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Nitroprusside dilates both arteries and veins, but generates cyanide w prolonged use of high doses as it breaks down Starting dose is 0 3– 0 5mcg/min, and max  

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blood pressure (hypertensive crises) that require medical treatment However, only infusion of an intravenous antihypertensive agent as first line therapy [55 ]

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high blood pressure may present as a true hypertensive emergency caused by doses (5 μg min 1) and as the infusion rate is increased usually by titrating the 

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Elevated blood pressure alone, in the absence of symptoms or new or progressive infusion Maximal dose rate must not be infused for > 10 minutes If BP

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UHS P&T Cardiovascular Subcommittee

Guidelines for the Urgent or Emergent Therapy of Hypertension

November 1998

The section in quotations has been abstracted from JNCvi, the 6 th

Report of the Joint National Committte on the

Detection, Evaluation and Treatment of Hypertension (NIH/NHLBI 1997). sublingual administration of fast-acting nifedipine has

been widely used forthis purpose, several serious adverse effects have been reported with itsuse and the inability to

control the rate or degree of fall in bloodpressure makes this agent unacceptable. The routine use of sublingual

nifedipine whenever blood pressure rises beyond a predetermined level in postoperative or nursing home patients is also not appropriate.

Cocaine

Amphetamines

Table 1: Drug Treatment of Hypertensive Urgencies and Emergencies according to co-morbidity or syndrome of

acute end-organ dysfunction CircumstancePreferred DrugsDrugs to Avoid (or Use With

Caution)

Table 2 Management of Hypertensive Emergencies and Urgencies according to drug Before ordering a medication, ask yourself the following questions improve any quickly

Goals & Pearls

frequently more harmful to reduce pressure quickly, than to control it gradually. emergencies

Accelerated

hypertension urgencies controlled reduction Short-acting Nifedipine should not be used for therapy of any form of hypertension in adults. Drug Dose OnsetCautions, Adverse Effects & Additional Comments

PARENTERAL VASODILATORS

Sodium

Nitroprusside

(Nipride) and infusion tubing

Nitroglycerin

Fenoldopam

(Corlopam®)

Diazoxide

Hydralazine

(Apresoline®)

Enalaprilat

(Vasotec IV®) (Not

Formulary)

Nicardipine

(Cardene IV®)Gradual reduction: every15 minutes

Rapid reduction:

every 5 minutes.

PARENTERAL ADRENERGIC INHIBITORS

Labetalol

(Normodyne®

Trandate®)

very

Phentolamine

(Regitine®)

Trimethaphan

(Arfonad®)

Methyldopate

(Aldomet IV®)

ORAL AGENTS

Captopril

(Capoten®)

Labetalol

(Normodyne®

Trandate®)

Clonidine

(Catapres®) Corlopam (Fenoldopam 1ml and 2 ml amps for IV infusion after dilution, Neurex Corp) principal alternativesSodium Nitroprusside (Nipride) and Nicardipine (Cardene). and one of the followingquotesdbs_dbs4.pdfusesText_8