Therapeutic Uses

Question 1

Use of ACE inhibitors

Answer 1

1.HNT
2.Acute MI
3. CHF
3.Diabetic nephropathy
4. Scleroderma renal crisis

1. 1st line tx of HNT
   •They not cause electrolyte disturbance, hyperuricemia,alter lipid profile,sexual dysfunction
   • ↓ cardiovascular and cerebrovascular morbidity
   •In diabetes ↓ progressive renal complication
2. Acute mi they started within 24hr short and long term improvement and
   ↓ reinfarction

3•.they are used to all pt. with impaired LV function
• ↓ preload ↓ atrial and pulmonary pressure ↓ congestion —
•reverse or retard ventricular remodelling by ↓ aldosterone

4. •↓ systemic bp and dilate renal afferent arteriole ↓ intraglomerular pressure
   •↓ang2 mediated mesangial cell growth
   •↓microalbuminuria

Question 2

Uses of ARBs

Answer 2

•Also used as 1st line drug in HNT
•Alternative to ace inhibitors in who are tolerant to ace inhibitors
•Do not affect lipid profile
Serum glucose and
heart rate
•Also used in pt. with ccf,mi,diabetic nephropathy ( ↓ renal complication)

Question 3

Use of aliskiren

Answer 3

Inhibit renin
↓ ang1 &2
used in combination with diuretics/ ace inhibitors/ARB

Question 4

Use of diuretics

Answer 4

•Well tolerated by elderly
•Decrease incident of fracture in elder •because retention of ca++
•Synergistic effect with combo with other anti HNT
•Use of k+ sparring prevent hypokalemia

Question 5

Use of CCBs

Answer 5

They not cause electrolyte disturbance, hyperuricemia,alter lipid profile,sexual dysfunction

Nifedipine safe in pregnancy .
I.v. nifedipine used in HNT emergency

Can also used in
diabetic pt. ( Delay renal complication and microalbuminuria)
Asthma pt.
Angina pt.

Question 6

Use of sympatholytic

Answer 6

Centrally acting
•In HNT
•To treat withdrawal symptoms in opioid and alcohol addicts and smoking cessation
•As antidiarrhoeal in diabetic neuropathy
•To reduce postmenopausal hot flushes

Beta#
Useful in
•Young pt. with high renin
•Pt. having angina post
mi ,migraine,psychosomatic disorder
• pt. Recieving vasodilators ( counteract reflex tachycardia)

Alpha#
•Not essential for HNT
•given in special conditions like HNT in pheochromocytoma, clonidine withdrawal , cheese reaction

Question 7

Uses of vasodilators

Answer 7

tx of HNT emergency - diazoxide
- fenoldopam
Tx of HNT crisis - sodium nitroprusside