Cardiovascular Drugs

1. ACE inhibitors
2. Angiotensin Receptor blockers
3. Renin inhibitors

Annotations:

• مدرات البول "تعمل على زيادة خروج الماء والملح من الجسم"

1. Carbonic Anhydrase Inhibitors (site1)

   Annotations:

   • *prototype carbonic anhydrase inhibitor.  Mechanism: inhibit carbonic anhydrase in renal proximal tubule cells. -->less  H+ for Na+/H+ exchange -->increased Na+, increased H2O retension (احتباس ) يحبسها عشان تطلع مع البول 
   1. Acetazolamide
   2. Brinzolamide
   3. Dorzolmide
   4. Therapeutic uses
      1. treat chronic open-angle glaucoma
      2. aqueous humor has high [HCO3-]
      3. acute mountain sickness
      4. treatment metabolic alkalosis
      5. epilepsy
      6. mostly used in combination
   5. side effects
      1. increase HCO3-excretion causes metabolic acidosis
      2. drowsiness
      3. K+wasting
      4. nephrolithiasis(renal stone)
      5. CNS depression
      6. paresthesia (تنمل)
      7. fatigue
2. Osmotic Diuretics(site2)

   Annotations:

   • directly renal blocker mechanism: -not reabsorbed -increase Na+ and H2O excretionتسحب ماء اكثر
   1. Mannitol

      Annotations:

      • -non-toxic, freely filtered, non-reabsorbable and non-metabolized -acute renal failure secondary to trauma, CVS disease, surgery or nephrotoxic drugs -short-term treatment of acute glaucoma infused to lower intracranial pressure.
      1. increased extracellular fluid volume
      2. cardiac failure
      3. plumonary edema
      4. hypernatremia
      5. hyperkalemis
      6. headache
      7. nausea
      8. vomiting
   2. Glycerol
   3. Isosorbide
   4. Urea
3. Loop Diuretics (site3)

   Annotations:

   • inhibit 25% of glomerular filtrate
   1. Furosemide
   2. Bumetanide
   3. Torsemide
   4. Ethacrynic acid
   5. Therapeutic uses
      1. edema
      2. cardic renal failure or nephrosis
      3. acute &chronic hyperkalemia
   6. side effects
      1. ototoxicity
      2. hyponatremia
      3. Mg2+ depletion
4. Thiazide Diuretics(site4)

   Annotations:

   • -inhibit Na+and Cl- transporter in distal convoluted tubule. -increased Na+ Cl- excretion. -increased HCO3 excrestion. -increased K+ /Mg2+ excretion. -decrease Ca2+ excretion.
   1. Indapamide
   2. HCTZ,HCT,HZT
   3. Chlorothiazide
   4. Chlorthalidone
   5. Metolazone, Clopamide, Benzthiazide, Xipamide
   6. Therapeutic uses
      1. osteoporosis

         Annotations:

         • cause decrease urine Ca excretion -> hypercalcemia
      2. hypercalciuria

         Annotations:

         • prevent excess Ca2+ excretion to form stones in ducts
      3. nephrogenic diabetes insipidus
      4. treatment of Li+ toxicity
   7. side effects
      1. hyperglycemia

         Annotations:

         • inhibition of insulin release due to K+ depletion
      2. hyperurecaemia
      3. sudden cardic death
      4. hyperlipidemia

         Annotations:

         • rise to total LDL level -risk of stroke.
      5. hypokalaemia

         Annotations:

         • muscle pain and fatigue
5. Potassium Sparing Diuretics(site5)
   1. Aldosterons Antagonis
      1. spironolactone
         1. side effects
            1. gynecomastia
      2. canrenone
      3. eplerenone
      4. Therapeutic uses
         1. primary hyeraldosteronsim
         2. cirrhosis
   2. Direct Acting
      1. pteridines
         1. triamterene
            1. megaloblastic anemia
      2. pyrazinoylguanidines
         1. amiloride
            1. increase in blood urea nitrogen

1. a1-blockers
   1. doxazosin(Caradura)
      1. prazosin(Minipress)
         1. terazosin(hytrin)
            1. Phentolamine (non selective)
               1. side effects
                  1. tachycardia
                  2. GI stimulation
                  3. hypoglycemia
               2. patients with gastric &peptic ulce(X)
                  1. PATIENTS WITH RENAL impairments
   2. LABETALOL(MIXED)
2. beta blockers
3. a2-adrenoceptor agonists

1. قصور القلب التاجي