Anti-hypertensive agents

Hydrazinopyridazines such as hydralazine have a venerable history as anti hypertensive agents. It is of note that this biological activity is maintained in the face of major modifications in the heterocyclic nucleus. The key intermediate keto ester in principle can be obtained by alkylation of the anion of pi peri done 44 with ethyl bromo-acetate. The cyclic acylhydrazone formed on reaction with hydrazine (46) is then oxidized to give the aromatized compound 47. The hydroxyl group is then transformed to chloro by treatment with phosphorus oxychloride (48). Displacement of halogen with hydrazine leads to the formation of endralazine (49). ... 

If patient is not at goal BP, assess efficacy, safety, and compliance of the antihypertensive regimen to determine if a dose increase or additional anti hypertensive agent (step 8) is needed to achieve goal blood pressure. 

Determine if drug therapy may be contributing to ARF. Consider not only drugs that can directly cause ARF (e.g., aminoglycosides, amphotericin B, NSAIDs, cyclosporine, tacrolimus, ACE inhibitors, and ARBs), but also drugs that can predispose a patient to nephrotoxicity or prerenal ARF (i.e., diuretics and anti hypertensive agents). 

Anti-diabetic agents Anti-epileptics Anti-fungal agents Anti-gout agents Anti-hypertensive agents... 

Use with caution in older patients with Renal impairment. Hepatic impairment, CHF, HTN, PUD, History of GI bleeding, GERD, Bleeding and platelet disorders. History of aspirin sensitivity reaction. Also use with caution in patients taking Anticoagulants, Aspirin, and Anti hypertensive agents. 

Carvedilol is indicated for the management of essential hypertension. It can be used alone or in combination with other anti-hypertensive agents. It is effective also in CHF. 

AccessMedicine Print Chapter 11. Anti hypertensive Agents... 

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