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Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Data in pregnancy are limited for most of these drugs: nicardipine, nitroglycerin, sodium nitroprusside, and esmolol have been reported. Nicardipine is developing a track record in pregnancy. It has been used successfully as a second-line treatment for pre-eclampsia after failure of ketanserin, labetalol, or hydralazine (65). In a small randomized trial, intravenous nicardipine was just as efficacious as labetalol for controlling bloodpressure inhypertensiveemergency during pregnancy (66). It has definite advantages over hydralazine, being a more predictable and titratable drug, with a much shorter time to onset and quicker disappearance once discontinued. Trimethaphan and phentolamine have largely been replaced by other drugs of better efficacy and greater predictability, and ketanserin is not available in the United States. Thereare, as yet, no data on fenoldopam or clevidipine in pregnancy.
Dopamine Receptors, Signaling Pathways, and Drugs
Published in Nira Ben-Jonathan, Dopamine, 2020
Fenoldopam, a benzazepine derivative, is a peripheral D1R agonist. Administered parenterally, fenoldopam acts as a vasodilator in the peripheral arteries, and as a diuretic in the kidneys. Fenoldopam has been approved by the FDA in 1997 for in-hospital, short-term management of severe hypertension, when a rapid, but a reversible, reduction of blood pressure is required [76]. Hypertensive emergencies that use fenoldopam include accelerated hypertension, hypertensive encephalopathy, acute left ventricular failure, acute aortic dissection, pheochromocytoma crisis, interaction between tyramine-containing foods or drugs and monoamine oxidase inhibitors, eclampsia, drug-induced hypertension, and occasionally intracranial hemorrhage.
Postjunctional Dopamine Receptor Stimulants
Published in M.D. Francesco Amenta, Peripheral Dopamine Pathophysiology, 2019
Administration of fenoldopam as a single oral dose or by intravenous infusion produces effects comparable to those seen in normotensive subjects, with the exception that systolic and diastolic pressures are significantly reduced. Despite the reduction in perfusion pressure, however, increases in renal blood flow are equivalent to, or greater than those obtained in normal man.59,63,65-69 Particularly dramatic effects have been reported in patients with severe diastolic hypertension (>120 mmHg) or hypertension not responding to triple drug therapy (diastolic BP > 115 mmHg). A 3-h intravenous infusion of fenoldopam (0.2 to 0.5 μg/kg/ min) produced reductions in diastolic pressure of 30 mmHg, increased urine volume and sodium and potassium excretion, and increased creatinine and uric acid clearance. The natriuretic and diuretic effect persisted for at least 2 h after stopping the infusion, while blood pressure remained depressed for more than 24 h.70
Large animal models for translational research in acute kidney injury
Published in Renal Failure, 2020
Balamurugan Packialakshmi, Ian J. Stewart, David M. Burmeister, Kevin K. Chung, Xiaoming Zhou
Increase of blood flow to the kidney by vasodilation through increasing either nitric oxide bioavailability, endothelin inhibition, or administration of hormone and neurotransmitter analogues has been shown to ameliorate AKI in LAM. By preserving nitric oxide bioavailability and preventing regional hypoxia, Sildenafil attenuates IRI in canine and swine kidneys [100,186]. Sitaxsentan, an endothelin receptor antagonist, improves hypoxia during AKI in a porcine model [99]. Sodium nitroprusside, a nitric oxide donor, in combination with N-acetyl cysteine and phosphormidon, an endothelin-1 converting enzyme inhibitor, improves renal function after I/R injury in a canine model [188]. Fenoldopam, a synthetic D1 dopamine receptor agonist, demonstrated a prophylactic benefit against the reduction in renal blood flow and renal tubular function during acute hypovolemia in anesthetized dogs [193]. Fenoldopam has also been shown to attenuate I/R-induced AKI in a porcine model [123]. Fenoldopam was found to be beneficial in the prevention or treatment of AKI in postoperative or intensive care patients [200], but a recent review only found that its renoprotective effect is transient [201]. Both atrial natriuretic peptide and brain natriuretic peptide relax vascular smooth muscles and improve blood flow and urine output in dogs [182]. Limited clinical trials suggest that low dose of atrial natriuretic peptide might be effective in preventing or treating AKI [202].
In-utero cold stress causes elevation of blood pressure via impaired vascular dopamine D1 receptor in offspring
Published in Clinical and Experimental Hypertension, 2020
Dongdong Sun, Ken Chen, Jialiang Wang, Lin Zhou, Chunyu Zeng
The prenatal cold stress elevated the blood pressure in an age-dependent manner. SBP, diastolic blood pressure, and mean blood pressure were significantly increased at 8 weeks of age (Figure 1). Additional vascular response studies showed the vasodilation caused by Ach and fenoldopam was lower in prenatal cold exposed offspring than the controls in the presence or absence of the endothelium (Figure 2), indicating that the elevated blood pressure may be ascribed to decreased D1 receptor-associated vasodilation. Since lower birth weight has been identified as a risk factor for elevation of blood pressure in offspring (22,23), we also found the prenatal cold stress decreased the birth weight of rats (Supplemental Figure S1).
Robot-assisted partial nephrectomy: How to minimise renal ischaemia
Published in Arab Journal of Urology, 2018
Chandran Tanabalan, Avi Raman, Faiz Mumtaz
One agent that has been commonly used as a renal protective agent for patients at high risk of developing renal failure is mannitol [26]. Retrospective studies suggest that mannitol has no renal protective effect on postoperative renal function [27,28]. A recent randomised controlled trial using fenoldopam (short acting dopamine-1 receptor agonist) showed no improvement in postoperative renal function compared to placebo in the setting of a clamped PN [29].