S15C190 - Antihypertensive OD

Question 1

Diuretic OD: presentation

Answer 1

(thiazides, loop diuretics, K-sparing)

• tachycardia, HoTN, lyte avn, weakness
• wide QTS or peaked T or prolonged QT

-Tx: volume, treat lyte abnormalities

Question 2

Sympatholytic OD

Answer 2

• alpha1 adrenergic receptor antagonists (prazosin, terazosin), reduce PVR (Tamsulosin)
• OD cause orthostatic HoTN, HoTN
• alpha2 agonist (clonidine), acts in CNS to inhibit release of catecholamines
• bradycardia, decr contractility, decr PVR
• OD may cause HTN at first then brady and HoTN, miotic pupils, somnolence
• tx clonidine with naloxone (10mg may be needed)
• tx brady with atropine

Question 3

ACEi/ARB OD

Answer 3

• fluids

- if refractory HoTN consider naloxone

Question 4

Angioedema related to ACEi/ARB

Answer 4

• thought to be inhibition of degradadation of bradykinin

- Tx with steroids, antihistamines, epinephrine, FFP

Question 5

Hydralazine

Answer 5

-relaxes arteriolar smooth muscle
-OD: HoTN, may get some cardiac ischemia from reflex
tachycardia
-tx with fluids, phenylephrine (so as not to cause tachy)

Question 6

Nitroprusside

Answer 6

• can result in cyanide toxicity
• give sodium thiosulfate to reduce amount of cyanide produced
• cyanide toxicity results in lactic acdisosis, cardiovascular collapse