Pharmacology: Antihypertensive Medication – IV gtt (Drip)

Hypertension (HTN)

Evaluation & Management

IV gtt (Drip) Antihypertensive Medication

Esmolol

  • Mechanism of Action: Beta Blocker
  • Dosing:
    • Bolus: 500-1,000 mcg/kg
    • Infusion: 50-300 mcg/kg/min
      • Start at 50-150 mcg/kg/min
  • Timing:
    • Onset: 1-2 Minutes
    • Duration: 10-30 Minutes
  • Contraindications:
    • Severe Bradycardia
    • 2nd/3rd Degree Heart Block
    • Cardiogenic Shock
    • Decompensated Heart Failure
    • Sick Sinus Syndrome
    • Pulmonary Hypertension
    • Hypersensitivity

Fenoldopam

  • Mechanism of Action: Dopamine-1 Agonist
  • Dosing: 0.1-1.6 mcg/kg/min
    • Start at 0.1-0.3 mcg/kg/min
  • Timing:
    • Onset: 5-10 Minutes
    • Duration: 30-60 Minutes
  • Intended Only for Short-Term (< 48 Hour) Management
  • Supports Renal Perfusion – Beneficial Over Others in AKI
  • Contraindications: None
    • Caution in Patients with Glaucoma

Nicardipine (Cardene)

  • Mechanism of Action: Calcium Channel Blocker (CCB)
  • Dosing: 5-15 mg/hr
    • Start at 5 mg/hr
  • Timing:
    • Onset: 1-2 Minutes
    • Duration: Less Than 8 Hours (50% Within the First 30-45 Minutes)
  • Contraindications:
    • Severe Aortic Stenosis
    • Hypersensitivity

Clevidipine (Cleviprex)

  • Mechanism of Action: Calcium Channel Blocker (CCB)
  • Dosing: 1-21 mg/hr
    • Start at 1-2 mg/hr
  • Timing:
    • Onset: 2-4 Minutes
    • Duration: 5-15 Minutes
  • Contraindications:
    • Severe Aortic Stenosis
    • Allergy to Soy or Eggs
    • Defect in Lipid Metabolism
    • Hypersensitivity

Nitroglycerin

  • Mechanism of Action: Nitrate Vasodilator by Generation of Free Radical Nitric Oxide
  • Dosing: 5-200 mcg/min
    • Start at 5-10 mcg/min
  • Timing:
    • Onset: Immediate
    • Duration: 3-5 Minutes
  • Should Not Be Used Longer than 24-48 Hours – Develop Tachyphylaxis
  • Contraindications:
    • Concurrent Use of PDE-5 Inhibitors
    • Increased Intracranial Pressure
    • Hypersensitivity

Sodium Nitroprusside

  • Mechanism of Action: Nitrate Vasodilator by Generation of Free Radical Nitric Oxide
  • Dosing: 0.1-10 mcg/kg/min
    • Start at 0.3-0.5 mcg/kg/min
  • Timing:
    • Onset: Immediate
    • Duration: 1-10 Minutes
  • Contraindications:
    • Pregnancy
    • Concurrent Use of PDE-5 Inhibitors
    • Acute Heart Failure with Reduced Systemic Vascular Resistance
    • Hypersensitivity
  • Limit Use in Renal Impairment – Toxicity Due to Thiocyanate Accumulation

Phentolamine

  • Mechanism of Action: Alpha Blocker
  • Most Often Used in the Setting of Catecholamine Excess (Pheochromocytoma)
  • Dosing:
    • Bolus: 1-5 mg
    • Infusion: 1-40 mg/hr
  • Timing:
    • Onset: 1-2 Minutes
    • Duration: 10-30 Minutes
  • Contraindications:
    • Coronary Artery Disease (CAD)
    • Myocardial Infarction (MI)
    • Hypersensitivity