Podcast 592:  Rapid Antihypertensives

<p><strong>Contributor: Ramnik Dhaliwal, MD, JD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Nitrates</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Nitroprusside: becomes effective in under a minute, and becomes ineffective 10 minutes after stopping it. </span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Nitroprusside can metabolize into cyanide leading to toxicity, however this is rare.</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Nitroglycerin: predominately causes vasodilation but some arterial dilation as well; preferred agent in patients with volume overload/CHF</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">A</span><span style= "font-weight: 400;">drenergic Blocking Agents</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Labetalol: alpha/beta-blocking agent with a rapid onset of 5 minutes or less given as bolus or intravenous drip</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Esmolol: cardioselective beta blocker with rapid onset and short duration of action making it easily titratable</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">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.</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Calcium Channel Blockers</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Nicardipine: Given as an IV infusion starting at 5