Hypertensive Emergency

Question 1

What is the mechanisms of nitroglycerin and nitroprusside?

Answer 1

1. Provide NO
2. Induces vasodilation of both arterioles and veins via generation of cGMP
3. cGMP activates Ca sensitve potassium channels

Question 2

What is the starting dose of nitroprusside? Max? Limitation with max?

Answer 2

1. 0.25-0.5 mcg/kg/min

2. 8-10 mcg/kg/min (Danger! use

Question 3

What is a toxicity of nitroprusside? How is this presented (signs in a patient)?

Answer 3

1. Metabolized to cyanide
2. Altered mental status
3. Lactic acidosis

Question 4

What is an important dose to remember with nitroprusside?

Answer 4

Doses > 2mcg/kg/min exceed the capacity of the body to detoxify cyanide