Hydralazine

Question 1

Alternate Name and Cost

Answer 1

Apresoline - rarely given chronically $4 per month

Question 2

Pharmacodynamics

Answer 2

“Direct” acting vasodilator; seems to act by inducing endothelium to produce NO, which then passes to SM cells and induces production of cGMP, minimal venodilating effects

Question 3

Pharmacokinetics

Answer 3

Given po, im, IV, metabolized extensively in GI mucosa and in liver, eventually excreted as metabolites in urine; F~40%; onset 30 after po dose, 10 min after IV dose; persist for 2-6 hours

Question 4

Toxicity

Answer 4

More dangerous in patients with renal disease, prior stroke, angina; watch for hypotension, edema, occasionally drug-induced lupus ** DRUG INDUCED SLE **

Question 5

Interactions

Answer 5

Additive effects with most other antihypertensives

Question 6

Special Considerations

Answer 6

Never use as chronic oral monotherapy for treatment of hypertension, since edema and reflex tachycardia will result; concern giving to patients with CAD

Question 7

Indications and Dose / Route

Answer 7

Dose 10-50 mg po qid

Question 8

Monitor

Answer 8

BP, weight, edema, BUN, creatinine, symptoms of lupus or angina