Hypertension Exercise Program

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ACTIONS AND PHARMACOLOGY This antihypertensive agent is a selective postsynaptic dopaminergic receptor (DA -,) agonist that has potent vasodilative and natriuretic properties.18 Recent clinical trials have shown this intravenous agent to be effective in the treatment of severe hypertension without causing a change in heart rate. The onset of action is 4 min, with duration of antihypertensive effect of 8 to 10 min.

INDICATIONS Fenoldopam shows promise for use in treating hypertensive emergencies but is not yet FDA approved for this purpose.

USE The initial dose is 0.05 to 0.1 (mg/kg)/min and can be increased at increments of 0.1 (mg/kg)/min to a maximum infusion rate of 1.6 (mg/kg)/min or to a diastolic pressure of less than 110 mmHg.

SIDE EFFECTS AND CONTRAINDICATIONS Mild side effects of headache and flushing occur in about 25 percent of patients. Nicardipine

ACTIONS AND PHARMACOLOGY This is a dihydropyridine calcium-channel blocker that decreases afterload by reducing total peripheral resistance without reducing cardiac output and without apparent negative inotropic effect on the heart. It improves left ventricular pumping activity in patients with mild to moderate heart failure.18 Nicardipine also displays a greater vasodilator effect on coronary than on systemic vessels and produces a clinically significant decrease in cerebral vasospasm after subarachnoid hemorrhage.24 The onset of action is 15 to 30 min, with a duration of action of 40 min.

INDICATIONS It has been used for the treatment of postoperative hypertension, stable angina, and congestive heart failure, and shows promise for use in patients with subarachnoid hemorrhage.

USE Nicardipine can be given initially as a 2-mg intravenous bolus, followed by a 4- to 15-mg/h infusion.

SIDE EFFECTS AND CONTRAINDICATIONS Nicardipine does not produce the negative inotropic effects seen with other calcium-channel blockers such as nifedipine. Headache occurs as a side effect in 20 to 50 percent of patients. Other less common effects include hypotension, tachycardia, nausea, and vomiting. The use of nicardipine is contraindicated in patients with severe aortic stenosis.

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