Other Antihypertensives
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See Table 28-7.
Mechanism of Action | Potential Effects in Overdose | Potential Treatments | Comments | |
Prazosin | α1 adrenergic blockade | Sedation, postural hypotension | Supportive, IV fluids, vasopressin/phenylephrine/norepinephrine | May cause priapism |
Hydralazine | Interferes with IP3-mediated Ca2+ release from sarcoplasmic reticulum → arteriolar relaxation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose |
Minoxidil | ATP-K+ channel opening, NO-mediated vasodilation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose, direct myocardial toxicity in animal models |
Nitroprusside | NO-mediated vasodilation | Hypotension, tachycardia, thiocyanate/cyanide toxicity | Discontinue offending agent. Consider sodium thiosulfate or hydroxocobalamin | Thiocyanate toxicity may occur due to impaired renal clearance |
Thiazide diuretics | Primarily by inhibition of NaCl cotransporter in distal convoluted tubule | Altered mental status, hypotension, electrolyte abnormalities, hyperuricemia, hyperglycemia | Supportive (correction of electrolytes, volume status) | |
Loop diuretics | Primarily by inhibition of Na-K-2Cl cotransporter in ascending loop of Henle | Altered mental status, hypotension, electrolyte abnormalities (hypokalemia, hypomagnesemia), ototoxicity | ||
K+ sparing diuretics | Aldosterone antagonists (spironolactone)/inhibition of epithelial sodium channel in collecting tubule (amiloride, triamterene) | Altered mental status, hypotension, electrolyte abnormalities (hyperkalemia) | ||
ACE inhibitors | Inhibition of angiotensin converting enzyme | Sedation, hypotension | Supportive, IV fluids, vasopressors | Reports of success using angiotensin II in ACE-I overdose. Reports of success in using methylene blue with cardiogenic shock |
ARBs | Inhibition of angiotensin type 1 receptor |
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See Table 28-7.
Mechanism of Action | Potential Effects in Overdose | Potential Treatments | Comments | |
Prazosin | α1 adrenergic blockade | Sedation, postural hypotension | Supportive, IV fluids, vasopressin/phenylephrine/norepinephrine | May cause priapism |
Hydralazine | Interferes with IP3-mediated Ca2+ release from sarcoplasmic reticulum → arteriolar relaxation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose |
Minoxidil | ATP-K+ channel opening, NO-mediated vasodilation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose, direct myocardial toxicity in animal models |
Nitroprusside | NO-mediated vasodilation | Hypotension, tachycardia, thiocyanate/cyanide toxicity | Discontinue offending agent. Consider sodium thiosulfate or hydroxocobalamin | Thiocyanate toxicity may occur due to impaired renal clearance |
Thiazide diuretics | Primarily by inhibition of NaCl cotransporter in distal convoluted tubule | Altered mental status, hypotension, electrolyte abnormalities, hyperuricemia, hyperglycemia | Supportive (correction of electrolytes, volume status) | |
Loop diuretics | Primarily by inhibition of Na-K-2Cl cotransporter in ascending loop of Henle | Altered mental status, hypotension, electrolyte abnormalities (hypokalemia, hypomagnesemia), ototoxicity | ||
K+ sparing diuretics | Aldosterone antagonists (spironolactone)/inhibition of epithelial sodium channel in collecting tubule (amiloride, triamterene) | Altered mental status, hypotension, electrolyte abnormalities (hyperkalemia) | ||
ACE inhibitors | Inhibition of angiotensin converting enzyme | Sedation, hypotension | Supportive, IV fluids, vasopressors | Reports of success using angiotensin II in ACE-I overdose. Reports of success in using methylene blue with cardiogenic shock |
ARBs | Inhibition of angiotensin type 1 receptor |
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