ANTI-HYPERTENSIVE

ACE INHIBITORS

- ACE inhibitors prevent the conversion of angiotensin 1 to angiotensin 2, a potent

vasoconstrictor. Besides decreasing vasoconstriction and thus reducing peripheral
arterial resistance, inhibiting angiotensin 2 decreases adrenocortical secretion of
aldosterone
- Examples: captopril, enalapril maleate. Trandolapril, Lisinopril

Peripheral Alpha blockers

- decrease peripheral vascular resistance and increase vein capacity produce vasodilation,
thereby lowering BP.
- Examples: doxazosin mesylate, prasozin hydrochloride

Beta blockers

- Beta clockers compete with beta agonists for available beta receptors; individual drugs
differ in their ability to affect beta receptors. Some drugs are nonselective thet block
beta1 receptors in cardiac muscle and beta2 receptors in bronchial and vascular smooth
muscle
- Beta blockers, also known as beta-adrenergic blocking agents, are drugs that block
norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves.
Norepinephrine and epinephrine are produced by nerves throughout the body as well as
by the adrenal gland. They serve as neurotransmitters (chemicals that nerves use to
communicate with one another) that may be active locally where they are produced, or
elsewhere in the body, when they are released into the blood. There are both alpha and
beta receptors in the body. There are three types of beta receptors and they control
several different functions based on their location in the body.
- beta-1 (β1) receptors are located in the heart, eye, and kidneys.
- beta (β2) receptors are found in the lungs, gastrointestinal tract, liver, uterus, blood
vessels, and skeletal muscle.
- beta (β3) receptors are located in fat cells.
Beta blockers primarily block β1 and β2 receptors and thereby the effects of
norepinephrine and epinephrine. By blocking the effects of norepinephrine and
epinephrine, beta blockers reduce heart rate; reduce blood pressure by dilating blood
vessels; and may constrict air passages by stimulating the muscles that surround the air
passages to contract considered an adverse side effect)
- examples: carvedilol, propanolol hydrochloride, metprolol

CALCIUM CHANNEL BLOCKERS

- inhibit calcium influx across the slow channels of myocardial and vascular smooth
muscle cells. By inhibiting calcium flow inti these cells, ccb reduce intrecellular calcium
levels. Thus, in turn dilates coronary artery, peripheral arteries, and arterioles and slows
cardiac conduction.
- Examples: amlodipine besylate, nicardipine hydrochloride, nifedipine
ANGIOTENSIN 2 RECEPTOR AGONIST

- Inhibits vasoconstrictive and aldosterone-secreting action of angiotensin 2 by blocking

angiotensin 2 receptor on the surface of vascular smooth muscle and other tissue cells
- Examples: losartan potassium, valsartan. Telmisartan

CENTRALLY ACTING ALPHA BLOCKERS

- Thought to stimulate alpha 2 receptors and inhibit the central vasomotor centers,
decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature, and
lowering peripheral vascular resistance, bp, hr.
- Ex: clonidine hydrochloride, guanfacine hydrochloride, methyldopa

Diuretics

LAXATIVES

BULK-FORMING

- Absorbs water and expands to increase bulk and moisture content of stools. The
increased bulk encourages peristalsis and bowel movement. As an antidiarrheal, drug
absorbs free fecal water, thereby producing formed stools.
- Bulk laxatives relieve constipation by forming soft, bulky stool, and promoting the
intestinal muscles contraction for easier passage of stools. They are generally considered
the safest one and are of particular value in patients with small hard stools.
Nevertheless, they do not work until after a few days of consumption and patients need
to take plenty of fluids. Examples of bulk laxatives include bran, ispaghula,
methylcellulose, psyllium and sterculia.
- Ex: calcium polycarbophil, psyllium

EMOLLIENT

- Stool softener that reduces surface tension of interfacing liquid contents of the bowel.
This detergent activity promotes incorporation of additional liquids into stools thus
forming a softer mass.
- Stool softeners add moisture to stools, and make them softer and easier to pass out of
the body. They have added value for patients with haemorrhoids or anal fissures, or
those in whom straining is potentially hazardous such as the elderly or those with
existing cardiovascular disease. Docusate is one of the examples.
- Ex: docusate calcium. Docusate sodium

HYPEROSMOLAR

- Osmotic laxatives soften the stools and make the stools bulk by drawing fluid into the
bowel, and facilitate bowel movement for the passage of the softened stools. Examples
 include macrogols, saline laxatives such as magnesium hydroxide, and poorly absorbed
sugars such as lactulose or sorbitol.
- EX: lactulose. Magnesium sulfate, sodium phosphates

STIMULANT

- Increases peristalsis, probably by direct effect on smooth muscle of the intestine, by

irritating the muscle or stimulating the colonic intramural plexus. Promotes fluid
accumulation in colon and small intestine
- Stimulant laxatives speed up the bowel movement by stimulating the contraction of
intestinal muscles. They have a more rapid onset of action (about 6-12 hours) than bulk
laxatives, and are usually given at night to help produce a bowel movement the
following morning. Examples of stimulant laxatives are bisacodyl, senna and sodium
picosulfate.
- Ex: bisacodyl, senna

Common side effects and precautions of Laxatives

Types of Laxatives Common side effects Precautions

1. Bulk laxatives  Bloating and flatulence  Must be taken with plenty of

 Abdominal distension
 Gastro-intestinal obstruction
or impaction
 Hypersensitivity
water, otherwise increase risk of
obstruction
 Should not be taken immediately
before going to bed
 Use with cautions in elderly, or
debilitated patients, or those with
intestinal narrowing or decreased
motility
 Avoid use in patients with
difficulty in swallowing, intestinal
obstruction and faecal impaction

2. Stimulant laxatives  Abdominal cramp  Avoid use in patients with

 Nausea and vomiting intestinal obstruction, acute
 Diarrhoea inflammatory bowel disease and
 Local irritation if suppository severe dehydration
preparation is used
 Tolerance

3. Osmotic laxatives  Abdominal pain  Avoid use in patients with

 Bloating and flatulence intestinal obstruction
  Nausea and vomiting  Avoid use of lactulose in patients
with galactosaemia
 Avoid use of saline laxatives in
patients with renal and hepatic
impairment
 Avoid use of saline laxatives in
patients with heart failure, as
saline laxatives contain sodium
salt
 Avoid use of macrogols in
patients with severe inflammatory
conditions of the intestinal tract
such as Crohn’s disease and
ulcerative colitis

4. Stool softeners  Abdominal cramp  Avoid use in patients with

 Nausea intestinal obstruction
 Skin rash