TY  - CHAP
M1  - Book, Section
TI  - Chapter 15. Hypotensive Agents
A1  - Butterworth, John F.
A1  - Mackey, David C.
A1  - Wasnick, John D.
Y1  - 2013
N1  - 
T2  - Morgan & Mikhail's Clinical Anesthesiology, 5e
AB  - Clinical  trials  have  shown  that  inhaled  nitric  oxide  is  a  selective  pulmonary  vasodilator  that  is  beneficial  in  the  treatment  of  reversible  pulmonary  hypertension.  By  improving  perfusion  only  in  ventilated  areas  of  the  lung,  inhaled  nitric  oxide  may  improve  oxygenation  in  patients  with  acute  respiratory  distress  syndrome  or  during  one-lung  ventilation.  Acute  cyanide  toxicity  is  characterized  by  metabolic  acidosis,  cardiac  arrhythmias,  and  increased  venous  oxygen  content  (as  a  result  of  the  inability  to  utilize  oxygen).  Another  early  sign  of  cyanide  toxicity  is  the  acute  resistance  to  the  hypotensive  effects  of  increasing  doses  of  sodium  nitroprusside  (tachyphylaxis).  By  dilating  pulmonary  vessels,  sodium  nitroprusside  may  prevent  the  normal  vasoconstrictive  response  of  the  pulmonary  vasculature  to  hypoxia  (hypoxic  pulmonary  vasoconstriction).  Preload  reduction  makes  nitroglycerin  an  excellent  drug  for  the  relief  of  cardiogenic  pulmonary  edema.  Hydralazine  relaxes  arteriolar  smooth  muscle,  causing  dilatation  of  precapillary  resistance  vessels  via  increased  cyclic  guanosine  3’,5’-monophosphate.  The  body  reacts  to  a  hydralazine-induced  fall  in  blood  pressure  by  increasing  heart  rate,  myocardial  contractility,  and  cardiac  output.  These  compensatory  responses  can  be  detrimental  to  patients  with  coronary  artery  disease  and  are  minimized  by  the  concurrent  administration  of  a  β-adrenergic  antagonist.  Fenoldopam  mesylate  (infusion  rates  studied  in  clinical  trials  range  from  0.01-1.6  mcg/kg/min)  reduces  systolic  and  diastolic  blood  pressure  in  patients  with  malignant  hypertension  to  an  extent  comparable  to  nitroprusside.  Dihydropyridine  calcium  channel  blockers  preferentially  dilate  arterial  vessels,  often  preserving  or  increasing  cardiac  output.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2022/08/17
UR  - accessmedicine.mhmedical.com/content.aspx?aid=57232089
ER  -