Pharm
Nitroprusside
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Nitroprusside
, Nipride
Indications
Hypertensive Emergency
Nicardipine
is now preferred instead for
Hypertensive Emergency
Reduces
Blood Pressure
rapidly
However difficult to titrate due to a wide variation in bloold pressure variation
Well tolerated
Easily reversed by discontinuing infusion
Congestive Heart Failure
with pulmonary congestion
Refractory to
Diuretic
s
Often used in combination with
Dopamine
Similar net effect to
Dobutamine
Nitroglycerin
is preferred in
Coronary Artery Disease
Mechanism
Potent peripheral vasodilation
Effects arterial and venous smooth muscle
Reduces arterial
Blood Pressure
Reduces peripheral arterial resistance
Increases venous capacitance
Decreases
Preload
Risk of reflex
Tachycardia
Metabolism
Metabolites include
Cyanide
and Thiocyanate
Hepatic dysfunction can allow
Cyanide
build-up
Red Blood Cell
s metabolize to
Hydrocyanic acid
Liver
converts to thiocyanate
Renal Excretion
Pharmacokinetics
Very short half-life
Effects are seen almost immediately on infusion
Effects cease as soon as infusion is stopped
Dosing
Preparation
Reconstitute 50-100 mg powder in 2-3 ml D5W
Dilute with 250 ml D5W or
Normal Saline
Final Concentration: 200-400 ug/ml
Additional Measures
Wrap solution immediately in aluminum foil
Prevents deterioration under light exposure
Use solution immediately after making it
Discard solution if becomes highly colored
Solution with faint brown tint is still usable
Infusion
Start 0.1 ug/kg/min
Titrate 0.5 to 8.0 ug/kg/min
Carefully monitor hemodynamic parameters
Use lower doses in elderly
Precautions
Hypotension
may precipitate secondary events
Myocardial Ischemia
or
Myocardial Infarction
Cerebral Vascular accident
Avoid Nitroprusside in
Coronary Artery Disease
Use
Nitroglycerin
instead
Thiocyanate
Intoxication
Rarely seen unless:
Nitroprusside doses over 3 ug/kg/min
Prolonged Nitroprusside infusion over 2-3 days
Renal Failure
Monitor blood thiocyanate level
Levels below 10 mg/100 ml are safe
Signs of thiocyanate
Intoxication
Tinnitus
Blurred Vision
Altered Level of Consciousness
Nausea
Abdominal Pain
Hyperreflexia
Seizure
disorder
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