Pharmacology Notes PDF 2022 - Part 1

Pharmacology Colloquium 2 HYPERTENSION Group Agent MOA SE Indication Contraindication Diuretics D: Carbonic anhydrase inhibi- Acetazolamide EC: NaCl ↓, NaHC...

Pharmacology Colloquium 2 HYPERTENSION Group Agent MOA SE Indication Contraindication Diuretics D: Carbonic anhydrase inhibi- Acetazolamide EC: NaCl ↓, NaHCO3 ↓↓↓, Hypokalemia Hypertension Hypokalemia tors K+↓ Metabolic acidosis Glaucoma Metabolic acidosis Inhibits carbonic anhydrase Congestive heart failure Renal insufficiency enzyme Pregnancy Bicarbonate gets retained in lumen Reduction in proximal tubule Na+ reabsorption D: Loop Diuretics Furosemide EC: NaCL ↓↓↓↓, K+ ↓, Ca2+ Hypovolemia Hypertension Anuria ↓↓↓ Hyperuricemia Liver cirrhosis Hypokalemia Greatest diuretic effect Torsemide In ascending loop of henle Hypokalemia Congestive heart failure Hypocalcemia Inhibit Na+ K+ cotransporter Hypocalcemia Renal disease Hepatic coma Greatest diuretic effect Pregnancy Remove water so reduce peri- pheral resistance (SVR) D: Thiazides Hydrochlorothiazide EC: Na+ ↓, Mg2+ ↓, K+ ↓, NaCl Hypokalemia Hypertension Gout ↓, Ca2+ ↑↑ Hyperuricemia Heart failure Diabetes Most common Indapamide Early part of distal tubule Hypercalcemia Diabetes insipidus Hyperlipidemia NaCl excretion by inhibiting Hyperlipidemia Hypokalemia Weak diuresis Chlorothiazide NaCl cotransporter Photosensitivity Pregnancy Vasodilation so reduced SVR Erectile dysfunction D: K+ sparring Agents Amiloride EC: K+ ↑↑, NaCl ↓, NaHCO3 ↓ Hyperkalemia Congestive HF Anuria Spironolactone In collecting tubule Metabolic acidosis Liver failure Renal insufficiency Mostly used in combination Inhibit Na+ reabsorption and GI upset To prevent hypokalemia Hyperkalemia with other diuretic K+ excretion In Spiro: Gynecomastia Pregnancy Amiloride: block Na+ channel Menstrual irregularities Weak Spironolactone: Antagonise Aldosterone Ca2+ channel blockers Dihydropyridines Amlodipine Inhibit L-Type Ca2+ channels Peripheral edema Hypertension HF Felodipine in vascular smooth muscle = Gum swell Angina pectoris Hypotension SVR - Headache Dizzy Flushing 16 of 65 Non-Dihydropyridines Verapamil Non selective Bradycardia Hypertension 2/3 AV Block Diltiazem Inhibit L-Type Ca2+ channels Arrhythmia Arrhythmia HF in vascular smooth muscle AV block Stable angina Hypotension and heart (AV/ SA node) Verapamil: Constipation ß blocker Contractility ↓ HR ↓, conduction ↓ Antiarrhythmics RAAS Inhibitors ACE inhibitors Perindopril Inhibit ACE Dry cough (because of brady- Hypertension Pregnancy Lisinopril No ANG2 production kinin) HF Hyperkalemia Captopril Bradykinin ↑: Dilation SVR ↓ Hyperkalemia Ramipril (ACE is killing Bradykinin) Angioedema Renal blood flow ↑ so less renal injury ARBs Telmisartan Block AT1 receptor so no Al- Hyperkalemia Hypertension Hyperkalemia (Angiotensin receptor blockers) Losartan dosterone release Leg swelling Congestive HF Pregnancy Candesartan SVR ↓ Dizzy Diabetic nephropathy ANG2 ↑ Headache Less ANG1 than in ACE inhibi- tors No bradykinin impact Renal blood flow ↑ so less renal injury 17 of 65 ANTIPLATELET Group Agent MOA SE Indication Contraindication TxA2 inhibitor Aspirin Irreversible inhibition of Cox 1 Bleeding Antiplatelet Stomach ulcers and Cox 2 Chest pain Fever Asthma Disrupt platelet regulation Pain Allergy Antidote: Children