Antihypertensive drugs Drug Sympatholytics Reserpine Guanethidine Mechanism of action Depletes nerve terminal of norepinephrine.

Depletes nerve terminal of norepinephrine. Side effects Sedation, depression, suicidal tendencies, sexual dysfunction. Orthostatic and exercise hypotension, sexual dysfunction. Other

Methyldopa

MNE is an agonist of 2 receptors which leads to a decrease of sympathetic discharges from CNS. 2 receptor agonist in CNS, same mechanism as methyldopa 1 receptors antagonist

Clonidine

Prazosin Diuretics Thiazides

Bradycardia, dry mouth, hypertensive rebound. Positive Coombs test due to haemolytic anemia. Severe hypertensive rebound, never discontinue abruptly. Mental depression. Dizziness, lipothymia (nearsyncope) Hypokalemia, hyperuricemia, hypomagnesemia, hyperlipidemia. Hypokalemia generates cardiac arrhythmias. Hypokalemia, hyponatremia

Abrupt removal could cause a hypertensive crisis because of upregulation of 1 receptors in vessels. Safe during hypertension associated with pregnancy.

Important in heroine withdrawal.

Reduce sodium in vessel wall by blocking Na+/Cl- cotransporter on distal convoluted tubule. Acts on the Na+/K+/2Clcotransporter to inhibit Na+ and Cl- reabsorption blockade, blockade in kidney (1 and renin). Lobetalol and Carvedilol also blocks receptors

Loop diuretics

Essential for treatment of hypertension. To prevent hypokalemia choose Spirolactone or Amiloride Necessary when hypertension is severe or other drugs retain sodium. Less effective in blacks. Avoid in patients with asthma or COPD, and peripheral artery disease.

blockers Metoprolol, Nadolol, Lobetalol, Caevedilol Vasodilators

Impotence, asthma, bradycardia, CHF, AV block, sedation, sleep alterations

Hydralazine

Increases formation of NO

Minoxidil

Open K+ channels, hyperpolarization that causes smooth muscle relaxation. Dilates only arterioles. Inhibit conversion of ANG I to ANG II, reduce or prevent release of aldosterone by ANG II and prevents vasoconstriction by ANG II Causes vasodilation and prevent vascular and cardiac remodeling. Block voltage-dependant L-type calcium channels of cardiac (Verapamil, DIltiazem) and vascular smooth muscle (Nifepidine, Nicardipine) thereby reduce muscle contractility. Increases cGMP via direct release of NO Dopamine D1 receptor agonist. Relaxes renal vascular smooth muscle. Causes peripheral vasodilation and natriuresis. K+ channel opener, hyperpolarizes and relaxes vascular smooth muscle.

Arthalgia, myalgia, lupus like syndrome, tachycardia, headaches, angina, perineuritis Hirsutism, arrhythmias

Fast and slow acetylators, fast shorter effect

ACE inhibitors Enalapril ,Captopril, Lisinopril

Cough, angioedema, small hyperkalemia, hypotension

Avoid in patients with bilateral renal stenosis, contraindicated in pregnant women.

AT1 receptor blockers (Losartan) Ca2+ channel blockers Verapamil, Diltiazem, Nifepidine, Nicardipine

Similar to ACE inhibitors, except cough. Excessive decrease in heart contractility, bradycardia, AV block.

Contraindicated in pregnant women. Contraindicated in heart failure. Interacts with digitalis and blockers at cardiac level.

Hypertensive crisis treatment Sodium Nitroprusside Fenoldopam

Cyanide toxicity (arrhythmias and metabolic acidosis) Ventricular tachycardia, increase intraocular pressure.

Sodium thiosulfate to prevent cyanide accumulation.

Diazoxide

Severe hypotension, MI, angina, tachycardia.

Contraindicated in patients with angina.