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



Avsnitt(1146)

Podcast 664: Rabies Prophylaxis

Podcast 664: Rabies Prophylaxis

Contributor: Jared Scott, MD Educational Pearls: 1-3 cases of rabies per year in US with 55,000 people per year receiving rabies prophylaxis 90% of rabies cases come from wildlife, most commonly by ...

27 Apr 20215min

Podcast 663:  Down Syndrome

Podcast 663: Down Syndrome

Contributor:  Alicia Oberle, MD Educational Pearls: Down Syndrome with Trisomy 21 have three copies of chromosome 21 Current birth rates are around 1 in 700 births  Average life span 25 years in 1980...

26 Apr 20213min

UnfilterED #13: Dr. Nadia Tremonti

UnfilterED #13: Dr. Nadia Tremonti

This week's episode features a fascinating conversation with Dr. Nadia Tremonti, medical director for the pediatric palliative care program at Children's Hospital of Michigan in Detroit. Dr. Tremonti ...

22 Apr 20211h 3min

Podcast 662: Droperidol for Sedation

Podcast 662: Droperidol for Sedation

Contributor:  Aaron Lessen, MD Educational Pearls: Droperidol for sedation in agitated patients in the emergency department was studied compared to ziprasidone (Geodon) and lorazepam (Ativan) Double-...

21 Apr 20213min

Podcast 661: Scalded Skin Syndrome

Podcast 661: Scalded Skin Syndrome

Contributor:  Ricky Dhaliwal, MD Educational Pearls: Primarily affects children Caused by staph aureus releasing exotoxins that result in erythema and sloughing of the skin Present with significant ...

20 Apr 20212min

Podcast 660: Rhabdomyolysis

Podcast 660: Rhabdomyolysis

Contributor: Ricky Dhaliwal, MD Educational Pearls: Rhabdomyolysis occurs when high levels of myoglobin are released from dying muscle tissue into the blood Severe levels of myoglobin cause renal in...

19 Apr 20215min

Podcast 659: Racial Bias in Pulse Oximetry

Podcast 659: Racial Bias in Pulse Oximetry

Contributor:  Aaron Lessen, MD Educational Pearls: Study in NEJM looked at occult hypoxemia, when oxygen saturation reads at >92% when the actual saturation is Rate of occult hypoxemia was 3 times h...

14 Apr 20213min

Podcast 658: Febrile Seizures

Podcast 658: Febrile Seizures

Contributor: Peter Bakes, MD Educational Pearls: Febrile Seizure clinical criteria 6 months - 5 years of age Rapid rise in temp No preexisting seizure disorder No other explanation for the seizure...

13 Apr 20214min

Populärt inom Vetenskap

p3-dystopia
dumma-manniskor
svd-nyhetsartiklar
allt-du-velat-veta
kapitalet-en-podd-om-ekonomi
det-morka-psyket
rss-ufo-bortom-rimligt-tvivel
sexet
rss-vetenskapsradion
pojkmottagningen
rss-vetenskapsradion-2
dumforklarat
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli
halsorevolutionen
rss-spraket
bildningspodden
hacka-livet
rss-experimentet
medicinvetarna
rss-lara-fran-larda-en-fackbok-och-en-forfattare