- Drugs affect|ng b|ood pressure

Ang|otens|n convert|ng enzyme (ACL) |nh|b|tors

Lxamples of ACL lnhlblLors benazeprll (LoLensln) capLoprll (CapoLen) enalaprll (vasoLec) foslnoprll
(Monoprll) lslnoprll (rlnlvll ZesLrll) moexlprll (unlvasc)

AcLlon AngloLensln ll ls a very poLenL chemlcal LhaL causes vasoconsLlcLlon 1he narrowlng of Lhe
vessels lncreases Lhe pressure wlLhln Lhe vessels and cause hyperLenslon AngloLensln ll ls formed
from angloLensln l by Lhe enzyme angloLensln converLlng enzyme (ACL) 1he use of ACL lnhlblLors
lnhlblL Lhe acLlvlLy of Lhe enzyme ACL whlch decreases Lhe producLlon of angloLensln ll hereby
relaxlng Lhe blood vessel and lower down blood pressure

pharmacologIcal aspects of care
A persIstent dry cough Is a common adverse effect belIeved to be assocIated wIth the Increases In
bradykInIn levels produced by ACE InhIbItors. PatIents who experIence thIs cough are often
swItched to angIotensIn receptor antagonIsts.

Ang|otens|n II receptor b|ockers

Lxamples of AngloLensln ll recepLor blockers
AngloLensln ll recepLor blockers (A88s) are medlcaLlons LhaL block Lhe acLlon of angloLensln ll by
prevenLlng angloLensln ll from blndlng Lo Lhe angloLensln ll recepLors As a resulL Lhe blood vessels
dllaLed and blood pressure ls reduced 1he effecLs of A88s are slmllar Lo ACL lnhlblLors buL ACL
lnhlblLors acL by prevenLlng Lhe formaLlon of angloLensln ll raLher Lhan by blocklng Lhe blndlng of
angloLensln ll Lo Lhe blood vessels

Calclum channel blockers
Calclum channel blockers prevenL calclum from enLerlng Lhe cardlac muscle and arLerles 1he enLry
of calclum lnLo Lhese cells causes Lhe hearL Lo conLracL and arLerles Lo narrowCalclum channel
blockers also called calclum anLagonlsLs decrease Lhe conLracLlon of Lhe hearL and dllaLe blood
vessels maklng Lhe hearL Lo pump easler
Some calclum channel blockers have Lhe added beneflL of slowlng Lhe hearL raLe whlch can furLher
reduce blood pressure relleve anglna (as Lhe hearL needs less oxygen) and conLrol an lrregular
hearLbeaL (LreaLlng cerLaln abnormal hearL rhyLhms such as arLerlal flbrlllaLlon)

ulrecL acLlng vasodllaLors
vasodllaLors are medlcaLlons LhaL dllaLe Lhe blood vessels 1hey work dlrecLly on Lhe walls of arLerles
prevenLlng Lhe muscles from LlghLenlng and Lhe walls from narrowlng As a resulL blood flows more
easlly Lhrough Lhe arLerles pumplng of Lhe hearL ls easler and blood pressure ls reduced

CardloLonlc/lnoLroplc

Cardlac glycosldes

-ames uegoxln
Cardlac glycoslde has poslLlve lnoLroplc acLlvlLy characLerlzed by an lncrease ln Lhe force of
myocardlal conLracLlon lL also reduces Lhe conducLlvlLy of Lhe hearL Lhrough Lhe aLrlovenLrlcular (Av)
node lL works by affecLlng cerLaln mlnerals (sodlum and poLasslum) lnslde Lhe cardlac cell 1hls
reduces sLraln on Lhe hearL and helps lL malnLaln a normal sLeady and sLrong hearLbeaL

Class l anLlarrhyLhmlcs Sodlum channel blocker


Class ll anLlarrhyLhmlcs 8eLa blocker

Lxamples of beLa blockers lnclude

* AcebuLolol (SecLral)
* ALenolol (1enormln)
* 8lsoprolol (ZebeLa)
* MeLoprolol
* -adolol (Corgard)
* -eblvolol (8ysLollc)
* ropranolol (lnderal LA)



8eLa blockers also known as beLaadrenerglc blocklng agenLs are drugs LhaL block noreplnephrlne
and eplnephrlne (adrenallne) from blndlng Lo beLa recepLors on nerves8y blocklng Lhe effecL of
noreplnephrlne and eplnephrlne beLa blockers reduce hearL raLe reduce blood pressure by dllaLlng
blood vessels and may consLrlcL alr passages by sLlmulaLlng Lhe muscles LhaL surround Lhe alr
passages Lo conLracL


Class lll anLlarrhyLhmlcs oLasslum channel blocker


Class lv anLlarrhyLhmlcs Calclum channel blocker


- Llpld lowerlng agenLs

8lle acld sequesLranLs
-ames cholesLyramlne (CuesLran) colesLlpol (ColesLld) and colesevelam (Welchol)

8lle acld sequesLranLs are medlcaLlons for lowerlng LuL cholesLerol 8lle acld sequesLranLs blnd blle
aclds ln Lhe lnLesLlne and cause more of Lhe blle aclds Lo be excreLed ln Lhe sLool 1hls reduces Lhe
amounL of blle aclds reLurnlng Lo Lhe llver and forces Lhe llver Lo produce more blle aclds Lo replace
Lhe blle aclds losL ln Lhe sLool ln order Lo produce more blle aclds Lhe llver converLs more
cholesLerol lnLo blle aclds whlch lowers Lhe level of cholesLerol ln Lhe blood

8lle acld sequesLranLs are noL absorbed lnLo Lhe body and Lherefore Lhey do noL have sysLemlc slde
effecLs 1herefore Lhelr mosL common slde effecLs are gasLrolnLesLlnal such as consLlpaLlon
dlarrhea vomlLLlng and bloaLlng Lncourage fluld lnLake and lv lnfuslon ls essenLlal Lo resLore fluld
and elecLrolyLes ln Lhe body

PMC CoA reducLase lnhlblLors (sLaLlns )
-ames rosuvasLaLln (C8LS1C8) lovasLaLln (Mevacor) aLorvasLaLln (LlplLor) pravasLaLln (ravachol)
fluvasLaLln (Lescol) plLavasLaLln (Llvalo) and slmvasLaLln (Zocor)

SLaLlns are a class of drugs LhaL lower Lhe level of cholesLerol ln Lhe blood by reduclng Lhe
producLlon of cholesLerol by Lhe llver SLaLlns block Lhe enzyme ln Lhe llver LhaL ls responslble for
maklng cholesLerol 1hls enzyme ls called hydroxymeLhylgluLarylcoenzyme A reducLase (PMCCoA
reducLase)
CholesLerol conLrlbuLes Lo Lhe developmenL of aLherosclerosls1hese cholesLerolconLalnlng plaques
block Lhe arLerles and reduce blood flow Lo Lhe Llssues LhaL arLerles supply When plaques rupLure a
blood cloL forms and Lhereby furLher blocklng Lhe arLery and reduclng Lhe flow of blood When
blood flow ls reduced sufflclenLly ln Lhe arLerles LhaL supply blood Lo Lhe hearL Lhe resulL ls anglna
or a hearL aLLack
8y reduclng Lhe producLlon of cholesLerol sLaLlns are able Lo slow Lhe formaLlon of new plaques and
occaslonally can reduce Lhe slze of plaques LhaL already exlsL

llbraLes
-ame gemflbrozll (Lopld) and fenoflbraLe (1rlcor)

llbrlc acld derlvaLlves (flbraLes) are a class of medlcaLlons LhaL lower blood Lrlglycerlde levels
llbraLes lower blood Lrlglycerlde levels by reduclng Lhe llver s producLlon of vLuL and by speedlng
up Lhe removal of Lrlglycerldes from Lhe blood llbraLes are also modesLly effecLlve ln lncreaslng
blood PuL cholesLerol levels however flbraLes are noL effecLlve ln lowerlng LuL cholesLerol
llbraLes have also been used alone Lo prevenL hearL aLLacks especlally ln paLlenLs wlLh elevaLed
blood Lrlglycerldes and low PuL cholesLerol levels
llbraLes can lncrease Lhe effecLlveness of blood Lhlnners such as warfarln (Coumadln) when boLh
medlcaLlons are used LogeLher 1hus Lhe dose ofwarfarln should be ad[usLed Lo avold overLhlnnlng
of Lhe blood whlch can lead Lo excesslve bleedlng

- AnLlanglnal agenLs

- urugs affecLlng blood anLlcoagulaLlon