Antihypertensives

Arjun Chanmugam Diuretics

ThiazidesandLoop „Diuretics Potassium-Sparing,, Diuretics Carbonic,, Anhydrase „Inhibitors osmotic „Agents Clonidine

Angiotensin-Converting Enzyme Inhibitors Angiotensin „II, ReceptorAntagonist Other Centrally Acting Antihypertensives Peripheral ,Vaso.dilators„a.nd„ Ganglionic, „Blockers Prazosin

Hydralazine

Minoxidil

SodiumNltr.oprusside

Chapter,, References

Hypertension is one of the most common diseases in the United States, affecting almost 24 percent of the population. 1 Medications used to control hypertension are among the most commonly prescribed drugs. As a result, the potential for overdose, inadvertent or intentional, is quite high. In 1997, according to the Toxic Exposure Surveillance System, cardiovascular drugs, including antihypertensive medications, accounted for nearly 3 percent of all adult toxic exposures. 2

There are many classes of antihypertensive medications available for use, with new agents introduced into the market routinely. The initial management of patients with an acute overdose of antihypertensive medication remains relatively uniform. Airway, breathing, and circulation remain the initial priorities, so oxygen, cardiac monitoring, and intravenous access remain the key initial interventions. If mental status changes are present glucose and naloxone should be also be considered as initial interventions. If no contraindications are present, antihypertensive-induced hypotension should be treated initially with volume expansion, using normal saline or an equivalent crystalloid solution (such as Ringer lactate solution). In most adults, initial fluid therapy should consist of bolus challenges of 500 mL or 10 to 20 mL/kg over 10 to 15 min. If hypotension persists despite fluid challenges, the use of a vasopressor may be warranted. In most cases, dopamine is the vasopressor of choice, with infusion rates started at 2 to 5 ^g/kg/min and increased as necessary.

Supportive measures and appropriate monitoring should be instituted as early as possible. The use of activated charcoal is indicated in most overdose situations, but gastric decontamination should be considered only in appropriate patients. The management of patients with antihypertensive poisonings rarely depends on serum levels of medications but instead depends on symptoms. However, a key to managing these patients is to determine the medication involved and target interventions specific for that class of antihypertensive agent (Table 171-1). In the following discussion, antihypertensive toxicology is divided into sections based on the class of medications. b Blockers, monoamine oxidase inhibitors, and calcium-channel blockers are discussed in separate chapters.

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