Medicatia anti-HTA
description
Transcript of Medicatia anti-HTA
![Page 1: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/1.jpg)
MEDICATIA MEDICATIA
APARATULUI APARATULUI CARDIOVASCULARCARDIOVASCULAR
![Page 2: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/2.jpg)
MEDICATIA APARATULUI MEDICATIA APARATULUI CARDIOVASCULARCARDIOVASCULAR
MEDICATIA HIPERTENSIUNII ARTERIALEMEDICATIA HIPERTENSIUNII ARTERIALE
MEDICATIA DIURETICAMEDICATIA DIURETICA
MEDICATIA CARDIOPATIEI ISCHEMICEMEDICATIA CARDIOPATIEI ISCHEMICE
MEDICATIA INSUFICIENTEI CARDIACEMEDICATIA INSUFICIENTEI CARDIACE
MEDICATIA TULBURARILOR DE RITM SI DE MEDICATIA TULBURARILOR DE RITM SI DE CONDUCERECONDUCERE
![Page 3: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/3.jpg)
MEDICATIA MEDICATIA HIPERTENSIUNII HIPERTENSIUNII
ARTERIALEARTERIALE
![Page 4: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/4.jpg)
MEDICATIA HIPERTENSIUNII MEDICATIA HIPERTENSIUNII ARTERIALEARTERIALE
Etiologia hipertensiunii arterialeEtiologia hipertensiunii arteriale
Hipertensiunea arteriala (HTA) este Hipertensiunea arteriala (HTA) este o afectiune plurifactoriala.o afectiune plurifactoriala.
HTA esentiala (HTA esentiala (>> 80-90% din cazuri) 80-90% din cazuri)
HTA secundara: boli renale, HTA secundara: boli renale, endocrine, etc.endocrine, etc.
![Page 5: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/5.jpg)
Etiologia HTAEtiologia HTA
![Page 6: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/6.jpg)
MEDICATIA HIPERTENSIUNII MEDICATIA HIPERTENSIUNII ARTERIALEARTERIALE
Patogenia HTAPatogenia HTA
cresterea rezistentei vasculare cresterea rezistentei vasculare perifericeperiferice - cel mai important factor - cel mai important factor
cresterea volemiei ca urmare a cresterea volemiei ca urmare a retentiei hidrosalineretentiei hidrosaline
cresterea fortei de contractie a cresterea fortei de contractie a inimii.inimii.
![Page 7: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/7.jpg)
CLASIFICAREA CLASIFICAREA HIPERTENSIUNII ARTERIELEHIPERTENSIUNII ARTERIELE
![Page 8: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/8.jpg)
Diagnostic HTADiagnostic HTA
3 determinări la 3 determinări la interval de o interval de o săptămână săptămână
valorile TA valorile TA >> normalul normalul
![Page 9: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/9.jpg)
Examinarea pacientului Examinarea pacientului hipertensivhipertensiv
![Page 10: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/10.jpg)
ComplicatiComplicatiile HTAile HTA
![Page 11: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/11.jpg)
Evaluarea Evaluarea riscului de riscului de boala boala cardiovasculcardiovasculara fatalaara fatala
![Page 12: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/12.jpg)
Clase terapeutice folosite Clase terapeutice folosite in tratamentul HTAin tratamentul HTA
1.1. Medicamente simpatoliticeMedicamente simpatolitice
2.2. Medicamente vasodilatatoareMedicamente vasodilatatoare
3.3. Medicamente blocante ale canalelor de calciuMedicamente blocante ale canalelor de calciu
4.4. Medicamente inhibitoare ale enzimei de Medicamente inhibitoare ale enzimei de conversieconversie
5.5. Medicamente Medicamente blocante blocante ale receptorilor de ale receptorilor de angiotensina II (sartani)angiotensina II (sartani)
6.6. Medicamente diureticeMedicamente diuretice
![Page 13: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/13.jpg)
1. Simpatoliticele1. Simpatoliticelea. Simpatolitice centralea. Simpatolitice centrale
aalfametildopalfametildopa clonidina, gclonidina, guuanfacinaanfacina, moxonidina, moxonidina
bb. Simpatolitice la nivelul terminatiilor . Simpatolitice la nivelul terminatiilor nervoase presinapticenervoase presinaptice
rezerpinarezerpina, , guanetidina guanetidina,, guanadrel guanadrel
cc. Blocante ale receptorilor alfa . Blocante ale receptorilor alfa (alfablocante(alfablocante))
ffentolaminaentolamina, f, fenoxibenzaminaenoxibenzamina pprraazosinzosin, t, terazosinerazosin, , doxozosindoxozosin
![Page 14: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/14.jpg)
1. Simpatoliticele1. Simpatoliticele
dd. Blocante ale receptorilor beta . Blocante ale receptorilor beta (betablocante(betablocante - BB - BB))
propproprranololanolol, , pindololpindolol bisoprolol, nebivolol, bisoprolol, nebivolol, metmetooprololprolol aatenololtenolol, , betaxololbetaxolol aacebutalolcebutalol, , nadolol nadolol,, oxprenolol oxprenolol
ee. Blocante ale receptorilor alfa si . Blocante ale receptorilor alfa si beta (blocanti adrenergici mixti - alfa beta (blocanti adrenergici mixti - alfa si beta)si beta)
labetolollabetolol, , carvedilol carvedilol
![Page 15: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/15.jpg)
2. Vasodilatatoarele
a. vasodilatatoare arteriale hidralazina minoxidilul diazoxidul fenoldopam
b. vasodilatatoare mixte arteriale si venoase
nitropursiatul de sodiu
![Page 16: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/16.jpg)
3. Blocantele canalelor de 3. Blocantele canalelor de calciu calciu (BCC) (BCC)
nifedipina (Adalat)nifedipina (Adalat) amlodipina (Norvasc)amlodipina (Norvasc) felodipina (Plendil)felodipina (Plendil) nimodipina, nicnimodipina, nicaardipinardipina lecarnidipina (Leridip)lecarnidipina (Leridip) diltiazem (Cardil, Diacordin, diltiazem (Cardil, Diacordin,
Dilzem)Dilzem) verapamil (Izoptin)verapamil (Izoptin)
![Page 17: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/17.jpg)
4. Inhibitorii enzimei de conversie (IEC)
Captopril (Tensiomin)Captopril (Tensiomin) Enalapril (Enap, Renitec)Enalapril (Enap, Renitec) Perindopril (Prestarium)Perindopril (Prestarium) Fosinopril (Monopril)Fosinopril (Monopril) Lisinopril (Listril)Lisinopril (Listril) Quinapril (Accupro)Quinapril (Accupro) Ramipril (Tritace)Ramipril (Tritace) TTranrandolapril (Gopten)dolapril (Gopten) Zofenopril (Zomen)Zofenopril (Zomen)
![Page 18: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/18.jpg)
5. Sartanii = blocantele receptorilor de angiotensina II
(BRA)(BRA)
Losartan (Cozaar)Losartan (Cozaar) Valsartan (Diovan)Valsartan (Diovan) Irbesartan (Aprovel)Irbesartan (Aprovel) Telmisartan (Micardis, Telmisartan (Micardis,
Pritor)Pritor) CaCanndesartandesartan (Atacand) (Atacand)
![Page 19: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/19.jpg)
6. Diureticele
diuretice tiazidicediuretice tiazidice hidroclortiazidhidroclortiazidaa (Nefrix) (Nefrix) ciclopentiazida (Navidrex)ciclopentiazida (Navidrex) clortalidona (Hygroton)clortalidona (Hygroton) clortiazida (Salvric)clortiazida (Salvric) ± indapamida± indapamida
diuretice de ansadiuretice de ansa ffurosemidurosemid acacid etacrinicid etacrinic
diuretice care economisesc potasiudiuretice care economisesc potasiu spironolactona (Aldactona, Verospiron)spironolactona (Aldactona, Verospiron) triamterenul (Dytac)triamterenul (Dytac) amilorid (Midamor)amilorid (Midamor)
![Page 20: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/20.jpg)
CCâând incepe tratamentul nd incepe tratamentul HTA?HTA?
Pacienți fără diabetPacienți fără diabet
– TA sistolică TA sistolică >> 140 mmHg 140 mmHg– TA diastolică TA diastolică >> 90 mmHg 90 mmHg
La pacienții cu diabetLa pacienții cu diabet TA sistolică TA sistolică >> 130 mmHg 130 mmHg TA diastolică TA diastolică >> 80 mmHg 80 mmHg
![Page 21: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/21.jpg)
Tratamentul in trepte al Tratamentul in trepte al HTAHTA
![Page 22: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/22.jpg)
Asocieri Asocieri de medicamente antiHTAde medicamente antiHTA
![Page 23: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/23.jpg)
Simpatolitice Simpatolitice antihipertensiveantihipertensive
![Page 24: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/24.jpg)
Medicamente simpatoliticeMedicamente simpatolitice
InIntervin la mai multe nivele ale sistemului nervos tervin la mai multe nivele ale sistemului nervos simpaticsimpatic::
a. centrala. central aalfametildopalfametildopa clonidina, gclonidina, guuanfacinaanfacina, moxonidina, moxonidina
bb. terminatii nervoase presinaptice. terminatii nervoase presinaptice rezerpinarezerpina, , guanetidina guanetidina,, guanadrel guanadrel
cc. receptori alfa (alfa blocante. receptori alfa (alfa blocante)) ffentolaminaentolamina, f, fenoxibenzaminaenoxibenzamina pprraazosinzosin, t, terazosinerazosin, , doxozosindoxozosin
![Page 25: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/25.jpg)
Medicamente simpatoliticeMedicamente simpatolitice
dd. receptori beta (betablocante. receptori beta (betablocante - BB - BB)) propproprranololanolol, , pindololpindolol bisoprolol, nebivolol, bisoprolol, nebivolol, metmetooprololprolol aatenololtenolol, , betaxololbetaxolol aacetobutalolcetobutalol, , nadolol nadolol,, oxprenolol oxprenolol
ee. receptori alfa si beta (blocanti . receptori alfa si beta (blocanti adrenergici mixti- alfa si betaadrenergici mixti- alfa si beta
labetolollabetolol, , carvedilol carvedilol
![Page 26: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/26.jpg)
Antihipertensive simpatolitice Antihipertensive simpatolitice cu actiune centralacu actiune centrala
![Page 27: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/27.jpg)
Antihipertensive simpatolitice cu actiune Antihipertensive simpatolitice cu actiune centralacentrala
ClonidinaClonidina Mecanism de actiune:Mecanism de actiune:
- la nivel central- la nivel central => => stimularestimulare receptorii receptorii alfa2 postsinapticialfa2 postsinaptici si si imidazolici imidazolici I1I1 bulbari bulbari impulsuri impulsuri inhibitoriiinhibitorii la periferie.la periferie.
- la nivel periferic- la nivel periferic => => stimularea stimularea receptorilor alfa2 receptorilor alfa2 presinaptici presinaptici inhibarea eliberarii de NA inhibarea eliberarii de NA scaderea tensiunii arteriale scaderea tensiunii arteriale ( compensata de stimularea rec alfa2 ( compensata de stimularea rec alfa2 postsinaptici care det vc.)postsinaptici care det vc.)
Caracteristici farmacologiceCaracteristici farmacologice
- nu reduce fluxul sanguin renal- nu reduce fluxul sanguin renal
- se absoarbe usor- se absoarbe usor, trece bariera hematoencefalică, trece bariera hematoencefalică IndicatiiIndicatii
- - hipertensiune arteriala medie sau gravahipertensiune arteriala medie sau grava
![Page 28: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/28.jpg)
Antihipertensive simpatolitice cu actiune Antihipertensive simpatolitice cu actiune centralacentrala
ClonidinaClonidina Efecte secundare:Efecte secundare:
- retentie de Na (se asociaza cu un diuretic)- retentie de Na (se asociaza cu un diuretic)
- bradicardie- bradicardie
- scade forta de contractie si debitul cardiac- scade forta de contractie si debitul cardiac Reactii adverseReactii adverse
- usoare- sedare, somnolenta, constipatie, - usoare- sedare, somnolenta, constipatie, uscaciunea gurii uscaciunea gurii
- grave - rebound la intreruperea tratamentului- grave - rebound la intreruperea tratamentului Preparate comerciale:Preparate comerciale: Clonidina, Haemiton. Clonidina, Haemiton. Doze:Doze: 0,1-0,2mg de 2-3 ori pe zi. 0,1-0,2mg de 2-3 ori pe zi.
![Page 29: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/29.jpg)
Clonidina și alfametildopaClonidina și alfametildopa
![Page 30: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/30.jpg)
Antihipertensive simpatolitice cu actiune Antihipertensive simpatolitice cu actiune centralacentrala
AlfametildopaAlfametildopa= = analog DOPA => sinteza de alfametianalog DOPA => sinteza de alfametillnoradrenalinanoradrenalina Mecanism de actiune:Mecanism de actiune:
- stimulare receptori alfa2 centrali (nucleul - stimulare receptori alfa2 centrali (nucleul tractului solitar)tractului solitar)
=> impulsuri inhibitorii la periferie=> impulsuri inhibitorii la periferie
Caracteristici farmacologiceCaracteristici farmacologice- nu scade fluxul sanguin renal- nu scade fluxul sanguin renal- tendinta de retentie sodata- tendinta de retentie sodata- scade debitul cardiac- scade debitul cardiac
Indicatii:Indicatii:- forme medii sau grave de hipertensiune - forme medii sau grave de hipertensiune
arterialaarteriala
![Page 31: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/31.jpg)
Antihipertensive simpatolitice cu actiune Antihipertensive simpatolitice cu actiune centralacentrala
AlfametildopaAlfametildopa Reactii adverse:Reactii adverse:
- asemanatoare cu cele ale clonidinei- asemanatoare cu cele ale clonidinei
- nu determina rebound - nu determina rebound
- rar produce hipotensiune ortostatica- rar produce hipotensiune ortostatica
-- anemie hemolitica, febraanemie hemolitica, febra
Preparate:Preparate: Aldomet, Dopegyt cp 250mg Aldomet, Dopegyt cp 250mg
Doze: 1cp x 2-3/ zi.Doze: 1cp x 2-3/ zi.
![Page 32: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/32.jpg)
Antihipertensive simpatolitice cu actiune Antihipertensive simpatolitice cu actiune centralacentrala
MoxonidinaMoxonidina Mecanism de actiune:Mecanism de actiune:
stimuleaza receptorii imidazolici I1 bulbaristimuleaza receptorii imidazolici I1 bulbari=> impulsuri => impulsuri inhibitoriiinhibitorii la periferie => scade tonusul la periferie => scade tonusul simpatic => scade TAsimpatic => scade TA
Caracteristici farmacologiceCaracteristici farmacologice stimuleaza mai putinstimuleaza mai putin receptorii alfa2 receptorii alfa2 postsinapticipostsinaptici
bulbari => mai putine efecte adverse: sedare, bulbari => mai putine efecte adverse: sedare, somnolenta, constipatie,somnolenta, constipatie, uscaciunea guriiuscaciunea gurii
IndicatiiIndicatii – HTA esentiala – HTA esentiala
Contraindicatii:Contraindicatii: blocuri sinoatriale si atrioventriculare, blocuri sinoatriale si atrioventriculare, bradicardie, IC, BICbradicardie, IC, BIC
Preparate: Cynt, Physiotens cp 0,2, 0,3, 0,4Preparate: Cynt, Physiotens cp 0,2, 0,3, 0,4 mg mg Doze:Doze: 0,2mg/zi 0,2mg/zi max 0,6mg/zi. Doza se creste progresiv la 3 max 0,6mg/zi. Doza se creste progresiv la 3
saptaminisaptamini
![Page 33: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/33.jpg)
Antihipertensive Antihipertensive simpatolitice cu actiune simpatolitice cu actiune
centralacentrala
![Page 34: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/34.jpg)
Medicamente simpatoliticeMedicamente simpatolitice
InIntervin la mai multe nivele ale sistemului tervin la mai multe nivele ale sistemului nervos simpaticnervos simpatic::
a. centrala. central aalfametildopalfametildopa clonidina, gclonidina, guuanfacinaanfacina, moxonidina, moxonidina
bb. terminatii nervoase . terminatii nervoase presinapticepresinaptice rezerpinarezerpina, , guanetidina guanetidina,, guanadrel guanadrel
cc. receptori alfa (alfa blocante. receptori alfa (alfa blocante)) ffentolaminaentolamina, f, fenoxibenzaminaenoxibenzamina pprraazosinzosin, t, terazosinerazosin, , doxozosindoxozosin
![Page 35: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/35.jpg)
Antihipertensive simpatolitice cu Antihipertensive simpatolitice cu actiune pe actiune pe terminatiiterminatiilele nervoase nervoase
presinapticepresinaptice
![Page 36: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/36.jpg)
SimpatoliticeSimpatolitice
RezerpinaRezerpina
alcaloid extras din Raalcaloid extras din Rauwuwololffia Serpentinaia Serpentina (iarba (iarba șarpelui)șarpelui)..
Mecanism de actiune:Mecanism de actiune: blocheza captarea NA, DA si 5-HT in veziculele de depozit blocheza captarea NA, DA si 5-HT in veziculele de depozit =>=> creste creste degradarea de MAO degradarea de MAO => scade eiberarea in fanta sinaptica => scade eiberarea in fanta sinaptica => scade stimularea receptori=> scade stimularea receptorillor alfa postsinapticior alfa postsinaptici => => se împiedică vasoconstricția => se împiedică vasoconstricția => vasodilatatie => vasodilatatie => scade scade
TATA Efecte farmacologice:Efecte farmacologice:
hipotensiune arterialahipotensiune arteriala bradicardiebradicardie linistire (actiune tranchilizanta si neurolepticalinistire (actiune tranchilizanta si neuroleptica))
Indicatii:Indicatii: hipertensiune arterialahipertensiune arteriala la administrarea i.v. actiunea este mai rapidala administrarea i.v. actiunea este mai rapida
![Page 37: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/37.jpg)
RezerpinaRezerpina
![Page 38: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/38.jpg)
SimpatoliticeSimpatolitice
RezerpinaRezerpinaReactii adverseReactii adverse::
- sedare, somnolenta- sedare, somnolenta- pirozis si congestie nazala- pirozis si congestie nazala- la doze mari- la doze mari:: tulburari extrapiramidale si tulburari extrapiramidale si
depresiedepresie Contraindicatii:Contraindicatii:
- depresie- depresie- insuficienta cardiaca- insuficienta cardiaca- insuficienta renala severa- insuficienta renala severa- ulcer- ulcer
Prezentare: Hipazin, Neocristepin, HiposerpilPrezentare: Hipazin, Neocristepin, Hiposerpil
![Page 39: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/39.jpg)
SimpatoliticeSimpatolitice
GuanetidinaGuanetidina Mecanism de actiune:Mecanism de actiune:
- blochaza eliberarea noradrenalinei in fanta - blochaza eliberarea noradrenalinei in fanta sinaptica.sinaptica.
Efecte farmacologice:Efecte farmacologice:- scade tensiunea arteriala (are caracter - scade tensiunea arteriala (are caracter
ortostatic)ortostatic)- scade frecventa cardiaca- scade frecventa cardiaca- scade fluxul sanguin renal- scade fluxul sanguin renal
Indicatii:Indicatii:- HTA -- HTA - cazuri severe care nu raspund la alte cazuri severe care nu raspund la alte
tratamentetratamente Reactii adverse:Reactii adverse:
- hipotensiune arteriala ortostatica - hipotensiune arteriala ortostatica colaps colaps- impotenta sexuala la barbati- impotenta sexuala la barbati- retentie salina- retentie salina
![Page 40: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/40.jpg)
GuanetidinaGuanetidina
![Page 41: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/41.jpg)
Medicamente simpatoliticeMedicamente simpatolitice
InIntervin la mai multe nivele ale sistemului nervos tervin la mai multe nivele ale sistemului nervos simpaticsimpatic::
a. centrala. central aalfametildopalfametildopa clonidina, gclonidina, guuanfacinaanfacina, moxonidina, moxonidina
bb. terminatii nervoase presinaptice. terminatii nervoase presinaptice rezerpinarezerpina, , guanetidina guanetidina,, guanadrel guanadrel
cc. receptori alfa (alfa blocante. receptori alfa (alfa blocante)) ffentolaminaentolamina, f, fenoxibenzaminaenoxibenzamina pprraazosinzosin, urapidil, t, urapidil, terazosinerazosin, ,
doxdoxaazosinzosin
![Page 42: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/42.jpg)
Medicamente simpatoliticeMedicamente simpatoliticeInIntervin la mai multe nivele ale sistemului nervos tervin la mai multe nivele ale sistemului nervos
simpaticsimpatic::
dd. receptori beta (betablocante. receptori beta (betablocante - BB - BB)) propproprranololanolol, , pindololpindolol bisoprolol, nebivolol, bisoprolol, nebivolol, metmetooprololprolol aatenololtenolol, , betaxololbetaxolol aacetobutalolcetobutalol, , nadolol nadolol,, oxprenolol oxprenolol
ee. receptori alfa si beta (blocanti . receptori alfa si beta (blocanti adrenergici mixti- alfa si betaadrenergici mixti- alfa si beta
labetolollabetolol, , carvedilol carvedilol
![Page 43: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/43.jpg)
Blocante ale receptorilor Blocante ale receptorilor alfaalfa
![Page 44: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/44.jpg)
Blocante alfa Blocante alfa adrenergiceadrenergice
medicamente antihipertensivemedicamente antihipertensive selective si neselectiveselective si neselective
Blocanti alfa-adrenergici neselectiviBlocanti alfa-adrenergici neselectiviFenoxibenzaminaFenoxibenzamina
Mecanism de actiune:Mecanism de actiune:- se leaga - se leaga covalentcovalent de receptorii de receptorii alfa1 postsinaptici + alfa2 alfa1 postsinaptici + alfa2 presinapticipresinaptici- actiune – 24 ore- actiune – 24 ore
Efecte farmacologice:Efecte farmacologice:- se impiedica vc. produsa de adrenalina => - se impiedica vc. produsa de adrenalina => ↓ rvp => ↓ rvp => tahicardie reflexatahicardie reflexa
IndicatiiIndicatii- HTA secundara feocromocitomului – mai ales - HTA secundara feocromocitomului – mai ales
preoperatorpreoperator
![Page 45: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/45.jpg)
Blocante alfa Blocante alfa adrenergiceadrenergice
![Page 46: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/46.jpg)
Blocante alfa-adrenergice Blocante alfa-adrenergice selectiveselective
Caracteristici generale:Caracteristici generale: Efecte farmacologiceEfecte farmacologice
1.1. scad vc. arteriala si venoasa => scad scad vc. arteriala si venoasa => scad rvp si TArvp si TA
2.2. favorizeaza mictiunea prin reducerea favorizeaza mictiunea prin reducerea tonusului sfincterului vezicii urinaretonusului sfincterului vezicii urinare
3.3. scad agregarea plachetarascad agregarea plachetara
SSunt utilizate in afectiuni unt utilizate in afectiuni vavassculare sau urologiceculare sau urologice
![Page 47: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/47.jpg)
Blocante alfa-adrenergice Blocante alfa-adrenergice selectiveselective
Caracteristici generale:Caracteristici generale:Reactii adverse :Reactii adverse :
la prima doza - hipotensiune arteriala la prima doza - hipotensiune arteriala ortostatica -> soc => primele ortostatica -> soc => primele
doze = mai micidoze = mai mici tahicardie reflexatahicardie reflexa retentie sodata => asociere cu diureticretentie sodata => asociere cu diuretic efect sedativefect sedativ cefalee si congestie nazalacefalee si congestie nazala vertijvertij disfunctie sexualadisfunctie sexuala
![Page 48: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/48.jpg)
Blocante alfa-Blocante alfa-adrenergice selectiveadrenergice selective
Blocanti selectivi alfa1 folositi Blocanti selectivi alfa1 folositi predominantpredominant in in hipertensiunea arterialahipertensiunea arteriala: : prazosin, urapidilprazosin, urapidil
Blocanti selectivi alfa1 folositi Blocanti selectivi alfa1 folositi predominantpredominant in in afectiuni urologiceafectiuni urologice: : alfuzosin, terazosin, doxazosin, alfuzosin, terazosin, doxazosin, tamsulosintamsulosin
![Page 49: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/49.jpg)
SimpatoliticeSimpatolitice Blocante alfa-adrenergice Blocante alfa-adrenergice
selectiveselective
PrazosinPrazosin (Minipress)(Minipress)
Mecanism de actiune Mecanism de actiune - blocant alfa1 selectiv- blocant alfa1 selectiv- are durata de actiune scurta- are durata de actiune scurta
Efecte farmacologice:Efecte farmacologice:- - ↓ rvp si TA ↓ rvp si TA - nu modifica DC, FG si FSR- nu modifica DC, FG si FSR
Indicatii:Indicatii:- hipertensiune arteriala- hipertensiune arteriala- insuficienta cardiaca, pentru reducerea - insuficienta cardiaca, pentru reducerea
postsarciniipostsarcinii- fenomene Raynaud- fenomene Raynaud
![Page 50: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/50.jpg)
SimpatoliticeSimpatolitice
ReactiiReactii
adverse laadverse la
alfablocantealfablocante
![Page 51: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/51.jpg)
Blocante Blocante
betaadrenergicebetaadrenergice
![Page 52: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/52.jpg)
SimpatoliticeSimpatolitice
Blocante beta adrenergiceBlocante beta adrenergiceCaracteristici generale:Caracteristici generale:
pot fi pot fi selective si neselectiveselective si neselective unele beta blocante au unele beta blocante au activitate activitate simpatica intrinsecasimpatica intrinseca
nu determina hipotensiune arteriala nu determina hipotensiune arteriala ortostaticaortostatica
intreruperea brusca a tratamentului intreruperea brusca a tratamentului determina determina efect de reboundefect de rebound
toate medicamentele au toate medicamentele au terminatia terminatia “olol“olol””
![Page 53: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/53.jpg)
SimpatoliticeSimpatolitice
Blocante beta adrenergiceBlocante beta adrenergiceIndicatii generale:Indicatii generale:
afectiuni cardiovasculareafectiuni cardiovasculare : : antiantihipertensivehipertensive antiantiaritmicearitmice antiantiischemiceischemice
glaucomglaucom migrenamigrena hipertensiune portalahipertensiune portala tratamentul simptomatic al tratamentul simptomatic al hipertiroidieihipertiroidiei
tremor esentialtremor esential
![Page 54: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/54.jpg)
Blocante beta Blocante beta adrenergiceadrenergice
Mecanismul de actiune Mecanismul de actiune antihipertensiv:antihipertensiv:
Scaderea fortei de contractie a inimiiScaderea fortei de contractie a inimii
Scaderea secretiei de reninaScaderea secretiei de renina
Inhibare simpatica centrala cu scaderea Inhibare simpatica centrala cu scaderea
consecutiva a tonusului simpatic perifericconsecutiva a tonusului simpatic periferic
![Page 55: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/55.jpg)
Mecanismul de actiune al Mecanismul de actiune al betablocantelorbetablocantelor
![Page 56: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/56.jpg)
Blocante beta Blocante beta adrenergiceadrenergice
Efectele antihipertensive Efectele antihipertensive se instaleaza lentse instaleaza lent
după mai mult dedupă mai mult de o o ssăăptptăămmââna na
![Page 57: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/57.jpg)
Blocante beta Blocante beta adrenergiceadrenergice
Indicate mai ales in urmatoarele Indicate mai ales in urmatoarele cazuri de HTA:cazuri de HTA:
HTA la tineriHTA la tineri HTA in sindr. hiperHTA in sindr. hiperkkinetice – inetice – hipertiroidiehipertiroidie
HTA declansata de stressHTA declansata de stress - - exista exista descarcari de catecolaminedescarcari de catecolamine
HTA cu reninemie cresutaHTA cu reninemie cresuta HTA cu cardiopatie ischemicaHTA cu cardiopatie ischemica HTA cu tulburari de ritmHTA cu tulburari de ritm
![Page 58: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/58.jpg)
SimpatoliticeSimpatoliticePropranololPropranolol
Efecte nedorite Efecte nedorite si contraindicatii:si contraindicatii:
1. bronhoconstrictie1. bronhoconstrictie => contraindicat astm bronsic si => contraindicat astm bronsic si BPOCBPOC
2. rebound2. rebound (crize angina, aritmii) (crize angina, aritmii)
3. tulburari metabolice3. tulburari metabolice => C.I in DZ insulinodependent => C.I in DZ insulinodependent
4. blocuri4. blocuri sinoatriale sau de ramura sinoatriale sau de ramura
5.5. tulburari ale functiei sexuale, sedare, somnolentatulburari ale functiei sexuale, sedare, somnolenta
6. racirea extremitatilor6. racirea extremitatilor - prin predominanta α ce - prin predominanta α ce determina vasoconstrictie => contraindicat in arteriopatia determina vasoconstrictie => contraindicat in arteriopatia obliteranta obliteranta
![Page 59: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/59.jpg)
SimpatoliticeSimpatolitice
Efecte Efecte
nedoritenedorite
lala
propranololpropranolol
![Page 60: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/60.jpg)
SimpatoliticeSimpatolitice
Efecte Efecte
nedoritenedorite
lala
propranololpropranolol
![Page 61: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/61.jpg)
SimpatoliticeSimpatolitice
Efecte adverse la propranololEfecte adverse la propranolol
![Page 62: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/62.jpg)
Efecte Efecte
nedoritenedorite
la la
betablocantbetablocantee
![Page 63: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/63.jpg)
SimpatoliticeSimpatoliticeAntagonistiAntagonisti selectivi β1 selectivi β1
adrenergiciadrenergici
atenolol, metoprolol, atenolol, metoprolol, bisoprolol, nebivololul, bisoprolol, nebivololul, bbetaxololuletaxololul, , acebutalol, esmolol, acebutalol, esmolol,
Caracteristici:Caracteristici:- - medicamente cardioselective (pe receptorii medicamente cardioselective (pe receptorii
beta1)beta1)- la doze mari bronhoconstrictie (pe beta2)- la doze mari bronhoconstrictie (pe beta2)
- difera prin timpul de injumatatire- difera prin timpul de injumatatireMetoprolol - 4 oreMetoprolol - 4 oreAtenolol – Atenolol – 9 9 oreoreBisoprolol – 1Bisoprolol – 111 ore oreBetaxolol – 15 - 20 oreBetaxolol – 15 - 20 ore
![Page 64: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/64.jpg)
SimpatoliticeSimpatolitice
Antagonisti selectivi β1 Antagonisti selectivi β1 adrenergiciadrenergici
Efecte farmacologice:Efecte farmacologice:- inhiba apoptoza miocardica – bisoprololul, - inhiba apoptoza miocardica – bisoprololul,
nebivololul. metoprololul succinat => indicatie - ICCnebivololul. metoprololul succinat => indicatie - ICC- - ↓↓TATA- cresc toleranta la efort in angina pectorala- cresc toleranta la efort in angina pectorala- actiune minima la nivel pulmonar, metabolic - actiune minima la nivel pulmonar, metabolic și și
circulatia perifercacirculatia periferca IndicatiiIndicatii::
- indicatiile propranololului, inclusiv la pacienti - indicatiile propranololului, inclusiv la pacienti care au asociat : care au asociat :
- astm- astm- diabet zaharat - diabet zaharat - arteriopatie- arteriopatie- insuficienta cardiaca (- insuficienta cardiaca (bisoprololul, bisoprololul,
nebivololul. metoprololul succinat)nebivololul. metoprololul succinat)
![Page 65: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/65.jpg)
Blocantele Blocantele betaadrenergicebetaadrenergice
1 – liposolubilitate1 – liposolubilitate 2 – betaselectivitate2 – betaselectivitate 3 – ASI (activitate simpatică intrinsecă)3 – ASI (activitate simpatică intrinsecă) 4 – eliminare (H – hepatică, R – renală)4 – eliminare (H – hepatică, R – renală) 5 – T/2 (timp de înjumătățire)5 – T/2 (timp de înjumătățire)
![Page 66: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/66.jpg)
SimpatoliticeSimpatoliticeBlocanti adrenergici mixti – alfa si betaBlocanti adrenergici mixti – alfa si beta
LabetololLabetolol Mecanism de actiune si efecte farmacologiceMecanism de actiune si efecte farmacologice
- - alfa blocant => vasodilatatie perifericaalfa blocant => vasodilatatie periferica- beta2 blocant + ASI (vasodilatatie periferica)- beta2 blocant + ASI (vasodilatatie periferica)- nu creste rezistenta vasculara periferica- nu creste rezistenta vasculara periferica- blocheaza mai mult receptorii beta decat alfa- blocheaza mai mult receptorii beta decat alfa
Indicatii:Indicatii:- - HTA persoane varstniceHTA persoane varstnice- HTA persoane de culoare- HTA persoane de culoare- HTA din sarcina- HTA din sarcina
Reactii adverse:Reactii adverse:- - hipotensiune arteriala ortostaticahipotensiune arteriala ortostatica- vertij- vertij
![Page 67: Medicatia anti-HTA](https://reader035.fdocuments.net/reader035/viewer/2022081417/55cf9898550346d033988e51/html5/thumbnails/67.jpg)
SimpatoliticeSimpatolitice
Blocanti adrenergici mixti – alfa Blocanti adrenergici mixti – alfa si betasi beta
Carvedilol Carvedilol Indicatii:Indicatii:
iinsuficienta cardiacansuficienta cardiaca HTAHTA cardiopatie ischemicacardiopatie ischemica
DozeDoze in functie de afectiunein functie de afectiune