Hypertension intravenous

Tetanus toxin often causes disturbances in autonomic control, resulting in sympathetic overactivity and high plasma catecholamine concentrations. The first-line treatment for autonomic dysfunction is by sedation with a benzodiazepine and opioid. Infusion of the short-acting i-blocker esmolol, or the o -adrenergic agonist clonidine, helps to control episodes of hypertension. Intravenous magnesium sulphate is also used to reduce autonomic disturbance. 

Oral indometacin abolished the hypotensive effects of intravenous hydralazine in one study, but no effect was found in another. In patients with pulmonary hypertension, intravenous indometacin reduced the effects of intravenous hydralazine, and in patients with hypertension, intravenous diclofenac reduced the effects of intravenous dihydralazine. 

Untoward effects of both E and NE (usually to a lesser degree) are anxiety, headache, cerebral hemorrhage (from vasopressor effects), cardiac arrhythmias, especially in presence of digitaUs and certain anesthetic agents, and pulmonary edema as a result of pulmonary hypertension. The minimum subcutaneous lethal dose of E is about 4 mg, but recoveries have occurred after accidental overdosage with 16 mg subcutaneously and 30 mg intravenously, followed by immediate supportive treatment. 

Diaz oxide (Hyperstat IV) and nitroprusside (Nitropress) are examples of intravenous (IV) drugs that may be used to treat hypertensive emergencies. A hypertensive emergency is a case of extremely high blood pressure that does not respond to conventional antihypertensive drug therapy. 

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

Etomidate Inhibits 1 7, 20-lyase, 6 g/day Limited clinical hypokalemia, edema, hypertension. Injection-site pain, aminoglutethimide if used in combination. Intravenous route of administration... 

N, nausea D, diarrhea HA, headache SOB, shortness of breath HTN, hypertension LFTs, liver function tests CBC, complete blood count ISR, injection-site reactions IR, infusion reactions IV, intravenous MYL, myelosuppression (watch for fever, symptoms of infection, easy bruisability, and bleeding) SC, subcutaneous. 

A dramatic example of photolysis is the photodegradation of sodium nitroprusside in aqueous solution. Sodium nitroprusside, Na2Fe(CN)5NO-2 H20, is administered by intravenous infusion for the management of acute hypertension. If the solution is protected from light it is stable for at least one year if exposed to normal room light, it has a shelf life of only 4 hours [35]. 

American Journal of Cardiology Figure 13. Sequential changes with intravenous and long-term Propranolol therapy in the same 10 hypertensive patients (31)... 

Intravenous administration of 4—lOmg/kg produced bradycardia and an initial transient hypertensive effect in the anesthetized dog. Toxicity is thought to occur from the decomposition of decaborane to a stable intermediate that in turn inhibits intracellular pyri-doxal phosphate-requiring enzymes. ... 

Sodium nitroprusside is a powerful, instantaneous-acting intravenous drug used to lower blood pressure in hypertensive crises. The hypotensive effect is caused by peripheral vasodilation resulting from a direct effect on both arterial and venous vessels. 

Urapidil is a selective ai-adrenoceptor antagonist with an additional central antihypertensive mechanism, mediated by the stimulation of serotonergic (5-HTia) receptors in the brain. It may be used in the treatment of essential, but also acute, peri-operative hypertension. The intravenous administration in the treatment of acute, peri-operative hypertension is not associated with a rise of intracranial pressure, in contrast to various other vasodilators. For this reason, urapidil may be used in neuro-surgical interventions. 

Diazoxide is a potassium channel opener with a rapid antihypertensive action after intravenous administration. Diazoxide causes hyperglycaemia which may underlie side-effects such as nausea and vomiting, cardiac dysrhythmia and ketosis. Diazoxide was used occasionally in the management of hypertensive emergencies, but it is now largely abandoned for this indication. Diazoxide is an alternative for glucagons in patients with hypogycaemia. 

Sodium nitroprusside (SNP) is both a venous and an arterial vasodilator. An important part of its vasodilator action is caused by the release of nitric oxide (NO), similarly as for the organic nitrates. SNP can only be administered via the intravenous route. It is a rapidly and short acting vasodilator. It has been used in the treatment of hypertensive emergencies and in the management of myocardial ischaemia. In spite of its vasodilator action it hardly influences heart rate, in contrast to hydralazine and minoxidil. The dosage of SNP should not be higher than 3 pg/kg/min within 48 h, in order to avoid the rise of cyanide ions and thiocyanate in the blood. 

Aldesleukin is a recombinant form of human Interleukin-2 (IL-2). It has been approved for the treatment of malignant melanoma and renal cell cancer. The medicine is administered every 8 hours by a 15-minute intravenous infusion for a maximum of 14 doses. Adverse reactions include hypo- and hypertension, gastrointestinal disturbances, fever, fatigue, lethargy, joint pain, headache. Cardiovascular problems may occur. 

Nitroglycerin by sublingual tablet (0.4 mg) every 5 minutes for a total of 3 doses will be used for ischemic discomfort relief. Intravenous injection will be considered when the ischemic discomfort, hypertension or pulmonary congestion cannot be controlled. Nitrates should not be used when the blood pressure is lower than 90 mmHg or 30 mmHg lower than a known base line value, bradycardia less than 50 bpm, tachycardia more than 100 bpm or suspected right ventricular (RV) infarction. 

---