antihypertensive drugs 2015-16

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CNS Stimulants

Dr. Hiwa K. SaaedPhD Pharmacology & Toxicology2015-16Reference: Lippincott illustrated Reviews of Pharmacology 6th ed. Antihypertensives

Cardiovascular Pharmacology

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Classification for the purpose of RXCategorySystolic Blood PressureDiastolic Blood PressureNormal< 120160>100

Hypertension (BP >140/90 mm Hg) is defined as either a sustained SBP of > 140 mm Hg or a sustained DBP of > 90 mm Hg.)Optimal healthy blood pressure is (150 mm Hg (with SBP >210 mm Hg) in an otherwise healthy person, or a DBP of 130 mm Hg in an individual with preexisting complications, such as encephalopathy, cerebral hemorrhage, left-ventricular failure, or aortic stenosis. The therapeutic goal is to rapidly reduce blood pressure. A.Sodium nitroprusside B. Labetalol C. Fenoldopam D. Nicardipine

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HTN Emergency

A. Sodium nitroprusside is administered IV, is metabolized rapidly (half life of minutes) and requires continuous infusion to maintain its hypotensive action. It is capable of reducing blood pressure in all patients regardless of the cause of hypertension, acting equally on arterial and venous smooth muscle. It can reduce cardiac preload. Adverse effects: hypotension caused by overdose. Nitroprusside metabolism results in cyanide ion production. Although cyanide toxicity is rare, it can be effectively treated with an infusion of sodium thiosulfate to produce thiocyanate, which is less toxic and is eliminated by the kidneys.[Note: Nitroprusside is poisonous if given orally because of its hydrolysis to cyanide.]

HTN EmergencyB. Labetalol is both an (alpha- and a beta-blocker and is given as an IV bolus or infusion. NO reflex tachycardia. The major limitation is a longer half-life, which precludes rapid titration. carries the contraindications of a nonselective beta- blocker. C. Fenoldopam Fenoldopam is a peripheral dopamine-1 receptor agonist that is given as an IV infusion. Unlike other parenteral antihypertensive agents, fenoldopam maintains or increases renal perfusion while it lowers blood pressure, beneficial in patients with renal insufficiency. D. Nicardipine Nicardipine, a calcium channel blocker, can be given as an IV infusion. limitation is a long half-life

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