Adrenergic Inhibitors in Hypertensive Emergencies

Question 1

Esmolol PK

Answer 1

Onset: 1–2 min
Duration: 10–30 min

Question 2

Esmolol Hypertensive Emergency Dose

Answer 2

LD 500–1000 mcg/kg IVB over 1 min, then a 50-mcg/kg/min infusion; for additional BP lowering, the bolus dose is repeated, and the infusion is increased in 50-mcg/kg/min increments as needed to a max 200 mcg/kg/min

Question 3

Esmolol Contraindications

Answer 3

Contraindicated in patients with concurrent β-blocker therapy, bradycardia, or decompensated HF

Question 4

Labetalol PK

Answer 4

onset: 5–10 min
duration: 3–6 h

Question 5

Labetalol Hypertensive Emergency Use

Answer 5

especially useful in hyperadrenergic syndromes; may worsen HF

Question 6

Labetalol Contraindications

Answer 6

Contraindicated in reactive airway disease or chronic obstructive pulmonary disease

Question 7

Phentolamine PK

Answer 7

onset: 2 min
Duration: 15–30 min

Question 8

Phentolamine Hypertensive Emergency Dose

Answer 8

IVB dose 5 mg; additional bolus doses every 10 min as needed

Question 9

Phentolamine Hypertensive Emergency Use

Answer 9

hypertensive emergencies induced by catecholamine excess (pheochromocytoma, monamine oxidase inhibitors interactions with food and/or drugs, cocaine toxicity, amphetamine overdose, or clonidine withdrawal)