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MEDICATIA ANTIHIPERTENSIVA

MEDICATIA ANTIHIPERTENSIVA. Prof. Dr. Rodica Cinca. HTA?. “LEGEA JUMATATILOR”. TA = DC x RVP. MENIU.  BLOCANTE BLOCANTE ALE CAN. Ca 2+ INHIBITORII SRAA DIURETICE VASODILAT. MUSCULOTROPE INHIBITOARELE SIMPATICULUI PRIN ACTIUNE PERIFERICA

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MEDICATIA ANTIHIPERTENSIVA

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  1. MEDICATIA ANTIHIPERTENSIVA Prof. Dr. Rodica Cinca

  2. HTA?

  3. “LEGEA JUMATATILOR”

  4. TA = DC x RVP

  5. MENIU •  BLOCANTE • BLOCANTE ALE CAN. Ca2+ • INHIBITORII SRAA • DIURETICE • VASODILAT. MUSCULOTROPE • INHIBITOARELE SIMPATICULUI • PRIN ACTIUNE PERIFERICA • VII. INHIBITOARELE SIMPATICULUI • PRIN ACTIUNE CENTRALA • VIII.  BLOCANTE

  6. ANGIOTENSINOGEN RENINA ANGIOTENSINA I EC ANGIOTENSINA II VASOCONSTRICTIE + SECR. DE ARTERIALA ALDOSTERON RETENTIE Na + H2O  VOLEMIA

  7. I. BETA BLOCANTELE • ANTIARITMICA ( automatismul) • ANTIANGINOASA + CORONARODILAT. ( consumul O2, Bd) • ANTIHTA ( DC) • ANTIGLAUCOMATOASA (Timolol, Betaxolol) • ANTIANXIOASA (Propranolol)

  8. BRONHOCONSTRICTIE  FC, TULBURARI DE CONDUCERE AV ISCHEMIE PERIFERICA 4. R. HIPERGLICEMICE 5. REBOUND AB, BPCO Bd severa, BAV gr. II si III SD. RAYNAUD, ARTERIOPATIE CR. OBLITERANTA DZ R.A. C.I.

  9. PROPRANOLOL OXPRENOLOL PINDOLOL NADOLOL TIMOLOL BETAXOLOL ATENOLOL METOPROLOL ACEBUTOLOL TALINOLOL ESMOLOL NESELECTIVE SELECTIVE1+ 2 + 1

  10. II. BLOCANTELE CANALELOR DE Ca2+ • ANTIARITMICA • ANTIANGINOASA • ANTIHTA ( DC, RVP si complianta a. mari) • ANTIATEROGENA

  11. CLASIFICARE: A. DIHIDROPIRIDINELE (tropism ): Gen.I: NIFEDIPIN NICARDIPIN FELODIPIN Gen.II: NIFEDIPINRnoi forme ale gen.I NICARDIPINR NIMODIPIN NISOLDIPIN noi principii active NITRENDIPIN Gen.III: AMLODIPIN LACIDIPIN

  12. B. FENILALCHILAMINELE (tropism ): VERAPAMIL GALOPAMIL FALIPAMIL C. BENZOTIAZEPINELE (tropism + ): DILTIAZEM

  13. III. INHIBITORII SRAA KININOGENANGIOTENSINOGEN kalicreina Renina BRADIKININA Pg ANGIOTENSINA I IEC Peptide inactiveANGIOTENSINA II + m.n.vasc. +centrul CA +setei ALDO vasomotor bulbar VASOCONSTRICTIA a. efer. ↑ VOL. reabs Na TA

  14. A. INHIBITORII ENZIMEI DE CONVERSIE • CAPTOPRIL • ENALAPRIL • LISINOPRIL • PERINDOPRIL • TRANDOLAPRIL

  15. UTILIZARI TERAPEUTICE: • HTA moderata, severa • + DZ • + IC • + IMA REMODELARE • + HVS • la varstnici

  16. EFECTE ADVERSE: • hTA DE PRIMA DOZA • IRn IN STENOZA BILATERALA DE ARTERA RENALA • ↑ K+

  17. B. ANTAGONISTII ANGIOTENSINEI II (SARTANII) • LOSARTAN • VALSARTAN • IRBESARTAN • CANDESARTAN

  18.  HIPERTROFIA si FIBROZA •  HIPERTROFIA si HIPERPLAZIA VASCULARA •  MICROALBUMINURIA

  19. NU!!!: • AFECTEAZA PROFILUL LIPIDIC • HIPERGLICEMIE • REBOUND • TUSE, BRONHOSPASM

  20. IV. DIURETICELE 1. - DE ANSA: - FUROSEMID - BUMETANID - PIRETANID - AC. ETACRINIC 2. – TIAZIDICE: - HIDROCLOROTIAZIDA - CLOPAMIDA - INDAPAMIDA 3. – CE ECONOM. K+: - SPIRONOLACTONA - AMILORID - TRIAMTEREN

  21. 1. DIURETICE DE ANSA

  22. ACTIUNE INTENSA + RAPIDA  inCRIZA HTA, EPA, ICgrava •  FPR  inI.Ren.

  23. EFECTE ADVERSE: •  K+ •  AC. URIC •  GLICEMIA • SURDITATE TRECATOARE • DESHIDRATARE

  24. 2. DIURETICE TIAZIDICE • SEGMENTUL DE DILUTIE AL TCD

  25. ACTIUNE MODERATA  HTA usoara/moderata (la varstnici) IC edeme , hepatice, alergice

  26. EFECTE ADVERSE: •  K+ •  AC. URIC •  GLICEMIA •  Ca+ •  Col

  27. 3. DIURETICE CE ECONOMISESC K+ • TCD si colector • ACTIUNE MODERATA/SLABA  HIPER-ALDO PRIMAR / SEC. IC HIPO K+

  28. EFECTE ADVERSE: •  K+ • IMPOTENTA SEXUALA, HIRSUTISM

  29. ASOCIERI DE DIURETICE IN ICC: FUROSEMID + AMILORID = LOGIREN + SPIRONOLACTONA = ALDALIX IN HTA: HIDRO-CL-TIAZIDA + AMILORID = MODURETIC + TRIAMTEREN = PRESTOL

  30. V. VASODILATATOARE MUSCULOTROPE • ↓ RVP • R. SIMP. => Th REFLEX => +β BLOCANT • RETENTIE H2O, Na+ => +DIURETIC

  31. 1.VASODILATATOARE ORALE HTA MODERATA / SEVERA • HIDRALAZINA R.A.: PALPITATII, ANGINA, LES • MINOXIDIL

  32. 2. VASODILATATOARE INJECTABILE IN URGENTE HTA • DIAZOXID (a.) R.A.:↑ GLICEMIA=> NU IN DZ • NITROPRUSIAT DE Na (a.+ v.) MONITORIZARE FOTOSENSIBILA

  33. VI. INHIBITOARELE SIMPATICULUI PRIN ACTIUNE PERIFERICA HTA USOARA / MODERATA • REZERPINA R.A.: ACTIVAREA ULCERULUI CANCER DE SAN LA FEMEI IRp LA NN

  34. VII.INHIBITOARELE SIMPATICULUI PRIN ACTIUNE CENTRALA • ↓ DC, ↓ FC, ↓ RENINA => ↓ TA 8 ORE • RETENTIE H2O, Na+ => +DIURETIC • SEDATIVE

  35. CLONIDINA (α2 - ADRENERGIC) R.A.: hTA ORTOSTATICA USCACIUNEA GURII SD. RAYNAUD TULB. SEXUALE ↓ PERFORMANTE PSIHOMOTORII REBOUND • METILDOPA →CREIER→SUBSTITUIE DOPA→α-CH3 A / NA ↓ ↓ TONUS MUSC. HTA LA GRAVIDE HTA CU IRC

  36. VIII. α BLOCANTE • FENTOLAMINA– FEOCROMOCITOM Th REFLEXA • PRAZOSIN (α1- SELECTIV) VENODILATATIE RETENTIE H2O, Na+ => + DIURETIC ↓ COL. total + LDL R.A.: hTA ORTOSTATICA FENOMENUL PRIMEI DOZE AGRAVAREA CI

  37. Implicatiile stomatologice ale antihipertensivelor • Criza HTA in cabinet stomatologic necesita tratament de urgenta pentru a preveni complicatiile majore (AVC, EPA, IC); • Pacientii cu HTA trebuie menajati; • Simpaticoliticele centrale: efecte antiHTA + efecte sedative. Atentie stoma!!! - cu alte sedative dau efecte de sumatie (atentie soferi !!!) - pacientii tratati cu simpaticolitice centrale pentru a fi sedati necesita doze mai mici de sedative; - produc xerostomie; - pacientii tratati cu simpaticolitice centrale + AL cu VC => modificare de TA si frecvente cardiace

  38. 4. NU fibre de retractie gingivala impregnate cu adrenalina la pacientii HTA 5. AINS (Aspirina) + IEC (Captopril) => ↓ act. IEC (stoma) (MG) NU AINS + diuretice (Furosemid) =>↓ act. diuretice (stoma) (MG) Acetaminofen + IEC (stoma) (MG) DA

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