Intra-Venous drug (s) that can be used in management of hypertensive emergency?
Ans. D. All of the above. (Ref Harrison 18th/pg. Table 247-10).Commonly used drugs Hypertensive emergency include nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam. Note that Nitroprussid is Short acting;>>cGMP via direct release of NO. Can cause cyanide toxicity (releases cyanide). Fenoldopam is a Dopamine D1 receptor agonist--coronary, peripheral, renal, and splanchnic vasodilation. Reduces BP and increases natriuresis. Clevidipine is latest generation dihydropyridine Ca channel antagonist available for IV administration (available as lipid emulsion). It is effective in Rx acute both pre-op and post-op hypertension.Usual Intravenous Doses of Antihypertensive Agents Used in Hypertensive Emergencies.Antihypertensive agentIntravenous doseNitroprussideInitial 0.3 (g/kg)/min; usual 2-4 (g/kg)/min; maximum 10 (g/kg)/min for 10 minNicardipineInitial 5 mg/h; titrate by 2.5 mg/h at 5-15 min intervals; max 15 mg/hLabetalol2 mg/min up to 300 mg or 20 mg over 2 min, then 40-80 mg at 10-min intervals up to 300 mg total Labetalol2 mg/min up to 300 mg or 20 mg over 2 min, then 40-80 mg at 10-min intervals up to 300 mg totalEsmololInitial 80-500 g/kg over 1 min, then 50-300 (g/kg)/minPhentolamine5-15 mg bolusNitroglycerinInitial 5 g/min, then titrate by 5 g/min at 3-5-min intervals; if no response is seen at 20 g/min, incremental increases of 10-20 g/min may be usedHydralazine10-50 mg at 30-min intervals# Malignant hypertension is a syndrome associated with an abrupt increase of blood pressure in a patient with underlying hypertension or related to the sudden onset of hypertension in a previously normotensive individual. The absolute level of blood pressure is not as important as its rate of rise. Pathologically, the syndrome is associated with diffuse necrotizing vasculitis, arteriolar thrombi, and fibrin deposition in arteriolar walls. Fibrinoid necrosis has been observed in arterioles of kidney, brain, retina, and other organs.# Initial goal of therapy is to reduce mean arterial blood pressure by no more than 25% within minutes to 2 h or to a blood pressure in the range of 160/100-110 mmHg. This may be accomplished with IV nitroprusside, a short-acting vasodilator with a rapid onset of action that allows for minute-to-minute control of blood pressure. Parenteral labetalol and nicardipine are also effective agents for the treatment of hypertensive encephalopathy.# In patients with malignant hypertension without encephalopathy or another catastrophic event, it is preferable to reduce blood pressure over hours or longer rather than minutes. This goal may effectively be achieved initially with frequent dosing of short-acting oral agents such as captopril, clonidine, and labetalol.# Currently, in the absence of other indications for acute therapy, for patients with cerebral infarction who are not candidates for thrombolytic therapy, one recommended guideline is to institute antihypertensive therapy only for patients with a systolic blood pressure >220 mmHg or a diastolic blood pressure >130 mmHg. If thrombolytic therapy is to be used, the recommended goal blood pressure is <185 mmHg systolic pressure and <110 mmHg diastolic pressure. In patients with hemorrhagic stroke, suggested guidelines for initiating antihypertensive therapy are systolic >180 mmHg or diastolic pressure >130 mmHg. The management of hypertension after subarachnoid hemorrhage is controversial. Cautious reduction of blood pressure is indicated if mean arterial pressure is >130 mmHg.# In addition to pheochromocytoma, an adrenergic crisis due to catecholamine excess may be related to cocaine or amphetamine overdose, clonidine withdrawal, acute spinal cord injuries, and an interaction of tyramine-containing compounds with monamine oxidase inhibitors. These patients may be treated with phentolamine or nitroprusside.Preferred Parenteral Drugs for Selected Hypertensive EmergenciesHypertensive encephalopathyMalignanthypertension (when IV therapy is indicated)Nitroprusside, nicardipine, labetalol Labetalol, nicardipine, nitroprusside, enalaprilatStrokeNicardipine, labetalol, nitroprussideMyocardial infarction/unstable anginaNitroglycerin, nicardipine, labetalol, esmololAcute left ventricular failureNitroglycerin, enalaprilat, loop diureticsAortic dissectionNitroprusside, esmolol, labetalolAdrenergic crisisPhentolamine, nitroprussidePostoperative hypertensionNitroglycerin, nitroprusside, labetalol, nicardipinePreeclampsia/eclampsia of pregnancyHydralazine, labetalol, nicardipine
Hydralaxine
Sodium nitroprusside
Esmolol
All of the above
C.V.S