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Hypertensive Crisis Drugs

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teaherbalist2's version from 2017-01-31 14:33

Section

Question Answer
IV LabetalolDosing
20mg initial bolus OR 2mg/min initial infusion over 2 minutes
Titrate every 10 minutes or up to total of 300mg.
PK
Onset: 2-5 min
Peak: 5-15 min
Duration: 2-4 hours
PO Labetalol200mg then 200-400mg in 6-12 hours later. Titrate as appropriate if intending to use maintenance therapy (bid dosing).
IV Phentolamine1-5mg bolus, may repeat with a continuous infusion 1mg/hr titrated to BP response to a max rate of 40mg/hr. (duration is 10-30, onset 1-2 mins).
PO Nifedipine IRNot recommended for HE. Dose is 10mg initial followed by 20mg dose in 20 minutes if needed.
PO Nifedipine ER30-60mg dose once, usual dose range is 30-60.
IV Metoprolol2.5:1 ratio (oral:IV) for equivalent effect. IV onset is 20 mins (PO is 1-2hrs); IV duration ?
IV Sodium Nitroprusside0.3-0.5mcg/kg/min, may be titrated by 0.5mcg/kg/min every few minutes to achieve effect. Max dose 10mcg/kg/min.
Onset is <2 mins. Duration 1-10 minutes.
Hepatic adjustment, none provided but recommends caution. Renal adjustment, none but renal impair increases risk of thiocyanate (limit use).
Metabolized by combining with hemoglobin to produce cyanide. Cyanide detox occurs through conversion to thiocyanate when cyanide is coupled to sulfane sulfur groups from a sulfur donor like thiosulfate.
ThiosulfateStart with 12.5g dose, may repeat with 6.25g dose if symptoms return.
Hydroxocobalamin
IV Nitroglycerin5mcg/min, increase by 5mcg/min every 3-5 minutes to 20mcg/minute. If no response, then increase by 10-20mcg/min every 3-5 minutes. Max dose ~400mcg/min.
IV Hydralazine
PO Hydralazine
PO Minoxidil5mg once daily, increase gradually every 3 days (or every 6 hours under close monitoring).
Clonidine
IV Enalaprilat1.25mg/dose over 5 minutes every 6 hours. Doses as high as 5mg/dose every 6 hours have been tolerated for up to 36 hours. IV to PO conversion, start enalapril 5mg daily or 2.5mg daily for 1.25mg and 0.625mg IV q6hr doses respectively.
Onset ~15min. Peak 1-4 hours. Duration 6 hours
Captopril
Nicardipine5mg/hr initial infusion may increase by 2.5mg/hr every 5-15mins up to a max of 15mg/hr. For rapidly titrated patients, consider reducing to 3mg/hr once goal BP obtained, adjust to maintain.
Onset within minutes. Peak effect by 45 mins. Duration ~8hrs or less.
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