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



Episoder(1145)

Podcast 818: Local Anesthetics and LAST

Podcast 818: Local Anesthetics and LAST

Contributor: Don Stader, MD Educational Pearls: There are two major groups of local anesthetics: Amide and Esther To recall what group an anesthetic belongs to, use this memory trick: Amide has...

4 Okt 20226min

Podcast 817: MI Risk during Elections

Podcast 817: MI Risk during Elections

Contributor: Aaron Lessen, MD Educational Pearls: 2020 retrospective study with dat from two California hospitals compared rates of cardiovascular admissions in a five day period two weeks before and...

3 Okt 20222min

Podcast 816: Ventilator Management in Asthmatics

Podcast 816: Ventilator Management in Asthmatics

Contributor: Aaron Lessen, MD Educational Pearls: The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation Asthma is an obstructive...

27 Sep 20224min

Podcast 815: Fluid Resuscitation in Pancreatitis

Podcast 815: Fluid Resuscitation in Pancreatitis

Contributor: Aaron Lessen, MD Educational Pearls: Historically, pancreatitis has been treated with aggressive IV fluid rehydration. Recently published data shows this may not be appropriate. A random...

26 Sep 20223min

Podcast 814: Post-concussion Treatment

Podcast 814: Post-concussion Treatment

Contributor: Aaron Lessen, MD Educational Pearls: Recent study looked at the impact of screen time on duration of post-concussive symptoms 125 patients aged 12-25 diagnosed with a concussion were ran...

19 Sep 20222min

Podcast 813: Pulse Oximetry

Podcast 813: Pulse Oximetry

Contributor: Travis Barlock, MD Educational Pearls: Most oxygen in the body is bound to hemoglobin, forming oxyhemoglobin. Less than 1% of the oxygen in the body is dissolved in plasma.  Pulse Oximet...

13 Sep 20224min

Podcast 812: PO Medications

Podcast 812: PO Medications

Contributor: Nick Tsipis, MD Educational Pearls: PO medications are less frequently used in the ED due to their longer onset of action The position the patient is in when given PO medications ...

12 Sep 20223min

Podcast 811: Ketamine for Pain

Podcast 811: Ketamine for Pain

Contributor: Lessen, Aaron MD Educational Pearls: Ketamine can be given at 0.2-0.3 mg/kg as subdissociative doses for pain control in the ED Ketamine coadministered with Haldol may reduce agitation...

7 Sep 20223min

Populært innen Vitenskap

fastlegen
tingenes-tilstand
rekommandert
jss
rss-nysgjerrige-norge
rss-rekommandert
sinnsyn
forskningno
rss-paradigmepodden
villmarksliv
vett-og-vitenskap-med-gaute-einevoll
fjellsportpodden
nordnorsk-historie
smart-forklart
rss-overskuddsliv
diagnose
abid-nadia-skyld-og-skam
aldring-og-helse-podden
pod-britannia
tidlose-historier