = V

15. Pharmacological Effects of Ca+ Blockers

16. ACE INHIBITORS • Captopril • Enalipril • Lisinopril • Fosinopril • Ramipril • Quinapril • Benazepril ANGIOTENSION II ANTAGONIST • losartan • Olmesartan

17. DRUGS COMMONLY USED

18. TABLE 29-12 PARENTERAL DRUGS FOR TREATMENT OF HYPERTENSIVE EMERGENCY (IN ORDER OF RAPIDITY OF ACTION)

19. TABLE 29-12 PARENTERAL DRUGS FOR TREATMENT OF HYPERTENSIVE EMERGENCY (IN ORDER RAPIDITY OF ACTION)(Cont.)

20. Table 9 – 35 Adverse Effects of Antihypertensive Agents

21. Table 9 – 35 Adverse Effects of Antihypertensive Agents(Cont.)