COMEDK 2007 MCQ Answer 149
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The correct answer is D
Antihypertensive Agents That Are Useful in Hypertensive Crises
Antihypertensive Agents That Are Useful in Hypertensive Crises
- Nitroprusside (Nipride) IV
Initial dose 0.3 µg/kg/min (Max dose 10µg/kg/min) Onset of action <1>10 mg/dl is toxic; >20 mg/dl may be fatal) ; hypotension, N&V, apprehension, convulsion, twitching, psychosis, dizziness, etc. It has decreased efficacy in renal failure - Nitroglycerin IV
Initial dose 5 µg/min (Max dose 100 µg/min) Onset of action <5> - Labetalol (Trandate) IV
Mixed alpha/beta blocker, excellent for most hypertensive emergencies.
First or second line for eclampsia; excellent in catecholamine surges
Initial dose :20 mg IV bolus over 2 minutes, then 20- 80 mg q10 min prn, or Continuous infusion at 0.5-2.0 mg/min (Max dose 300 mg),
Onset of action <5>first-degree heart block, severe bradycardia - Diazoxide (Hyperstat) IV
Initial dose: 1-3 mg/kg (up to 150 mg) IV bolus q5-15 min over 5 minutes until BP is controlled (Max dose 600 mg),
Onset of action <2> - Nicardipine (Cardene) IV
Initial dose: 5 mg/h (Max dose 15 mg/h), Onset of action <1 color="#0000ff">Best use for Vascular surgery, subarachnoid hemorrhage
Side effects: Headache ,Elevated heart rate
Contraindication: Severe aortic stenosis - Enalapril (Vasotec) IV
Highly variable response; precipitous BP drop in high-renin states, rarely angioedema, hyperkalemia, or acute renal failure.
Initial dose: 1.25 -5mg IV over 5 min q6h if needed, duration 6 hours
Best use for Left ventricular failure
Contraindication: Angioedema - Diltiazem (Cardizem) IV
Initial dose 0.25 mg/kg over 2 min, followed by infusion of 0.35 mg/kg at an initial rate of 10 mg/hour
Onset: 3-30 min
Adverse effects: excessive hypotension, flushing - Trimethaphan
Initial dose: 1 mg/min (Max dose 4 mg/min), Onset of action <5> - Hydralazine (Apresoline) IV
Indicated primarily for eclampsia
Dose is 10-50 mg IV or IM titrate to effect (onset <20> - Phentolamine
Mainly for catecholamine surges as in pheochromocytoma hypertension (pure alpha-adrenergic blockade)
Dose is 5-15mg IV; onset 1-2 minutes; duration 3-10 minutes
Side effects: Tachycardia, flushing and headache may occur - Esmololol (Breviblock®)
Mainly for acute aortic dissection, perioperatively, acute coronary ischemia
May be used with caution in acute MI with depressed LV to modulate heart rate
Very short half life (2-4 minutes) non-selective ß-blockade
Dose is 250-500µg/kg/min for 1 minute, then 50-100µg/kg for 4 minutes
Sequence may be repeated, and continuous drip may be maintained
Onset of action is 1-2 minutes; 10-20 minute duration
Very close monitoring is required, and fluid load is large with this agent
Tags: Hypertensive Crisis
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