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Pharm Autonomic NS

Alpha 2 Agonists: Central

QuestionAnswer
Drugs in this class include clonidine [Catapress], guanabenz [Wytensin] guanfacine [Tenex, Intuniv], methyldopa
central alpha 2 agonists reduce sympathetic tone and increase parasympathetic tone which results in lower BP, bradycardia, peripheral resistance
crosses the blood brain barrier so should be used cautiously in depression, older adults, cerbrovascular disease clonidine, methyldopa
nightmares and insomnia have been associated with clonidine
have been associated with life-threatening rebound HTN mediated by increased SNS activity so should be tapered gradually. This is exacerbated if pt is also taking beta-adrenergic blockers
has been associated with a positive Coombs' test methyldopa
beta blockers and centrally acting alpha2 agonists should not be given together but if they are and one needs to be withdrawn the beta blocker should be tapered first to prevent excessive opposed stimulaton of alpha 2 receptors that can result in a hypertensive crisis in as little as 12 hours
because they lower BP by reducing sympathetic function, they can produce compensatory effect on BP resulting in retention of sodium and expansion of blood volume through mechanisms that are not dependent on adrenergic nerves
for treatment of HTN usually 2nd line, except for methyldopa which is first line in pregnancy
methylodopa and clonidine can be used with a diuretic to address sodium and water rention
combination tablet chlorthalidone[Clorpres], clonidine with thiazide
unlabeled uses of clonidine withdrawal symptoms, ADHD
monitoring during tx with methyldopa Coombs' test before and at 6-12 months after initiation of therapy
methyldopa adverse reactions jaundice (hepatotoxicity), weakness [amemia], urine left standing may darken or turn red/black [not hematuria]
Created by: heatherbrown2020