Drugs Selectivity Uses Mechanism of Action Side effect (toxisty))

-stimulation of alpha2 -bradycardia.

adrenergic receptor in
-drymouth
vasomotor center of brain -sedation.
1-clinodin Centrally acting -Treatment of
steam. -fluid & Na retentio
on , constipation.
2-Guanbenz alpha2 adrenergic essential HTN.
-inhibition of sympathetic -postural hypotensioion.
3-Guanfacine agonist. -management of
activity. -sudden withdrawal al can result in hypertensive crisis, nervousness,
sever HTN or rennin
-predominance of insomnia.
dependent HTN
parasympathetic activity.
Centrally active

decrease SNS bradycardia.

(sympathetic outflow from -dry mouth, edema. a.
vasopressor centers of -unpleasant sedation
ion (vertigo)
(
Metabolite of a- brain steam. -constipation.
methyl NE that -treatment of - a-methyl NE weaker than -postural hypotensio ion.
stimulate essential HTN. NE in certain vascular beds -hemolytic anemia.
ia. -drug fever, liver damage.
4-methyldopa
presynaptic - in hypertension (renal) Idiosyncratic reaction
ion
alpha2 pregnant women , -false-transmitter released -lactation(high prolactin
lactin in plasma)
adrenergic. high rennin, renal instead of NE so less -exterpyramidal sig
igns, nightmares , psychic depression
insufficiency.- vasoconstriction is -sudden withdrawal al can result rebound hypertensive .
produce. -drug & metabolitess interfere with catecholamine's.- Ejaculatory
failure
-unpleasant sedation
ion & lethargy & nightmares dreams.
-exterpyramidal sig
igns.
Adrenergic blocking

-increase tone, moti

otility & secretions of GIT with abdominal cramps,
1-Reserpine -
- Antihypertensive diarrhea & increasee acid secretion.
agent

agent -bradycardia, miosiss, nasal congestion, flushing, orthostatic (postural

hypotension.
postural hypotension
ion ((sever), dizziness, weakness.
2-Guanethidine Moderately sever
- Selective -intestinal crampingg & diarrhea.
3-Guandrel hypertension
-Ejaculatory failure,, edema, nasal congestion.
st
-treatment of -no block of a2 -1 dose produce hypotension.
hyp
alpha1
Adrenergic receptor

1-alpha1 adrenergic

prazosin essential HTN. receptor>>no reflex of - dizziness, weaknes

kness, headache.
receptor blocker -CHF>>decrease
Others (phetolamine tachycardia. -decrease LDL\HDL.DL.
antagonist

on vascular
blockers

& afterload & preload. -block a1 that control - dry mouth, urinary
ary frequency,
fr lethargy, sexual dysfunction.
smooth -improve urine flow
phenoxybenzamine constriction of Bothe -nasal congestion.
muscle>>relaxing in elderly male with
& doxazosin & prostate & ureters. -nightmares.- postuural hypotension.
bl. Ves. benign prostatic
terazosin) -salt &water retenti
tention.
>>lowering BP. hyperplasia.

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drugs selectivity Drug agent Uses Mechanism of action Side effect (toxisty)

B1 blocker -HTN. HTN: -heart failure.

Atenolol - HTN & Antiangina
-HTN in young patient. -action appear after 4 weeks. -rebound phenomenon
Betaxolol Antiangina -in high rennin & HTN -decrease rennin& level of angiotnsion2. (angina,arrhythmia, MI HTN,)
with angina or -decrease NE & sympathetic flow from CNS -exacerbation of asthmatic
acebutolo Antiangina
carioselective

arrythemia. (presynabtic B receptor blocked). symptom.

HF -ischemic heart -cardioprotective &antagonize tachycardia -Hypotension A.V. block in patint
bisoprolol B1 blocker
disease, angina induced by other hypotension drugs. reciving Ca channel blocker.
Very short antiarrhythmtic pectoris. -↓ blood pressure. -detrimental diabetics dut to 2
Esmolol -CHF, migraines. action
acting
-most be withdrawn Heart failure: 1- tachycardia>>signals
-HTN & gradually to avoid -↑catecolamins. hypoglycemia.
metoprolol B1 blocker
antiarrhythmia angina or infraction -upregulation of B-receptors. 2-suppression of glycogenolysis.
- -HTN & -supraventicular & -↓HF.↓ remodeling block catecholamine. -exaggerated & mask hypoglycemic
antiarrhythmia ventricular -prevent of cardiac arrhythmia. action of insulin or oral
Adrenergic receptor blockers

2-beta adrenergic antagonist

-use with arrythemias. -antagnoisem of ventricular wall stress hypoglycemic.

propranolol Non selective
vasodilators r to .-mild & moderate HF. caused by sympathetic overactivity. -↓ hepatic blood flow &produce
prevent reflex of -↓mortility & hosplition non specific enzyme inhibition.
tachycardia. in HF. Antiarrythmia: -elevated triglyceride & decrese
--HTN & -Patient of MI & -↓slop of p4 depolarization slwing heart. HDL-cholestrol.
antiarrhythmia HF>>most take long -↓automaticity. -decrease exercize tolerance>>mild
Pindolol Non selective -Partial agonist (less term treatment. -dealy AV conduction. chronic fatigue.
bradycardia than ↑AV nodal refraction>>help in terminate -sedation
Non cardio selective

other beta blocker) nodal reentrant arrhythmia. -nightmares.

sotalol antiarrhythmtic -contractility diminished. -depression , vivd dreams &
timolol Antiangina impotence.
penbutolol Antiangina Antiangina: -intermittent claudation & cold
carteolol Antiangina --ve chronotropic & inotropic & ↓ aftrload. extremities.
-↓ myocardial O2 consumptionm Carvedilol & labetolol:
- HTN & Antiangina
especially during exersize. Orthostatic HTN due to a1.
Nadolol Non selective Long half life (better
-↓ heart rate, force of myocardial -sexual dysfunction.
patient compliance)
contraction, CO, velocity of contraction. -liver injury by labetelol.
HTN & HF & -HTN with -protect cardiomyocyte from O2 free
Carvedilol B1 & a2 blocker -paresthesias (scalp tingling)
Antiangina pheochromocytoma. radicals formed during ischemic episodes.
-a 1receptor blocked -labetalol metabolite: false positive
B1 & a2 blocker -improve perfusion of subendocardium by for phyochromcytoma.
result vasodilatation. increasing diastolic perfusion time.
& -reductiot of HR by B1.
labetolol HTN & Antiangina
sympatholetic -Labtelol dose't alter
to B2 serum lipids.

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Drugs selectivity Drug agent Uses Mechanism of action Adverse effect

Antiangina & -orally active. Antiarrhythemia: verapamil & Diltiazem:

1-Amilodipin st
-exhibit high 1 pass -slow conduction by AV node &↓ slow of P4 -depression cont. &HF, ↓CO
antihypertensive
metabolism & high protine depolarization & ↓ cardiac contractility. -bradycardia & AV block, cardiac arrest &
Antiangina & binding. -dihydropyridines don't effect the atrioventricular constipation , hypotension, edema,
2-Felodipin
antihypertensive -active after 30 min & have conduction sys. & sinoatrial node at normal indigestion & reflux oseophagitis.
plasma half live of several dose>>don't have direct effect on conduction or -short acting dihydropyridines have
vascular selective

dihydropyridines 3-Nimodipine
Dihdropyridines

Antiangina & hour (24-50hr) automaticity. associated with ↑ sympathetic tone .

(selective to
antihypertensive -exerted as metabolite in
st
-Bioavilability is ↓ because of 1 pass hepatic -long acting safe in treat HTN
cerebral ves)
urine. metabolism.
Antiangina & -↓myocardial O2 -longer half life lives for elderly patints &npatints minor toxicity ( dihydropyridines):
4-Isradipine
antihypertensive consumption by: with hepatic cirrhosis or renal insufficiency. -hypotension, headach, dizziness, edema &
5-Nicardipine Antiangina & 1-↓afterload (aortic flushing due to excessive dilatation.
pressure). Antihypertensive: -aggrevating of myocardial ischemia due to
(coronary ves) antihypertensive
2- verapamil ↓HR & -↓preiphral resistance. reflex tachycardia resulting from
Antiangina & contractility except -interfeare with angiotension2 & a1 mediated hypotension.
6-Nifedipine antihypertensive dihydropyridines which vasoconstriction. st
-short acting should not be used as 1 line to
& antiarrhytmaia have minimal effect -no effect on venues bed>>no effect on preload treat HTN but long acting such as amilodipin
(↓bp,↑HR & COP) >>vent. Filling pressure. appear safe.
-littile or no effect on non vascular smoothe cell
Ca channel blocker

-improve O2 delivary to
diarylaminopropylamine
(arterio-dilator)

ischemic myocardium by (tracheal). -Bepridil :

vasodilators of coronary -T-type regulating Ca influxin pacemaker cells & can prolong AP. & cause torsades de pointes
Antiangina & arterioles & ↓ HR (↑time cell of conduction sys. arrhytmia (drug induced long QT syndrome).
7-Bepridil spent in diastole) -↓CVR & ↑ coronary blood flow.
antihypertensive
-may inhibit platlet - Non- Dihdropyridines inhibt liver enzyme. - verapamil :
aggregation. may ↑ serum digoxin level in digitalized
patient.
Non- Dihdropyridines

Antiangina: -IV administration most contraindicated wih

cardiac selective

-block voltage sensitive Ca channel. beta blocker due to the possibility of AV

-all block L-type Ca channel which are aboundent block or sever depression of ventricular
Benzothiazipines

in cariomyocyte,arteriole smoothe muscle cell, SA function.

Antiangina & nodal tisse & AVnoda tissue.
8-Diltiazem antihypertensive -bepridil block Na & K channel that blocking -Non- Dihdropyridines can worsen cardiac in
& antiarrhytmaia activity in the heart>>prolong cardiac patint with HF.
repolarization. -in patint
-dihydropyridines reflex ↑ in sympathetic tone (
-IV administration for inotropic, chronotropic) due to ↓ arterial pressure,
phenylalkylamins

interrupting can ↑ HR & contractility which may aggravate

Antiangina & supraventricular angina.
9-verapamil antihypertensive arryhtemias. -Non- Dihdropyridines drug have direct –ve
& antiarrhytmaia inotropic, chronotropic & dromotropic effect.

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 drugs Drug agent Treatment of Act on Mechanism of action Uses Take it with Side effect (toxisty)
--decrease Na & Cl
r
reabsorbtion. -mild to moderate hypertension & normal cardia
iac/ -fixed dose with -hypokalemia.
-
-decrease PVR. renal function. potassium sparing & -impaired diabetic
hydrochorothiazide, Distal -
-promote Ca reabsorbtion. other hypertensive control.
hypertension
chlorothaliadone tubule -
-potassium lose in exchange drug. -Hyperuricemia.
-not useful in renal insufficiency (glom filtration
n
THIAZIDE

m
mechanism. -combination with -muscle cramps.
-
-direct arteriolar vasodilators rate less than 40 ml/min). vasodilators drug . -increase LDL\HDL.
aff
affect.
hypertension
and edema -vasodilators diuretic .
Distal
Indapamide caused by
tubule
congestive
heart failure

Edema (fluied retention) associated with heart

-ototoxicity
+ + - failure.
--inhibitors of Na -K -2Cl (furosemise).
Use supplemental
in the s
symporter. - furosemise &
hepatic cirrhosis potassium , ACEIs or
thick -
-decrease circulatory volume. ethacrynic acid block
potassium sparing
Loop diuretic

furosemise & ascending -

-decrease preload & edema. renal excretion of uric
Hypertension diuretic to prevent
ethacrynic limb of -
-increase urinary Ca in useful in renal insufficiency (glom filtration rate acid.
& heart potassium depletion.
acid,Bumetanide,torse the loop co
constant to action of thiazide. less than 40 ml/min ,nephrotic syndrome. -potassium depletion.
failure Use different side of
mide of Henle -
-increase renal blood flow by -hyperglycemia &
diuretic in patient not
(high de
decrease RVR. hypertension hyperlipidemia.
response to oral
ceiling) -
-veno dilators through PG -dehydration.
diuretic
p
pathway. -shorter duration of
cerebral/pulmonary edema where rapid diuresis is
required (IV injection). action.

- to avoid potassium depletion in patint takingg

--Spironolactone antagonize digitalis. Hyperkalemia &
e
effect of aldosteron. -combination with other diuretic to prevent effeect gynecomastia.
Potassium sparing

hypertension of hypokalemia).
amiloride, and
spironolactone & management
Triamterene. of congestive
heart failure. - amiloride& Triamterene Amiloride inhibit smooth muscle response to Hyperkalemia &
d
don't antagonize effect of contraction (effect in trans-membrane & gastrointestinal -
al
aldosteron. interacellular Ca movement). distribances.

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drugs Treatment of Vasodilators of Mechanism of action Uses Take it with Side effect (toxisty)
Hydralazine HTN & HF. dilate resistance 1-direct effects on the vascular Hypertension: used in -headaches, edema ,paresthesias, flushing
(apresoline) vessels (arterial smooth muscle (dilation). conjunction with tachycardia.
dilators) 2- highly specific for arterial 1- arterial HTN a beta-blocker -precipitate angina in patients with coronary artery
vessels greater than viens. 2- acute HTN emergencies. (propranolol) and disease.
3- reduces total periphral 3- secondary HTN . thiazide diuretic -lupus-like syndrome.
resistance and arterial 4- pulmonary HTN to attenuate the
pressure. baroreceptor-
4- increase cardiac work & mediated reflex
Heart failure:
decrease afterload. tachycardia and
5-Indirect cardiac stimulation sodium retention,
(e.g., tachycardia) due to 1- management of chronic respectively.
activation of the baroreceptor heart failure because of
reflex. its ability to reduce
6-salt and water retention due afterloadand thereby
to reflex of stimulation of RAS. enhance stroke volume
and ejection fraction.

minoxidil HTN & HF. dilate resistance Open K channels in smoothe 1- HTN emergencies. used in -Tachycardia, palpitation, angina , edema, fluied
vessels (arterial muscle membrane. 2- treatment of male- conjunction with retention, nausea, vomiting, flushing, headache,
dilators) pattern baldness. a beta-blocker sweating.
and diuretic -hypertrichosis.
diazoxide HTN arterial dilator 1-IV infusion. 1- HTN emergencies>>long Used (hyperstat) -sever Tachycardia, prolonged hypotension, nausea ,
2-activation of ATP sensitive duration of action. infusion pumps vomiting . salt & water retention,
potassium channel. 2- Hypoglycemia. are unavailable. -hyperglycemia due to inhibit insulin release and can
3-hyperpolarization of cause diabetes.
arteriolar smoothe muscle.
4-rapid fall of TPR >>reflex
tachycardia.
fenoldopam HTN Dilation of Agonist at dopamine D1 1- HTN emergencies. Given continous Tachycardia, palpitation, headache.
peripheral receptor. IV infusion -Increase intraorpital pressure so avoided in
arterioles and glaucoma.
naturesis.
Prazosin HTN & HF. Arteriolar & venous. Block of alpha1 adrenergic 1- HYPERTENSION.
receptor. 2- Raynaud's disease.
ACEIs HTN & HF. Arteriolar & venous. Inhibit ACE & decrease AII 1- HTN CHF.
Nitroglycerin CHF & angina venous Produce No increase cGMP. 1- Raynaud's disease
pectoris 2- CHF & angina pectoris
Na HTN & HF. Arteriolar & venous. Produce No increase cGMP. 1- Acute CHF Take with beta- Due to vasodilatation : hypotension , nausea ,
nitroprosside 2- HTN emergency blocker because vomiting , muscle twitching , methemoglobinemia ,
tachycardia of reflex toxicity , arrhethmei

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