Other Antihypertensives

Other Antihypertensives is a topic covered in the Washington Manual of Medical Therapeutics.

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See Table 28-7.

Table 28-7: Other Antihypertensives

Mechanism of ActionPotential Effects in OverdosePotential TreatmentsComments
Prazosinα1 adrenergic blockadeSedation, postural hypotensionSupportive, IV fluids, vasopressin/phenylephrine/norepinephrineMay cause priapism
HydralazineInterferes with IP3-mediated Ca2+ release from sarcoplasmic reticulum → arteriolar relaxationHypotension, tachycardiaSupportive, IV fluids, vasopressorsMyocardial ischemia reported in overdose
MinoxidilATP-K+ channel opening, NO-mediated vasodilationHypotension, tachycardiaSupportive, IV fluids, vasopressorsMyocardial ischemia reported in overdose, direct myocardial toxicity in animal models
NitroprussideNO-mediated vasodilationHypotension, tachycardia, thiocyanate/cyanide toxicityDiscontinue offending agent. Consider sodium thiosulfate or hydroxocobalaminThiocyanate toxicity may occur due to impaired renal clearance
Thiazide diureticsPrimarily by inhibition of NaCl cotransporter in distal convoluted tubuleAltered mental status, hypotension, electrolyte abnormalities, hyperuricemia, hyperglycemiaSupportive (correction of electrolytes, volume status)
Loop diureticsPrimarily by inhibition of Na-K-2Cl cotransporter in ascending loop of HenleAltered mental status, hypotension, electrolyte abnormalities (hypokalemia, hypomagnesemia), ototoxicity

K+ sparing diureticsAldosterone antagonists (spironolactone)/inhibition of epithelial sodium channel in collecting tubule (amiloride, triamterene)Altered mental status, hypotension, electrolyte abnormalities (hyperkalemia)

ACE inhibitorsInhibition of angiotensin converting enzymeSedation, hypotensionSupportive, IV fluids, vasopressorsReports of success using angiotensin II in ACE-I overdose. Reports of success in using methylene blue with cardiogenic shock
ARBsInhibition of angiotensin type 1 receptor

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See Table 28-7.

Table 28-7: Other Antihypertensives

Mechanism of ActionPotential Effects in OverdosePotential TreatmentsComments
Prazosinα1 adrenergic blockadeSedation, postural hypotensionSupportive, IV fluids, vasopressin/phenylephrine/norepinephrineMay cause priapism
HydralazineInterferes with IP3-mediated Ca2+ release from sarcoplasmic reticulum → arteriolar relaxationHypotension, tachycardiaSupportive, IV fluids, vasopressorsMyocardial ischemia reported in overdose
MinoxidilATP-K+ channel opening, NO-mediated vasodilationHypotension, tachycardiaSupportive, IV fluids, vasopressorsMyocardial ischemia reported in overdose, direct myocardial toxicity in animal models
NitroprussideNO-mediated vasodilationHypotension, tachycardia, thiocyanate/cyanide toxicityDiscontinue offending agent. Consider sodium thiosulfate or hydroxocobalaminThiocyanate toxicity may occur due to impaired renal clearance
Thiazide diureticsPrimarily by inhibition of NaCl cotransporter in distal convoluted tubuleAltered mental status, hypotension, electrolyte abnormalities, hyperuricemia, hyperglycemiaSupportive (correction of electrolytes, volume status)
Loop diureticsPrimarily by inhibition of Na-K-2Cl cotransporter in ascending loop of HenleAltered mental status, hypotension, electrolyte abnormalities (hypokalemia, hypomagnesemia), ototoxicity

K+ sparing diureticsAldosterone antagonists (spironolactone)/inhibition of epithelial sodium channel in collecting tubule (amiloride, triamterene)Altered mental status, hypotension, electrolyte abnormalities (hyperkalemia)

ACE inhibitorsInhibition of angiotensin converting enzymeSedation, hypotensionSupportive, IV fluids, vasopressorsReports of success using angiotensin II in ACE-I overdose. Reports of success in using methylene blue with cardiogenic shock
ARBsInhibition of angiotensin type 1 receptor

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