Hypotension caused

Monitor blood pressure to evaluate for hypotension caused by drug therapy. 

With either type of dialysis, studies suggest that recovery of renal function is decreased in ARF patients who undergo dialysis compared with those not requiring dialysis. Decreased recovery of renal function may be due to hemodialysis-induced hypotension causing additional ischemic injury to the kidney. Also, exposure of a patient s blood to bioincompatible dialysis membranes (cuprophane or cellulose acetate) results in complement and leukocyte activation which can lead to neutrophil infiltration into the kidney and release of vasoconstrictive substances that can prolong renal dysfunction.26 Synthetic membranes composed of substances such as polysulfone, polyacrylonitrile, and polymethylmethacrylate are considered to be more biocompatible and would be less likely to activate complement. Synthetic membranes are generally more expensive than cellulose-based membranes. Several recent meta-analyses found no difference in mortality between biocompatible and bioincompatible membranes. Whether biocompatible membranes lead to better patient outcomes continues to be debated. 

Immediate attention should be given to the management of hypotension caused by fluid loss Few drugs are effective... 

Sodium ferric gluconate complex administered to patients during dialysis may cause transient hypotension. Administration may augment hypotension caused by dialysis. 

Diuretics, typically spironolactone, form the main therapy, combined with restricted salt intake. Sodium restriction is usually unnecessary where fluid retention is mild, and if marked limitation (less than 40 mmol per day intake) is imposed, may lead to impaired nutrition and is poorly accepted. Diuretic treatment often requires reinforcement with loop diuretics. Treatment can be maintained if urinary sodium excretion is at least 30 mmol per day. Removal of ascites through diuresis requires fluid transfer through the intravascular fluid compartment. If diuresis is too intense the intravascular fluid volume is reduced and hypotension causes hepatorenal failure to follow. The aim should be, through monitoring weight loss, to restrict fluid removal to 0.5 kg per day. In this way the risks of hyponatraemia, renal and hepatic impairment should be reduced. 

Hypotensive. Causing or marking a lowering of blood pressure. 

Chinese medical practitioners in the 15th century recommended ephedra as an antipyretic and antitussive agent. Modem physicians use intravenous ephedrine for the prophylaxis and treatment of hypotension caused by spinal anesthesia, particularly during cesarean section (see Chapter 29). 

Nitroprusside [nye troe PRUSS ide] is administered intravenously, and causes prompt vasodilation, with reflex tachycardia. It is capable of reducing blood pressure in all patients, regardless of the cause of hypertension. The drug has little effect outside the vascular system, acting equally on arterial and venous smooth muscle. [Note Because nitroprusside also acts on the veins, it can reduce cardiac preload.] Nitroprusside is metabolized rapidly (t1/2 of minutes) and requires continuous infusion to maintain its hypotensive action. Sodium nitroprusside exerts few adverse effects except for those of hypotension caused by overdose. Nitroprusside metabolism results in cyanide ion production, although cyanide toxicity is rare and can be effectively treated with an infusion of sodium thiosulfate to produce thiocyanate, which is less toxic and is eliminated by the kidneys (Figure 19.14). [Note Nitroprusside is poisonous if given orally because of its hydrolysis to cyanide.]... 

The prophylaxis of orthostatic hypotension caused by tricyclic antidepressants.] Ars Med (Brux) 1979 34 641. 

The potentially life-threatening hypotension caused by an interaction with sildenafil citrate (Viagra), a treatment for male erectile dysfunction, should be highlighted, especially in patients with coronary heart disease needing regular nitrates (6). 

Sternon J, Owieczka J. La prophylaxie de I hypotension orthostatique induite par les antidepresseurs tricycliques. [The prophylaxis of orthostatic hypotension caused by tricyclic antidepressants.] Ars Med (Brux) 1979 34 641... 

Hypotension caused by local anesthetic agents is often unrelated to the type of drug u.sed and can be prevented by premedication with a suitable scdativc. ... 

NEUROTOXIN constituent of the fly agaric fungus Amanita muscaria and various /nocyfte spp. It is a very potent MUSCARINIC CHOLINOCEPTOR AGONIST with pronounced PARASYMPATHOMIMETIC actions. It is a HYPOTENSIVE, causes bronchoconstriction and stimulates gut, bladder and exocrine glands. Stereoisomers show only a fraction of the activity, and it is valuable as a pharmacological tool in studies on muscarinic receptors. It is very toxic orally, with stimulatory actions on the CNS (atropine sulphate may be used as an antidote). 

Physicians routinely used intravenous ephedrine for the prophylaxis and treatment of hypotension caused by spinal anesthesia particularly during caesarean section (9). In the past, ephedrine was used to treat Stokes-Adams attacks (complete heart block), and was also recommended as a treatment for narcolepsy. Over the years, ephedrine has been replaced by other, more effective agents (10), and the advent of highly selective [3-agonists has mostly eliminated the need to use ephedrine in treating asthma. 

The major clinical feature of patients with deficiency of dopamine p-hydroxylase is orthostatic hypotension caused by reduced synthesis and release of norepinephrine by sympathetic nerves. The deficiency is characterized neuro-chemically by decreased levels of norepinephruie and norepinephrine metabolites and increased levels of dopamine and dopamine metabolites. Diagnosis is best achieved from an increased ratio of plasma dopamine to norepinephrine. Copper deficiency in Menkes disease is due to defects in the gene coding for a copper-transporting adenosine triphosphatase. Because dopamine p-hydroxylase is a copper-dependent enzyme, the deficiency is associated with decreased activity of the enzyme and reduced production of norepinephrine from dopamine. Prompt diagnosis at childbirth is essential for copper-replacement therapy, and... 

Since intravenous sodium bicarbonate is used as therapy for certain arrhythmias and hypotension caused by tricyclic antidepressant poisoning, some practitioners have advocated its prophylactic use. There is little evidence to indicate which patients would benefit from prophylactic use. The risks of potentially producing alkalosis in a patient who is not seriously toxic should be considered. 

Patients with AD are more sensitive to antipsychotic side effects than other patient groups. Increased sensitivity to antipsychotic side effects in the elderly appears to be the result of altered pharmacodynamics rather than altered pharmacokinetics. Particularly problematic side effects are extrapyramidal side effects, postural hypotension caused by a-adrenergic blockade, and anticholinergic effects, including increased confusion, urinary retention, constipation, and dry mouth. For a more detailed description of antipsychotic side effects see Chap. 66 on schizophrenia. Overall, fewer side effects are seen with tlie newer atypical antipsychotics, making them a preferred choice for treatment of psychosis or aggression in the AD patient. Effective doses of antipsychotic medications are much lower than those typically used to treat schizophrenia (see Table 63-8). The rule of thumb is to start low and go slow. ... 

Drastic changes in blood pressure may occur as a toxic response to a foreign compound, such as the hypotension caused by hydrazoic acid and sodium azide. There may be various mechanisms involved such as vasodilation, /1-adrenoceptor blockade or altered water balance. Anti-hypertensive drugs will clearly cause dangerous hypotension if given in large doses, but such an exaggerated response may also be due to reduced metabolism in some individuals, as in the case of debrisoquine (see Chapter 5). 

Which one of the following drugs is most often associated with hypotension caused by histamine release ... 

The major toxic side effect of bretylium is hypotension caused by inhibition of catecholamine release. Qrthostatic hypotension may persist tor several hours. 

Hypotension caused by venodilation is common and usually mild. In severe cases, hypotension results from myocardial depression and may be refractory to treatment some patients die with progressive intractable cardiogenic shock. Pulmonary edema is also common in severe poisonings. 

B. Low-dose infusion is most effective tor hypotension caused by venodiiation or reduced cardiac contractiiity high-dose dopamine is indicated for shock resulting from decreased peripheral arterial resistance. 

C. To raise the diastolic blood pressure in patients with hypotension caused by excessive beta-2-mediated vasodilation (eg, theophylline or metaproterenol). 

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