Nitroprusside: Difference between revisions
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==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Start 0.3 mcg/kg/min IV, max 10 mcg/kg/min for 10 min | |||
==Contraindications== | ==Contraindications== | ||
*Pregnancy | |||
*[[ICH]] - theoretical concern for raising [[ICP]] via cerebral vasodilation, consider [[nicardipine]] instead<ref>Suri MF et al. A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage. Neurocrit Care. 2009;11(1):50-5. doi: 10.1007/s12028-009-9192-1. Epub 2009 Feb 18.</ref> | |||
*Aortic coarctation | |||
*Arteriovenous shunt | |||
*Existing cyanide toxicity | |||
*High output heart failure | |||
*Lack of arterial line monitoring | |||
===Maximum Dose Rate=== | |||
*Infusion at maximum dose rate of 10 mcg/kg/min should never last for more than 10 minutes | |||
*If blood pressure is not controlled after 10 minutes of infusion at max rate, immediately terminate infusion | |||
==Indications== | ==Indications== | ||
*[[Hypertensive emergency]] | |||
*[[CHF]], low output | |||
==Mechanism of Action== | ==Mechanism of Action== | ||
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==Kinetics== | ==Kinetics== | ||
*Cyanide and thiocyanate metabolites potentially toxic | |||
*Metabolized via liver CYP450, excreted via urine | |||
*Half life 2 min | |||
*However, thiocyanate half life is 3 days | |||
==See Also== | ==See Also== | ||
Latest revision as of 23:30, 6 October 2018
Background
- Sodium nitroprusside is primarily used as a potent vasodilator.
- Works predominantly in arterioles and venules as a result of its breakdown to nitric oxide (NO).[1]
- Nitric oxide reduces both total peripheral resistance and venous return, thus decreasing both preload and afterload
- Thiocyanate level when checking for toxicity
Adult Dosing
- Start 0.5 mcg/kg/min IV, increasing 0.5 mcg/kg/min q5 min
- Usual dosage 3-4 mcg/kg/min IV
- Max dose 10 mcg/kg/min for 10 min
Pediatric Dosing
- Start 0.3 mcg/kg/min IV, max 10 mcg/kg/min for 10 min
Contraindications
- Pregnancy
- ICH - theoretical concern for raising ICP via cerebral vasodilation, consider nicardipine instead[2]
- Aortic coarctation
- Arteriovenous shunt
- Existing cyanide toxicity
- High output heart failure
- Lack of arterial line monitoring
Maximum Dose Rate
- Infusion at maximum dose rate of 10 mcg/kg/min should never last for more than 10 minutes
- If blood pressure is not controlled after 10 minutes of infusion at max rate, immediately terminate infusion
Indications
- Hypertensive emergency
- CHF, low output
Mechanism of Action
Potent arteriolar dilation from its active metabolite, nitric oxide (NO).
Adverse Drug Reactions
Kinetics
- Cyanide and thiocyanate metabolites potentially toxic
- Metabolized via liver CYP450, excreted via urine
- Half life 2 min
- However, thiocyanate half life is 3 days
See Also
- ↑ "nitroprusside sodium (Rx) - Nipride, Nitropress, more..". Medscape Reference. WebMD. Retrieved 20 November 2013.
- ↑ Suri MF et al. A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage. Neurocrit Care. 2009;11(1):50-5. doi: 10.1007/s12028-009-9192-1. Epub 2009 Feb 18.