Description of Antihypertensive Drugs

Session 28: Description of Antihypertensive Drugs

Total Session Time: 120 minutes

Prerequisites

Learning Tasks

By the end of this session students are expected to be able to:

Resources Needed:

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Objectives

2 10 minutes Presentation Classes of Antihypertensives

Presentation/

3 15 minutes Indications of Antihypertensive Drugs

Buzzing

Presentation/ Contraindications of Antihypertensive Drugs

4 10 minutes

brainstorming

Dose, Dosage and Course of Antihypertensive

5 30 minutes Presentation

Drugs

Presentation/ Side Effects and Adverse Effects of

6 20 minutes

brainstorming Antihypertensive Drugs

Interactions and Precautions of

7 15 minutes Presentation

Antihypertensive Drugs

8 05 minutes Presentation Key Points

9 10 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any question(s) before continuing.

STEP 2: Classes of Antihypertensives (10minutes)

pressure). Antihypertensive therapy seeks to prevent the complications of high blood

pressure, such as stroke and myocardial infarction

o Mild hypertension: Diastolic Blood Pressure range of 90 – 99 mm Hg and Systolic

Blood Pressure range of 140-159mm Hg

o Moderate hypertension: Diastolic Blood Pressure range of 100 – 109 mm Hg and

Systolic Blood Pressure range of 100-180mmHg

o Severe hypertension: Diastolic Blood Pressure range of 110 mm Hg or above and

Systolic Blood Pressure range of 180mm Hg and above

o Malignant hypertension: Severe hypertension associated with retinal exudates,

haemorrhages or papilledema

means. Among the most important and most widely used classes are:

o Thiazide Diuretics

o Loop Diuretics

o Potassium Sparing Diuretics

o Central Adrenergic Inhibotor

o Beta Blockers

o Alpha& Beta blockers

o Angiotensin Converting Enzyme Inhibitors (ACEI)

o Angiotensin II Receptor Agonist (ARB's)

o Calcium Channel Blockers (CCB)

o Direct vasodilators

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STEP 3: Indications of Antihypertensive Drugs (15 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Table 17.1: Indications of various classes of Antihypertensives

Compelling indications Drug class

Angina • ß-blocker or Long acting calcium channel

blocker

Prior or Post-myocardial infarct • ß-blocker and ACE inhibitor

•If s-blocker contraindicated: Long acting

calcium channel blocker eg verapamil

Heart failure • ACE inhibitor and Carvedilol

For volume overload: • Diuretics – Spironolactone Furosemide

Left ventricular hypertrophy (confirmed by ACE inhibitor or ARB

ECG)

Stroke: secondary prevention Hydrochlorothiazide or Indapimide and ACE

inhibitor

Diabetes Mellitus ACE inhibitor or ARB, usually in

combination with diuretic

Chronic kidney disease ACE inhibitor, usually in combination with

diuretic

Isolated systolic hypertension Hydrochlorothiazide or Long acting calcium

channel

blocker

Pregnancy Methyldopa or Hydralazine (Avoid

ACEI/ARB tetratogenic)

Prostatism alpha-blocker

Elderly CCB

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STEP 3: Contraindications of Antihypertensive Drugs (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

o Heart block

o Cardiogenic shock

o Heart failure

pregnancy

insufficiency

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STEP 5: Dose, Dosage and Course of Antihypertensive Drugs (30 minutes)

Table 17.2: Antihypetensives and their corresponding doses

Sn Class Drug Dosage

1 Thiazide Diuretics Bendroflumethiazide 5mg once daily

Hydrochlothiazide 12.5mg once daily

2 Loop Diuretics Furosemide 40mg- 80mg daily

Torasemide 2.5mg-5mg daily

3 Potassium Sparing Spirinolactone 25mg once daily

Diuretics Eplerenone 25mg once daily

4 Central Methylodopa 250mg 12hrly

Adrenergic

Inhibotor

5 Beta Blockers

Non selective Propranolol 80mg 12 hrly

Selective Atenolol 50 – 100mg once daily

Metoprolol 100mg 12hrly

Alpha& Beta

blockers Carvedilol 12.5 -25mg daily

6 ACE Inihibitors Captopril 12.5mg- 25mg 12hrly

Enalapril 5- 20mg daily

Angiotensin II Losartan 50mg-100mg daily

Receptor Agonist

(ARB's)

7 Calcium channel Nifedipine SR 10- 20mg 12hrly

blochers (CCB) Amlodipine 5 – 10mg once daily

8 Direct vasodilators Hydralazine 25mg 12hrrly

STEP 6: Side Effects and Adverse Effects of Antihypertensive Drugs

(20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

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Table 17.3: Classes of Antihypertensives and their Side Effects

Sn Class Side effects

1 Thiazide Diuretics Orthostatic hypotension(upon sitting or standing, the

blood pressure drops, causing dizziness or fainting).

Severe side effects are difficulty urinating, gout, and hives

2 Loop Diuretics Hypokalemia, or low potassium, dry mouth, weakness,

diarrhea and headache

3 Potassium Sparing Include nausea, headache and stomach upset.

Diuretics

4 Central Adrenergic Dizziness • light-headedness • drowsiness • headache •

Inhibotor weakness.

Severe; jaundce, fever, pale stool, dark urine, numbness,

slow palse, chest pain, larger breast than normal

5 Beta Blockers Fatigue, dizziness and weakness

Non selective

Selective

Alpha& Beta blockers

6 ACE Inihibitors Diarrhea, headache and joint pain, fever and chills

Angiotensin II Recepto Severe side effect is trouble breathing or jaundice and

Agonist (ARB's) cough

7 Calcium channel Headache and flushing , tachycardia and palpitation,

blochers swelling of ankles and occasionally hands

8 Direct vasodilators Tachycardia, palpitation, angina. Excessive hypotension ,

headache anorexia, nasal congestion, dizziness, rash,

constipation

STEP 7: Interactions and Precautions of Antihypertensive Drugs

(15minutes)

hyperkalemia

inhibitors

sympathomimetic bronchodilators

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Step 8: Key Points (5minutes).

pressure)

means

STEP 9: Evaluation (10minutes)

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References

Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines &

National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam,

Tanzania government printers.

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill

Education.

Sally S.R, & Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed)

New York, Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook

(2nd ed.). Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: The

Extra Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National

Formulary (59th ed). London, BMJ Group and RPS Publishing.

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