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 532:  SVC Syndrome

Podcast 532: SVC Syndrome

Contributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushin...

14 Jan 20204min

Podcast 531:  Migraine Cocktail

Podcast 531: Migraine Cocktail

Contributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.  The most effective agent in...

13 Jan 20203min

Podcast 530: Anion Gap Acidosis + Metformin Toxicity

Podcast 530: Anion Gap Acidosis + Metformin Toxicity

Contributor: Don Stader, MD Educational Pearls: The common causes of anion gap metabolic acidosis include (MUDPILES) Metformin, Methanol Uremia DKA Paraldehyde INH/Iron Lactate Ethylene Glycol ...

8 Jan 20204min

Podcast 529: Hemophilia

Podcast 529: Hemophilia

Contributor: Aaron Lessen, MD Educational Pearls: Hemophilia is characterized by bleeding (A /B) A is is 8, B (chrstmas, 9) Hemophilia refers to a group of bleeding disorders caused by a deficiency ...

8 Jan 20203min

Podcast 528:  Decompensated Liver Failure

Podcast 528: Decompensated Liver Failure

Contributor: Michael Hunt, MD Educational Pearls: Cirrhosis is the end stage of chronic structural damage to the liver. This is most commonly due to  alcohol but other causes viral hepatitis and hepa...

6 Jan 20204min

Podcast 527: Knee Dislocations

Podcast 527: Knee Dislocations

Contributor:  Erik Verzemnieks, MD Educational Pearls: Knee dislocations are most common in high energy trauma, such as a motor vehicle accident The knee may appear grossly normal on initial inspecti...

3 Jan 20202min

Podcast 526:  Desmopressin for Intracranial Hemorrhage

Podcast 526: Desmopressin for Intracranial Hemorrhage

Contributor: Charleen Melton, PharmD Educational Pearls: Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works b...

30 Dec 20193min

Podcast 525:  Enjoyable Epistaxis?

Podcast 525: Enjoyable Epistaxis?

Contributor: Jared Scott, MD Educational Pearls: The ED is full of painful procedures. One of the most commonly dreaded procedures is nasal packing for epistaxis, as it is quite uncomfortable for the...

24 Dec 20193min

Populärt inom Vetenskap

p3-dystopia
dumma-manniskor
svd-nyhetsartiklar
allt-du-velat-veta
kapitalet-en-podd-om-ekonomi
rss-ufo-bortom-rimligt-tvivel
det-morka-psyket
rss-vetenskapsradion
medicinvetarna
rss-vetenskapsradion-2
rss-experimentet
sexet
hacka-livet
rss-spraket
dumforklarat
pojkmottagningen
rss-arkeologi-historia-podden-som-graver-i-vart-kulturlandskap
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli
halsorevolutionen
paranormalt-med-caroline-giertz