Medical Pharmacology

Introduction
Medical pharmacology is the science of chemicals (drug) that
interact with the human body. These interactions are divided into two
classes :
Pharmacodynamics, the effects of the drug on the body.
Pharmacokinetics, the way the body affects the drug wiith time
( absorption, distribution, metabolism, and excretion )

Drugs used in hypertension

High blood pressure is associated with decreased life expectancy and
increased risk of stroke, coronary heart disease and other organ disease.
Therapy is indicated if the diatolic pressure is greater than 100 mmHg and
or the systolic pressure is igreater than 160 mmHg.
In patients with mild hypertension, weight reduction, reduced alcohol
consumption and moderate reduction in salt maybe sufficient, but usually
drug treatment is required.
The drug that used in the treatment of hypertension are :
Thiazide diuretics
The mechanism by which diuretics reduce arterial blood oressure is not
known. Initially the blood pressure falls because of the decrease in blood
volume,

Venous return and cardiac output. The Drug that used are :
-

Furosemide

Hydrochlorothiazide (HCT)

Bendroflumethiazide

Spironolacton

Thiazide diuretics may cause hypokalemia so that the smooth muscle

becomess less responsive. But the spironolacton may not cause
hypokalemia.

-Adrenoreceptor antagonists (-Blokers)

-Blokers Initially produce a fall in blood pressure by decreasing the

cardiac output. With continued treatment, the cardiac output returns
to normal. Drug that used are :
-

Propranolol

Atenolol

Metoprolol

Bisoprolol

Disadvantages of bloskade are the common adverse effect, such us

provocation of asthma, cold hand and fatigue. But at least some of
the side effects can be reduced by using cardio selective hydrophilic
drugs (i.e those without liver metabolism) such us atenolol.

Vasodilator drugs

ACE Inhibitors
Angiotensin II is apowerfull circulating vasoconstrictor anh inhibition of
its syntheis in hypertensive patients results in a fall in peripheal
resistance and lowering in blood pressure. The drug common used
are :

Captopril

Enalapril

Lisinipril

A common unwanted effect of ACE inhibitors is a dry cough that may

caused by increased bradykinin

Angiotensis receptor antagonists

Lowering the blood pressure by blocking Angiotensin 1 receptors. They

similiar properties to the ACE inhibitor but do not cause cough,
perhaps cause they do not prevent bradykinin degradation. The
examples are :
-

Losartan

Candesartan

Valsartan

Calcium-channel blockers (calcium antagonists)

The drug mechanism by blocking the entry of Ca to enter the cell,

and cause relaxation of the arteriolar smooth muscle. This reduces
the peripheral resistance and result in a fall blood pressure. The
drugs common used are :
-

Nifedipine

Amlodipine

Adrenoreceptor antagonists

Adrenoreceptor antagonists cause vasodilatation by selectively

blocking vascular 1 adrenoreceptor. The examples drug are :
-

Prazosin

Doxasozin

These drugs are not likely to cause tachycardia, but they may
cause postural hypotension.
Hydralazin
Hydralazin is used in combination with a blocker and diuretic,
side

effects

include

tachycardia,

which

may

provoke

angina,

headaches and fluid retention.

Minoxidil
Minoxidil is a potent vasodilator that causes severe fluid retention
and oedema. However, when givenwith a blocker and loop diuretic,
it is effective in severe hypertension resistant to other drug
combination.

Acute severe hypertension

In hypertensive crisis, drugs may be given by intravenous infusion
(e.g hydralazine in hypertension associated with eclampsia of
pregnancy;

nitroprusside

wncephalopathy).

in

However,

malignant
intravenous

hypertension
drugs

are

with
rarely

necessary, and the trend is to use oral agent whenever possible

(i.g atenolol, amlodipine).

GOOD LUCK