Vasodilators (antihypertensives) and vasoconstrictors (antihypotensive)

Vasodilators (antihypertensives) and vasoconstrictors (antihypotensive

Vasodilators (Antihypertensives)

The drugs that decrease arterial pressure with direct or indirect mechanism of action

                                    Classification

I.              Remedies that decrease the influence of adrenergic enervation upon  cardiovascular system:

A. Remedies decreasing the tonus of vasomotor center (with central action)

-       clonidine

-       methyldopa

-       guanfacine

-       moxonidine

B. Remedies with peripheral action

1.    Ganglioblockers

-       hexamethonium

-       triperium iodide

-       trimetaphan

-       azamethonium

2. Adrenoblockers: (the remedies that inhibit adrenoreceptors)

a)    a adrenoplockers

       1) nonselective                                              2) selective

-       pnentolamine                                    - prasosine

-       tropodiphen                                       - doxasosine

                            b) b adrenoblockers

-       propranolol                       - atenolol

-       metoprolol                        - talynolol

            c) ab adrenoblockers

-       labetolol

3. Sympapholitics:

-       rezerpine

-       guanethidine  (octadine)

II.            Remedies that act on renin-angiotensin system.

      a) inhibitors of angiotensin II  synthesis

-        captopril                    - ramipril           -trandolapril     - kinapril

-       enalapril maleat           -fosinapril        - pirindopril

      b) angiotensin II receptor blockers (AT _1A, AT_2B)

-       saralasin             - telmisartan         - eprosartan

-       losartan               - valsartan            - irbesartan

     c) renin inhibitors (direct mechanism): enalkiren, remikiren

     d) vasopeptidase inhibitors (inhibitors of angiotensinII and endopeptidase)

-       omapatrilat

III.          Remedies with direct action on the vessels muscle (Musculatropic vasodilators )

1.    Remedies that act on the ionic channel

a)    Ca⁺⁺ channels blocker: nifedipine, verapamil, diltiazem, felodipin

b)    K ⁺channels activators: minoxidil, diazoxide

2.    Donators of NO (nitric oxide) group:

-       sodium nitropruside

3.    Various musculotrop drugs:

-       hydralazine

-       bendazol

-       magnesium sulfate

IV.         Remedies that act hydrosaline metabolism (diuretics)

-       frusemide (furosemide)

-       hydrochlorothiaside

-       spironolactone

-       ethacrinic acid

Classification of antihypotensions according to the pathogenic principle:

1.    Remedies increasing cardiac output and tonus of peripheral vessels

              Adrenomimetics (epinephrine and ephedrine)

2.    Remedies increasing peripheral vessels tonus

a)    adrenomimetics (norepinephrine, ethylephrine and phenylephrine)

b)    vasoactive peptides (angiotensinamide, vasopresine)

c)    izothyoureic derivates (izoturon, difetur, profetur)

3.    Remedies increasing the cardiac output

a)    cardiac glycosides

b)    adrenomimetics (doputamine, izoprenaline)

c)    dopamine

d)    glucagons

                4 . Remedies that substitute the blood volume

a)    blood, plasma,

b)    plasma’s substituents

c)    isotonic solutions.

Classification of systemically vasoconstrictors ( Antihypotensives)

1.Vasoconstrictors                      2. Remedies increasing the cardiac 

     a) with central action:                         contractility and cardiac output

- niketamide                                  1. cardiac glycosides: Strophanthine

- camphor                                      2. cardiostimulants:

- sulphocamphocaine                    b₁b₂ adrenomimetics izopenaline

- pentetrasol                                  b₁ adrenomimetics: dopamine, doputamine                                                     Vasoactive polypeptides: glucagon  

      psychostimulants: caffeine

                natrio-benzoic caffeine

general tonizants and adaptogenes           3. Remedies increasing the blood volume

  Panax (Ginseng), Bioginseng,                Dextran 70 (polyglucine)       

  Eleuterococcus, Rodiola, Leuzea            Dextran 40

   Pantocrin, Rantarin                                Gelatinol

  b) with peripheral action                         Haemodes

      a and a,b adrenomimetics                   Human albumin

·      epinephrine                                   4. Antihypotensives with mixed action

·      norepinephrine                                  desoxycorticone acetate

·      ephedrine                                          fludrocortizon

·      etylephrine                                    5. antihypotensives with premisive action

·      phenylephrine                                  glucocorticoids

     N-cholinomimetics                                   - hydrocortisone

·      lobeline                                               - prednisone

·      cititone                                                - dexamethasone

     musculotropics

1.alkaloids from Ergot

·      ergotal 

·      ergotamine tartrate

·      dihydroergotamine

2.vasoactive polypeptides

·      angiotensinamide

·      vasopresine

3. izothyoureic derivates

·      izoturon

·      difetur

·      profetur

Classification of vasoconstrictors ( Antihypotensives) according with the duration of action

A. Short action (10-15 minutes)

- epinephrine

- norepinephrine

- dopamine]

-angiotensinamide

They are administrated only intravenous in the hospitals.

B. Medium  action (20-90 minutes)

- adrenomimetics (fenylephrine, izoprenaline)

Way of administration is intravenous (20-40 minutes-)

                      intramuscularly ,subcutaneous (40-90 min)

They are administrated in hospitals and prehospital conditions

 C. Long action (60min.-2, 4 hours)

     Adrenomimetics (ephedrine, etylephrine)

     Izothyoureic derivates (difetur, izoturon)

         Intravenous > 60 min.

        S/c, i/m 2-4 hours

They are administrated in hospitals and prehospital conditions also, during the patients transportation.

Classification of vasoconstrictors ( Antihypotensives) according with the type of action

1. Vasoconstricors with general and systemic action:

     a) with the action on the vessels (arteries and veins) 

- sympaphomimetics (adrenomimetics)

- izothyoureic derivates

    b) arterials vasoconstrictors

- angiotensinamide

  c) veins vasoconstrictors

- dihydroergotamine

- octapresine

- porlisine

2. vasoconstrictors with specific territorial action 

         a) in the carotid zone  

-ergotamine (small doses)

         b) in the splanhnic zone

- vasopresine

3 vasoconstrictors with local action

a) nasal and conjunctive decongestives

                 - naphazoline             - xylomethasoline        - phenylephrine

  - tetrizoline               - ephedrine

b) adrenaline+lidocaine or procaine for producing a long duration of action of local anesthetics