Vasodilator in Hypertensive Emergencies Flashcards
Sodium nitroprusside PK
onset: immediate
durtation: 2–3 min
Sodium nitroprusside Hypertensive Emergency Dose
0.3–0.5 mcg/kg/min, increase in increments of 0.5 mcg/kg/min to
achieve BP target; max 10 mcg/kg/min; for infusion rates ≥ 4–10 mcg/kg/min or duration > 30 min, thiosulfate can be coadministered to
prevent cyanide toxicity
Nitroglycerin PK
onset: 2–5 min
duration: 5–10 min
Nitroglycerin Hypertensive Emergency Dose
5–10 mcg/min, increase in increments of 5 mcg/min every 3–5
min to a max 20 mcg/min
Nitroglycerin Hypertensive Emergency Use
Use only in patients with ACS and/or acute pulmonary edema; do not use in volume-depleted patients
Hydralazine PK
onset: 10 min
Duration: 1–4 hr
unpredictability of response and prolonged duration of action make hydralazine less desirable first agent
Hydralazine Hypertensive Emergency Dose
5–10 mg by slow IV infusion every 4–6 hr (NTE initial 20 mg/dose)
Hydralazine Caution
Angina or MI, elevated ICP, aortic dissection
Enalaprilat PK
onset: within 30 min, dose not easily adjusted; relatively slow onset (15 min) and unpredictability of BP response
Duration: 12–24 hr (long half life)
Enalaprilat Hypertensive Emergency Use
Should not be used in acute MI; mainly useful in hypertensive emergencies associated with high plasma renin activity
Fenoldopam PK
onset < 5 min
Duration: 30 min
Enalaprilat Contraindications
Pregnancy, bilateral renal artery stenosis, angioedema
Fenoldopam Hypertensive Emergency Dose
0.1–0.3 mcg/kg/min, increased by 0.05–0.1 mcg/kg/min every 15 min to a max of 1.6 mcg/kg/min
Fenoldopam Contraindications
Contraindicated in patients at risk of increased intraocular pressure (glaucoma) or ICP and those with sulfite allergy
Nicardipine PK
onset: 1–5 min
Duration:15–30 min; up to 4 hr if prolonged infusion
