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pharmacology
02-12-2005, 01:50 PM
A 78-year-old woman with type 2 diabetes, diabetic nephropathy, and hyperuricemia presents to her physician for a physical examination, which is remarkable for hypertension. Which of the following drugs would be best for the initial treatment of this woman's hypertension?

A. Atenolol
B. Captopril
C. Hydrochlorothiazide
D. Indapamide
E. Minoxidil

Asclepius1
02-14-2005, 11:25 AM
B. Captopril helps protect the kidneys?
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stepanida
02-15-2005, 07:38 PM
captopril

pharmacology
02-21-2005, 10:08 PM
A 78-year-old woman with type 2 diabetes,
diabetic nephropathy, and hyperuricemia presents to her physician for a
physical examination, which is remarkable for hypertension. Which of
the following drugs would be best for the initial treatment of this
woman's hypertension?

A. Atenolol
B. Captopril
C. Hydrochlorothiazide
D. Indapamide
E. Minoxidil


The correct answer is B. The question is essentially asking,
"Which of the following agents would be recommended in a women with
diabetic nephropathy and hyperuricemia?" The angiotensin-converting
enzyme (ACE) inhibitors, such as captopril, are commonly recommended for
the treatment of hypertension in diabetic patients, especially those
with renal complications, since these agents have been shown to delay
the progression of renal disease. Furthermore, these agents are
generally well tolerated.

Atenolol (choice A) is a beta-1 adrenergic antagonist that is
generally not recommended for diabetic patients since it can "block" the
appearance of the normal signs and symptoms of hypoglycemia.


The thiazide diuretics, such as hydrochlorothiazide (choice C)
and indapamide (choice D), are commonly associated with
hyperuricemia. Furthermore, they can precipitate an acute gout attack in
patients with hyperuricemia.


Minoxidil (choice E) is a direct acting vasodilator most
commonly used in the treatment of severe refractive hypertension because
of its profound side effect profile. This agent is rarely used as an
initial treatment agent.


Angiotensin Converting Enzyme (ACE) Inhibitors-






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Many
ACE inhibitors have been developed. Captopril was the first agent
developed and hence is the prototype. Enalapril is a prodrug that is de-esterified
by plasma esterases to enalaprilat. Most of the ACIs are activated in this
fashion.

Benazepril - Metabolized to benazeprilat

Captopril
Enalapril - Metabolized to enalaprilat
Fosinopril - Metabolized to fosinoprilat
Lisinopril
Moexipril- Metabolized to moexiprilat
Quinapril - Metabolized to quinaprilat
Ramipril - Metabolized to ramiprilat
Trandolapril-Metabolized to tandolaprilat
Perindopril - metabolized to perindoprilat












Effects on the Cardiovascular System



ACE inhibitors decrease circulating levels of angiotensin II and
aldosterone.

These agents decrease peripheral vascular resistance.

Despite this fall in peripheral resistance, there is little effect on
heart rate.

Angiotensin II is a stimulus for cardiac remodeling and hypertrophic
growth. ACE inhibitors block this growth response.

ACE inhibitors are effective regardless of the circulating renin levels.

ACE inhibitors also have beneficial effects on elevated serum lipids.

ACE inhibitors are also widely used to treat hypertension.

While there are many ACE-inhibitor products available, their mechanisms of
action are the same. The differences are in the requirement of activation
and/or duration of action and plasma half life.

In addition to ACE there are other enzymes, such as chymase, that can form
angiotensin II. Therefore, ACE inhibitors cannot completely block the
generation and biological activity of angiotensin II.




Side Effects



Persistent cough

Can decrease renal function in certain patients; should not be used in
patients with renal artery stenosis.

Angioedema

Loss of taste



Status in Cardiovascular Medicine



ACE-inhibitors are first line medications in the treatment of heart
failure. Numerous clinical trials have shown that these drugs decrease the
risk of death, improve outcomes and decrease symptoms of patients with heart
failure.

ACE-inhibitors have been shown to be effective in reducing morbidity and
mortality in patients following myocardial infarction.

ACE-inhibitors are also drugs of first choice in the treatment of
hypertension and are especially useful in patients with co-existing heart
failure or post MI.

Asclepius1
05-29-2005, 06:16 PM
If you allow my advice, stop giving richness to multinational enterprises and buy generic drugs, they have exactly the same ingredient as brand names. I found the following Indian pharmacy some months ago, with $10 Worldwide shipping and 30 day money back guarantee. www.generictabs.com (http://www.generictabs.com/)

Health and long life.







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