Alpha 2 Agonists: Central
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| Drugs in this class include | clonidine [Catapress], guanabenz [Wytensin]
guanfacine [Tenex, Intuniv], methyldopa
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| central alpha 2 agonists reduce sympathetic tone and increase parasympathetic tone which results in | lower BP, bradycardia, peripheral resistance
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| crosses the blood brain barrier so should be used cautiously in depression, older adults, cerbrovascular disease | clonidine, methyldopa
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| nightmares and insomnia have been associated with | clonidine
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| 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
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| has been associated with a positive Coombs' test | methyldopa
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| beta blockers and centrally acting alpha2 agonists should not be given together but if they are and one needs to be withdrawn | the beta blocker should be tapered first to prevent excessive opposed stimulaton of alpha 2 receptors that can result in a hypertensive crisis in as little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
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| 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
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| for treatment of HTN | usually 2nd line, except for methyldopa which is first line in pregnancy
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| methylodopa and clonidine can be used with a diuretic to address | sodium and water rention
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| combination tablet | chlorthalidone[Clorpres], clonidine with thiazide
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| unlabeled uses of clonidine | withdrawal symptoms, ADHD
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| monitoring during tx with methyldopa | Coombs' test before and at 6-12 months after initiation of therapy
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| methyldopa adverse reactions | jaundice (hepatotoxicity), weakness [amemia], urine left standing may darken or turn red/black [not hematuria]
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