hydralazine

minoxidil

sodium nitroprusside

• stroke
• cardiac failure
• renal insufficiency
• MI
• sudden cardiac death

• bp = CO x TPR
  • decrease TPR
    • relaxation of resistance vessels (arterioles)
    • decrease symp. activity
• CO = HR x SV
  • decrease SV
    • SV proportional to contractility
    • SV proportional to preload
    • decrease preload
      • preload proportional to venous tone
      • preload proportional to blood volume

• drop in bp cause baroR reflex
  • cause increase in symp activity and withdrawl of parasymp. activity
    • increase HR
    • increase contractility
    • increase plasma renin
    • increase fluid retention
    • increased cardiac oxygen demand that can lead to ischemia
• AVOID by co-administering with sympatholytic agents

• metabolized to active metabolite minoxidil sulfate
• activate ATP modulated potassium channel in arterial smooth muscle
  • little effect on venous and capacitance vessels

• increase HR
• increase contractility
• increase plasma renin
• increase fluid retention

HAIR GROWTH (became rogaine)

• metabolize to nitric oxide
• activate guanylate cyclase
• envoke vasodil. in arterioles and esp. in venules

Reflex responses minimal, but effect is transient.

HTN emergencies

acute MI

EFFECT IS TRANSIENT

• block NE binding to arterioles, leading to inh. of vasoconstriction
• lead to decrease arterial resistance and venous capacitance

• first dose phenomenon- orthostatic hypotension that occurs in half of all patients
  • most likely in patients on diuretics, beta blockers
  • tolerance to this response occurs after few doses
• sodium, water retention
• not effective as monotherapy

guanethidine

reserpine

• transported into vesicles in peripheral adrenergic neurons
  • replace and depletes NE
  • blocks excitation-secretion coupling

• postural hypotension
• sexual dysfunction (delayed, retrograde ejaculation)
• diarrhea

• binds to storage vesicles in central and peripheral adrenergic neurons
• interfere with transmitter uptake system in vessicles
  • renders vesicles dysfunctional
  • CNS-lose ability to conc., store norepi and dopamine
  • long term: deplets NE

• severe depression
• sedation
• inability to concentrate

• methyldopa
• clonidine

• methyldopa converted to methyl-dopamine to methyl-NE
• methyl NE substitues for NE and depletes NE in vesicles
• acts as alpha 2 agonists to presyn. inhibit CNS symp. activity

• dizziness
• reduced libido
• sedation
• depression
• immunological abnormalities

elderly

African Americans

• block beta receptors
• reduce contractility
• reduce cardiac output
• reduce secretion of renin
• decrease levels of Ang II

• angina
• arrhythmias
• HTN
• reduce mortality of acute MI

• erectile dysfunction
• depression
• insomnia

CONTRAINDICATED IN ASTHMA PATIENTS

• decreases HR
• decreases contractility
• pronounced effect on arterioles w/dihydropyridines (could lead to reflex tachycardia)
• non- DHP dont have much of a reflex due to additional direct negative chronotropic effect

dihydropyrindines (amlodipine) and non-dihydropyrindines (verapamil)

• ventricular hypertrophy
• CAD
• ischemic heart disease

It causes increase in preload

• low renin populations
  • elderly
  • African American

• inhibit Na/Cl contransport in DCT of nephrons
• increase urine volume
  • increased sodium, chloride
• decrease blood volume
• decrease preload, SV, and CO

• impaired renal function
• edema

• increased loss of potassium
  • due to depolarization of lumen, drawing K out of CD
• increase risk of arrhythmias and fibrillation
• sexual dysfunction

• you prolong QT interval when giving an antiarrhythmic
• if accompany prolong QT interval with hypokalemia, there is huge increase in risk of ventricular arrhythmias and fibrillation

Prevent using potassium sparing diuretics

vasoconstriction

sodium, water retention

• regress LV hypertrophy
• prevent/delay heart failure and MI
• slow progression of renal disease in DM patients

• ACE produce bradykinin
• increase in bradykinin responsible for a dry cough that occurs with patients
• solution- Ang I R blockers

• pregnacy
  • could decrease GFR
• bilateral renal artery stenosis
  • could cause renal failure

• diuretics, also good in:
  • systolic HTN
  • heart failure
• beta blockers, also good in those w/ history of:
  • MI
  • angina
  • tachycardia
  • fibrillation

• DM- ACE inh.
• heart failure- ACE inh.
• cardiac hypertrophy- ACE inh.
• MI- beta blockers, ACE inh.
• angina- beta blockers, calcium channel blockers
• arrrhythmias, fibrillations
  • beta blockers
  • calcium blockers (not DHP)

asthma

depression

renal stenosis

pregnancy

• w/troublesome side effects- substitute another drug from a different class
• if they tolerate, but inadequate response- add a second agent from a different class (diuretic if not already used)
• if we still are not at goal, keep adding agents from other classes, or turf them to another specialist