Organic Chemistry Honors Presentation Chipola Junior College THE TREATMENT OF HIGH BLOOD PRESSURE Organic Chemistry Honors Presentation By: Stacy Brock Chipola Junior College

Taking Medication For High Blood Pressure                                                            Many medications, known as antihypertensives, are available to lower high blood pressure. Some, called diuretics, rid the body of excess fluids and salt (sodium). Others, called beta blockers, reduce the heart rate and the heart's output of blood. Another class of antihypertensives is called sympathetic nerve inhibitors. Sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause the arteries to constrict, raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels. Yet another group of drugs is the vasodilators. These can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). Other classes of drugs used to treat high blood pressure are the angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and the calcium antagonists (calcium channel blockers). The ACE inhibitors interfere with the body's production of angiotensin, a chemical that causes the arteries to constrict, and the angiotensin II receptor blockers block the effects of angiotensin. The calcium antagonists can reduce the heart rate and relax blood vessels. Treating high blood pressure may require lots of time, patience and care by both doctor and patient. It may be annoying to take pills and possibly have side effects, especially if you felt fine before treatment. Don't be discouraged if you must be treated indefinitely. Some people can reduce their drug dosages after achieving normal blood pressure and maintaining it for a year or more. (You usually can't stop treatment entirely.) Enduring the inconvenience of medication is still much better than suffering a stroke or heart attack. Most people who are treated successfully live a long and healthy life. Not everyone with high blood pressure needs to be treated with drugs listed here. Some people may do just as well on other therapy such as reducing weight, eating properly and getting the right amount of exercise. Don't insist that your doctor use a certain drug because you've read or heard about its effect on other people. You can have a serious side effect if you take a "wonder drug" that isn't right for you. Let your doctor decide what drug, if any, to use. If your doctor does recommend medication, remember that people respond very differently to these medications. That's why you might have to go through a trial period to find out which medications work best with the fewest side effects. Your blood pressure is only lowered while you are taking these medications. That's why medication can't be stopped, in most cases, even after blood pressure is lowered. Some treatment must be continued over a lifetime for good results. Here is a checklist for taking your prescriptions. Use this handy chart to keep track of your medications. Here are some drugs used to treat high blood pressure. Your doctor may prescribe others. This listing isn't meant to be all-inclusive. (List is arranged with generic name first and brand name following. These brand names are registered to various companies.) Diuretics chlorthalidone Hygroton furosemide Lasix hydrochlorothiazide Esidrix, Hydrodiuril, Microzide indapamide Lozol metolazone Mykrox, Zaroxolyn Potassium-sparing diuretics amiloride hydrochloride Midamar spironolactone Aldactone triamterene Dyrenium Combination diuretics amiloride hydrochloride + hydrochlorothiazide Moduretic spironolactone + hydrochlorothiazide Aldactazide triamterene + hydrochlorothiazide Dyazide, Maxzide Beta blockers acebutolol Sectral atenolol Tenormin betaxolol Kerlone bisoprolol fumarate Zebeta carteolol hydrochloride Cartrol metoprolol tartrate Lopressor metoprolol succinate Toprol-XL nadolol Corgard penbutolol sulfate Levatol pindolol Visken propranolol hydrochloride Inderal timolol maleate Blocadren ACE inhibitors benazepril hydrochloride Lotensin captopril Capoten enalapril maleate Vasotec fosinopril sodium Monopril lisinopril Prinivel, Zestril moexipril Univasc quinapril hydrochloride Accupril ramipril Altace trandolapril Mavik Angiotensin II receptor blockers candesartan Atacand irbesarten Avapro losartin potassium Cozaar valsartan Diovan Calcium channel blockers amlodipine besylate Norvasc diltiazem hydrochloride Cardizem CD, Cardizem SR, Dilacor XR, Tiazac felodipine Plendil isradipine DynaCirc, DynaCirc CR nicardipine Cardene SR nifedipine Adalat CC, Procardia XL nisoldipine Sular verapamil hydrochloride Calan SR, Covera HS, Isoptin SR, Verelan Alpha blockers doxazosin mesylate Cardura prazosin hydrochloride Minipress terazosin hydrochloride Hytrin Combined alpha and beta blockers carvedilol Coreg labetolol hydrochloride Normodyne, Trandate Central agonists alpha methyldopa Aldomet clonidine hydrochloride Catapres guanabenz acetate Wytensin guanfacine hydrochloride Tenex Peripheral adrenergic inhibitors guanadrel Hylorel guanethidine monosulfate Ismelin reserpine Serpasil Blood vessel dilators hydralazine hydrocholoride Apresoline minoxidil Loniten** **Used in severe cases or when kidney failure is present.                                                                                                            Links on This Site Taking Prescription Medications Medicine Chart Nearly one third of all Americans with high blood pressure don't even know they have it. read more...                                                                                                                     HIGH BLOOD PRESSURE Many people have high blood pressure for years without knowing it. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure or kidney failure. The only way to tell if you have high blood pressure is to have your blood pressure checked. According to recent estimates, one in four U.S. adults has high blood pressure, but because there are no symptoms, nearly one-third of these people don't even know they have it. This is why high blood pressure is often called the "silent killer." Get the facts on high blood pressure and how to live a more heart-healthy life. Find out how you can reduce your risks for heart attack and stroke with proper monitoring by a physician and simple lifestyle changes, even if you have high blood pressure.                              Privacy Statement | Use of Personal Information | Copyright ©2002 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.                                                                                                                                       

TREATMENT OF HIGH BLOOD PRESSURE Many medications, known as antihypertensives, are available to lower high blood pressure. Some, called diuretics, rid the body of excess fluids and salt (sodium). Others, called beta blockers, reduce the heart rate and the heart's output of blood. Another class of antihypertensives is called sympathetic nerve inhibitors. Sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause the arteries to constrict, raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels.

Yet another group of drugs is the vasodilators Yet another group of drugs is the vasodilators. These can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). Other classes of drugs used to treat high blood pressure are the angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and the calcium antagonists (calcium channel blockers). The ACE inhibitors interfere with the body's production of angiotensin, a chemical that causes the arteries to constrict, and the angistensin II receptor blockers block the effects of angiotensin. The calcium antagonists can reduce the heart rate and relax blood vessels.

FIVE MAJOR CLASSES OF MEDICATIONS DIURETICS BETA BLOCKERS ACE INHIBITORS ALPHA AGONISTS CALCIUM CHANNEL BLOCKERS

REPRESENTATIVES OF DIURETICS LASIX (Furosemide) HCTZ (Hydrochlorothiazide)

Chemical Structures of Lasix and HCTZ

How Lasix Works? Lasix, sometimes called a “water pill” is considered a loop diuretic, and is stronger than the thiazide diuretics, but works in a a similar fashion. They affect parts of the kidneys, including the “loop of Henle.” They help lower blood pressure by inhibiting the primary reabsorption of sodium and chlorine not only in the proximal and distal tubules, but also in the “loop of Henle.” This causes fluids to be excreted from the body, which in turn plays a role in lowering blood pressure.

Possible Side Effects of Lasix Hypokalemia Dry Mouth Excessive thirst Weakness Drowsiness Restlessness Muscle pain or cramps Low blood pressure Upset stomach Nausea Vomiting Alter sugar metabolism Decreased frequency of urination or urine volume Abnormal heart rate

How HCTZ Works? Hydrochlorothiazide is another type of “water pill.” It too affects the kidneys. HCTZ affects the distal renal tubular mechanism of electrolyte reabsorption. It increases excretion of sodium and chloride from the body in equivalent amounts. This drug eliminates fluids from the body which lowers blood pressure.

Possible Side Effects of HCTZ Fluid or Electrolyte Imbalance Hypokalemia Dryness of mouth Thirst Weakness Drowsiness Restlessness Seizures Muscle pains Cramps Irregular Heartbeat Nausea Vomiting Confusion

Other Benefits of Diuretics LASIX HCTZ Used to treat Edema Congestive Heart Failure Cirrhosis of the Liver Renal disease Nephrotic Syndrome Used to treat Edema Congestive Heart Failure Hepatic Cirrhosis Corticosteroid Therapy Estrogen Therapy Nephrotic Syndrome Chronic Renal Failure

Representatives of Beta Blockers Zebeta (Bisoprolol Fumarate) Tenormin (Atenolol)

Chemical Structures of Beta Blockers

How Zebeta Works? Zebeta is a Beta-selective (cardioselective) adrenoceptor blocking agent and its main effect is the negative chronotropic effect. It results in a reduction of resting and exercise heart rate. There is a fall in resting and exercise cardiac output with little observed change in stroke volume, and only a small increase in right atrial pressure or pulmonary capillary pressure at rest or during exercise.

Possible Side Effects of Zebeta Impotence Unusual tiredness Weakness Slow Heartbeat Heart Failure Dizziness Breathing Difficulties Hair loss Bronciospasm Confusion Anxiety Constipation Nausea Vomiting Urinary Difficulties Blurred Vision

How Tenormin Works? Tenormin is a Beta-selective (cardioselective) beta receptor blocking agent that reduces resting and exercise heart rate and cardiac output. It also reduces systolic and diastolic blood pressure at rest and on exercise, and also inhibits rapid heart rate. All of these effects help to lower blood pressure.

Possible Side Effects of Tenormin Impotence Unusual Tiredness Slow Heartbeat Heart Failure Swelling of Legs, Ankles, and Feet Dizziness Breathing Difficulties Weakness Bronchiospasm Confusion Anxiety Memory Loss Cold Hands and Feet Constipation Nausea Vomiting Blurred Vision

Other Benefits of Beta-Blockers Tenormin Zebeta Abnormal Heart Rhythms Treats Angina Pectoris Prevention of 2nd Heart Attack Migraines Aids in Alcohol Withdrawal Abnormal Heart Rhythms Treats Angina Pectoris

Representatives of ACE Inhibitors Vasotec (Enalapril Maleate) Zestril (Lisinopril)

Chemical Structures of ACE Inhibitors

How Vasotec Works? Vasotec (Enalapril Maleate) after hydrolysis inhibits angiotensin-converting enzyme in humans. It has beneficial results with lowering blood pressure by primarily suppressing the renin-anigiotensin-aldosterone system. Inhibition of ACE results in decreased plasma angiotensin II, which leads to decreased vasopressor activity, which in turn leads to a decreased blood pressure.

Possible Side Effects of Vasotec Dizziness Fatigue Headache Nausea Chronic Cough Chest tightness Abdominal pain Diarrhea Bronchitis Urinary Tract Infection Weakness Rash

How Zestril Works? Zestril and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure.

Possible Side Effects of Zestril Headache Dizziness Fatigue Nausea Diarrhea Chronic cough Chest pain Low blood pressure Vomiting Upset stomach Breathing difficulties Rash Muscle weakness

Other Benefits of ACE Inhibitors Vasotec Zestril Congestive Heart Failure Kidney protection (diabetes) Post- Heart Attack Victims Heart Failure Diabetic kidney disease Heart Attack treatment when left ventricle has been affected.

Representative of Alpha Agonists Catapres (Clonidine)

Chemical Structure of Alpha Agonists

How Catapres Works? Catapres stimulates the alpha-adrenoreceptors in the brain stem. This action results in reduces sympathetic outflow from the central nervous system and in decreases in peripheral resistance, renal vascular resistance, heart rate, and blood pressure.

Possible Side Effects of Catapres Dry Mouth Drowsiness Dizziness Constipation Sedation Headache Fatigue Appetite loss Swelling/pain in throat glands Nausea Weight gain Vomiting Blood-sugar elevation Breast pain Rapid heartbeat

Other Benefits of Alpha Agonists Used for excess sweating Childhood growth delay Attention-Deficit Hyperactivity Disorder Tourette’s Syndrome Restless leg syndrome Schizophrenic psychosis Migration Ulcerative colitus Difficult menstruation Kidney poisoning Smoking cessation Withdrawal from alcohol Nerve pain

Representatives of Calcium Channel Blockers Cardizem (diltiazem hydrochloride) Procardia (nifedipine)

Chemical Structures of Calcium Channel Blockers

How Cardizem Works? Cardizem works to lower blood pressure by its ability to inhibit the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle.

Possible Side Effects of Cardizem Dizziness Light-headedness Weakness Headache Fluid in the hands, legs, or feet Low blood pressure Fainting Abnormal heart rate Abnormal heart rhythm Heart Failure Nervousness Fatigue Nausea Rash

How Procardia Works? Procardia is a calcium ion influx inhibitor (slow channel blocker or calcium ion antagonist) which inhibits the transmembrane influx or calcium ions into vascular smooth muscle and cardiac muscle. The contractile processes of vascular smooth muscle and cardiac muscle are dependent upon the movement of extracellular calcium ions into these cells through specific channels. This mechanism reduces arterial pressure.

Possible Side Effects of Procardia Swelling of the ankles, feet and legs Dizziness Light-headedness Flushing Nausea Headache Weakness Shakiness Jitteriness Muscle cramps Inflammation Nervousness Mood changes Heart failure Wheezing

Other Benefits of Calcium Channel Blockers Cardizem Angina Pectoris Raynaud’s disease Prevention of second heart attacks Tardive Dyskinesia Procardia Angina Pectoris Prinzmetal’s Angina Migraine Asthma Raynaud’s Disease Gaulbladder and kidney stone attacks

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