Download - MEDCHEM - Hypertention PP Presentation
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Hypertension
By Ankur Rathore
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What is Hypertension (HTN)?
High blood Pressure (BP) Systolic pressure > 140 mm Hg Diastolic pressure > 90 mm Hg
Classification of Hypertension Primary Secondary
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Pathophysiology of High BP
Blood pressure – is the force of blood exerted on arteries as it flows through them Classification of BP – Systolic – Diastolic
(mm Hg) (mm Hg) Normal <120 <80 Prehypertension 120-139 80-89 Stage 1 Hypertension 140-159 90-99 Stage 2 Hypertension >160 >100
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Blood Pressure Control Mechanism
Blood Pressure
Depends on:-Cardiac Output
-Contractility-Fluid Volume
-Peripheral vascular resistance
Is affected by:-Nervous system-Kidney function-Hormonal changes-Capillary fluid shift
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Causes of Hypertension
Aging Smoking Obesity High sodium (salt) diet High cholesterol Lack of exercise Drinking Being insulin resistant
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www.foodfacts.info/blog/uploaded_images/mcdon..
www.dailygalaxy.com
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Risk Factors of HTN
Smoking Age
Women older than 65 years of age Men older than 55 years of age
Obesity Diabetes Lack of Physical activity Chronic alcohol consumption Family history of cardiovascular disease Sex – men and postmenopausal women African American 2x more likely than Whites
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Facts About Hypertension
According to American Society of HTN 50 millions of Americans are affected More than 90% of cases have no cause Children who’s parents have HTN will more likely
be affected HTN is called a “SILENT KILER” due to having no
warning signs or symptoms but increases one’s risk of cardiovascular collapse
Due to not being aware of having HTN, only ¼ of people are being treated
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What are the Symptoms?
Prehypertension and Stage 1 HTN Usually none
Stage 2 HTN If occurs rapidly – symptoms of
Hypertensive Crisis Headache (pulsating behind eyes more in the
AM) Visual disturbances Nausea & vomiting
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How is HTN Diagnosed?
Usually by routine doctor’s visit One high BP reading does not mean you
have HTN Repeated BP reading will be done at
different positions Complete physical, medical and family
history will be performed Risk factors identified
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Treatment of HTN
There are following steps in treating HTN
1. Lifestyle modification
2. First line treatment
3. Second line treatment
4. Third line treatment
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Lifestyle Modification
Weight reduction Reduction of sodium intake Decrease of alcohol intake Smoking cessation Increase in physical activity If inadequate, continue to first line
treatment
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First Line Treatment
Continue with lifestyle modification Initial drug selection:
Diuretic Beta-blocker If inadequate, continue to second line
treatment
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Second Line Treatment
Adding drugs from the folloving categories Angiotensine Converting Enzyme (ACE)
Inhibitor Calcium Channel Blocker Angiotensine II Receptor Blocker (ARB) α- blocker, α- and β-blocker If inadequate, continue to third line
treatment
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Third Line Treatment
Increase drug dose, or Substitute another drug, or Add a second drug from another class If inadequate, may need to do further
studies Serious organ damage may be present
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Possible Outcomes of Delayed Treatment of HTN
Stroke Myocardial infarction Congestive heart failure Renal failure
www.nlm.nih.gov
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Hypertension Treatment
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Drugs Used to Treat HTN
Diuretics Furosemide (Lasix); Hydrochlorothizide
(HydroDIURIL) Beta blockers
Atenolol (Tenormin); Propranolol (Inderal) ACE inhibitors
Captopril (Capoten); Enalapril (Vasotec) ARB’s
Irbesartan (Avapro); Losartan (Cozaar) Calcium channel blockers
Amlodipine (Norvasc); Diltiazem (Cardizem)
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Site Of Action of Antihypertensive Drugs
Action of Beta-Blockers Block vasoconstriction Decrease heart rate Decrease cardiac muscle
contraction Tend to increase blood flow to
the kidneys -> leading to a decrease in the release of renin
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What Are Beta-Blockers?
Beta blockers are Beta-adrenergic receptor blockers – they block action of Adrenalin and Noradrenaline (SNS stimulants), which are involved in “Fight-or-flight’ response
There are two types of Beta receptors β1 – found mostly in the heart Β2 – found mostly in the lungs
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Classification of Beta Blockers
β1 receptors blockers Atenolol (Tenormin) Betaxolol (Kerlone) Bisoprolol (Zabeta) Metoprolol (Lopressor, Toprol-XL)
β1, β2 receptor blockers Nadolol (Corgard) Propranolol (Inderal, Inderal LA)
β1, β2, α receptor blockers Labetolol (Normodyne, Trandate)
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Beta Blockers
www.ualberta.ca/~csps/JPPS4(2)/R.Mehvar/Fig2.gif
Commonalities:
-One chiral center-Aromatic ring-Side alkyl chain-Secondary hydroxyl group-Amine
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Discovery of Beta Blockers
Started in 1950’s when “Heart disease had become a serious epidemic”
By Sir James Black, an English physician and a basic scientist who started research in Glasgow Veterinary School laboratory
His goal was to find a drug that would decrease the oxygen demand in the heart
He developed the first Beta-blocker – Propranolol (Inderal) in 1964
It successfully blocked the heart’s adrenaline-responsive beta-receptors
Hence the name “Beta-Blockers” He was awarded the Nobel Prize in 1988 for this and
other discoveries
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Beta Blockers – Side Effects Fatigue Orthostatic hypotension Weakness Blurred vision Stuffy nose Impotence Rash CHF Bradycardia Pulmonary edema
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Treatment of Side Effects
Changing position slowly Sit at the edge of bed or chair for a few
minutes before standing up Drink adequate amount of fluids Contact physician in more serious case
to adjust the dose or change the medication
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How Much the Drug Cost?
Drug Name Dosage of PO drug
Frequency of Use
Monthly
Cost of Generic
Monthly Cost of Brand
Atenolol (Tenormin) 25mg
50mg
2x/day $10
$10
$47
$47
Betaxolol (Kerlone) 10mg 1x/day $30 $41
Bisoprolol (Zabeta) 10mg 1x/day $38 $55
Labetolol (Normodyne) 100mg 2x/day $26 $38
Metoprolol tartrate (Lopressor)
25mg
50mg
1x/day
1x/day
$9
$9
$35
$35
Nadolol (Korgard) 20mg 1x/day $18 $59
Propranolol (Inderal) 20mg
40mg
2x/day
2x/day
$13
$15
$44
$56
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Propranolol
Nursing2007 Drug Handbook
Initial Dose in treating HTN- 80mg PO 2x/day- 80mg extended release form 1x/day
Increase at 3-7 day intervals to max daily dose of 640mg
Maintanance dose -120-240mg daily-120-160mg extended release form
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Propranolol Metabolism
www.ualberta.ca/~csps/JPPS4(2)/R.Mehvar/Fig2.gif
Part of my future research
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Further Research
Development of propranolol from the lead compound
Pharmacokinetics and pharmacodynamics of propranolol in our body
Interview with heart specialists at Atlanta Medical Center about current treatment of HTN
Interview with my family members and clients with HTN – how is their life affected by this condition
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QUESTIONS?
???
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References
Beta Blockers – common dosage guidelines (2008). The clinician’s Ultimate Reference Retrieved March 15, 2008 from http://www.globalrph.com/beta.htm
Karch, A. (2006). Focus on Nursing Pharmacology. (3rd. Ed.). Philadelphia: Lippincott Williams &Wilkins
Pharmacokinetics and Pharmacodynamics Mehvar, R.; Brocks, D. R. (2001). Stereospecific of Beta-Adrenergic Blockers in Humans. J Pharm Pharmaceut Sci 4(2), 185-200. Retrieved march 15, 2008 from http://images.google.com/imgres?imgurl=http://www.ualberta.ca/~csps/JPPS4(2)/R.Mehvar/Fig2.gif&imgrefurl=http://www.ualberta.ca/~csps/JPPS4(2)/R.Mehvar/betablockers.htm&h=629&w=490&sz=9&hl=en&start=7&tbnid=-br7jKXMxHZijM:&tbnh=137&tbnw=107&prev=/images%3Fq%3Dpropranolol%26gbv%3D2%26hl%3Den%26sa%3DG
Popple, I. (2004, October 14). How Beta-Blockers came To Be. McGill Reporter, 37(3), 2004-2005. Retrieved March 15, 2008 from http://www.mcgill.ca/reporter/37/03/black/
Propranolol tablets Retrieved March 15, 2008 from psyweb.com Treating the High Blood Pressure and Heart Disease: Beta-blockers. (2008).
Consumer Reports:Best Buy Drugs Retrieved March 13, 2008 from http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/2pager_BetaBlockers.pdf