Podcast 592:  Rapid Antihypertensives

Podcast 592: Rapid Antihypertensives

Contributor: Ramnik Dhaliwal, MD, JD

Educational Pearls:

  • Nitrates
    • Nitroprusside: becomes effective in under a minute, and becomes ineffective 10 minutes after stopping it.
      • Nitroprusside can metabolize into cyanide leading to toxicity, however this is rare.
    • Nitroglycerin: predominately causes vasodilation but some arterial dilation as well; preferred agent in patients with volume overload/CHF
  • Adrenergic Blocking Agents
    • Labetalol: alpha/beta-blocking agent with a rapid onset of 5 minutes or less given as bolus or intravenous drip
    • Esmolol: cardioselective beta blocker with rapid onset and short duration of action making it easily titratable
    • Hydralazine: direct arterial dilator; patient dependent response that can be unpredictable. Use with caution in patients with CAD or an aortic dissection because there will be a reflexive increase in heart rate to combat the arteriolar dilation.
  • Calcium Channel Blockers
    • Nicardipine: Given as an IV infusion starting at 5g/hr up to 15g/hr. This drug has a slower onset of action making it difficult to titrate and it has a longer serum elimination half-life (3-6 hours)
    • Clevidipine: rapid onset and short duration of action; Reduces BP without affecting cardiac filling pressures but can cause reflex tachycardia

References

)Wani-Parekh P, Blanco-Garcia C, Mendez M, Mukherjee D. Guide of Hypertensive Crisis Pharmacotherapy. Cardiovasc Hematol Disord Drug Targets. 2017;17(1):52-57. doi:10.2174/1871529X16666161220142020

Suneja M, Sanders ML. Hypertensive Emergency. Med Clin North Am. 2017;101(3):465-478. doi:10.1016/j.mcna.2016.12.007

Maloberti A, Cassano G, Capsoni N, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. High Blood Press Cardiovasc Prev. 2018;25(2):177-189. doi:10.1007/s40292-018-0261-4

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD



Jaksot(1146)

Podcast 576: Status Epilepticus Drugs

Podcast 576: Status Epilepticus Drugs

Author: Charlene Gnisci Melton, PharmD Educational Pearls: Status Epilepticus is defined as continuous seizure activity for >5 minutes, or 2 or more seizures without full return to consciousness betw...

7 Heinä 20205min

Podcast 575:  Light on the Sedation

Podcast 575: Light on the Sedation

Contributor: Aaron Lessen, MD Educational Pearls: Studies have shown that patients who are under deeper sedation in the ICU have worse outcomes. Recent study compared lighter vs heavier sedation of p...

6 Heinä 20202min

Epidemic Meets Pandemic #4: The Patient Perspective

Epidemic Meets Pandemic #4: The Patient Perspective

This limited series will investigate how the nation's opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction me...

6 Heinä 202047min

Epidemic Meets Pandemic #3: The Law Enforcement Perspective

Epidemic Meets Pandemic #3: The Law Enforcement Perspective

This limited series will investigate how the nation's opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction me...

1 Heinä 20201h 2min

Epidemic Meets Pandemic #2: The Addiction Medicine Perspective

Epidemic Meets Pandemic #2: The Addiction Medicine Perspective

This limited series will investigate how the nation's opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction me...

30 Kesä 202029min

Epidemic Meets Pandemic #1: The Harm Reductionist Perspective

Epidemic Meets Pandemic #1: The Harm Reductionist Perspective

This limited series will investigate how the nation's opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction me...

29 Kesä 202041min

UnfilterED Clips: A Toxicologist's Perspective on COVID-19, Biological Warfare and the Need for Disaster Preparedness

UnfilterED Clips: A Toxicologist's Perspective on COVID-19, Biological Warfare and the Need for Disaster Preparedness

Taken from 'UnfilterED #8: Dr. Christopher Hoyte'. "This current sars-coV-2 / COVID-19 situation should really be a wake-up call for not just a pandemic, but for a biological attack...One of the thing...

27 Kesä 202011min

UnfilterED #8: Dr. Christopher Hoyte

UnfilterED #8: Dr. Christopher Hoyte

Dr. Chris Hoyte is an ED physician, toxicologist and researcher based in Denver, CO. He was featured in Bring Em' All: Chaos. Care. Stories from Medicine's Front Line, a book celebrating emergency phy...

24 Kesä 202047min

Suosittua kategoriassa Tiede

rss-poliisin-mieli
tiedekulma-podcast
rss-mita-tulisi-tietaa
docemilia
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita
rss-duodecim-lehti
utelias-mieli
radio-antro
rss-astetta-parempi-elama-podcast
rss-lapsuuden-rakentajat-podcast
rss-lihavuudesta-podcast
rss-sosiopodi