Hypotension emergency

The most serious complication of pericarditis is cardiac tamponade which is manifested by shortness of breath and hypotension. Emergency pericardiocentesis is required. In most cases, the frequency and duration of dialysis should be increased after pericarditis develops. Pericarditis is an absolute indication for beginning haemodialysis if the patient has not been previously dialyzed. Indomethacin may be used in patients with chest pain, although its value has not been substantiated by placebo-controlled studies. 

Hypotensive emergencies during spinal anesthesia IV Initially, 0.2 mg IV. Subsequent doses should not exceed the previous dose by more than 0.1 to 0.2 mg. Maximum of 0.5 mg per dose. 

Adrenaline is used in cardiac resuscitation to convert asystole prior to defibrillation. It is also used in acute hypotensive emergencies and low cardiac output states, especially in severe sepsis or following extracorporeal circulation in cardiac surgery. In anaphylactic shock the combination of powerful a (vasoconstriction) and 32 (bronchodilatation) effects may be life-saving (Appendix AAGBI protocol). Adrenaline is also used to relieve bronchoconstriction in bronchial asthma and status asthmaticus. Dose... 

Cardiovascular Postural hypotension emerged as a dose-limiting event during the development of maraviroc. In a phase I single-dose study, there was orthostatic hypotension in four of nine patients who took a dose of 1200mg[239 =]. 

No natural products or their analogues are included among the pyridopyridazines, but several interesting biologically active compounds have emerged. Some l-chloro-4-hydrazino- and 4-chloro-l-hydrazino-pyrido[2,3-d]pyridazines (460) are very active hypotensives, whilst related dialkoxy compounds have anticonvulsant activity (65CPB586). 

When diazoxide or nitroprusside isused fora hypertensve emergency, the nurse placesthe patient in a supine position immediately before, as well as after, administration of the drug. The rate of infusion (nitroprussde) or rate of direct IV administration (diazoxide) and the patient s blood pressure are monitored closely during and after administration of the drug because severe hypotension can occur. The blood pressure and pulse rate may need to be monitored every 15 minutes until the blood pressure is reduced to safe levels The systolic pressure should not drop below 60 mm Hg. 

Labetalol hydrochloride 20-80 mg IV bolus every 10 minutes 5-10 minutes 3-6 hours Vomiting, scalp tingling, dizziness, bronchoconstriction, nausea, heart block, orthostatic hypotension Most hypertensive emergencies except acute heart failure... 

Disulfiram works by irreversibly blocking the enzyme aldehyde dehydrogenase, a step in the metabolism of alcohol, resulting in increased blood levels of the toxic metabolite acetaldehyde. As levels of acetaldehyde increase, the patient experiences decreased blood pressure, increased heart rate, chest pain, palpitations, dizziness, flushing, sweating, weakness, nausea and vomiting, headache, shortness of breath, blurred vision, and syncope. These effects are commonly referred to as the disulfiram-ethanol reaction. Their severity increases with the amount of alcohol that is consumed, and they may warrant emergency treatment. Disulfiram is contraindicated in patients who have cardiovascular or cerebrovascular disease, because the hypotensive effects of the disulfiram-alcohol reaction could be fatal in such patients or in combination with antihypertensive medications. Disulfiram is relatively contraindicated in patients with diabetes, hypothyroidism, epilepsy, liver disease, and kidney disease as well as impulsively suicidal patients. 

Parenfera/- The most important treatment-emergent adverse effects were hypotension, asystole/cardiac arrest/electromechanical dissociation (EMD), cardiogenic shock, CFIF, bradycardia, liver function test abnormalities, VT, and AV block. The most common adverse effects leading to discontinuation of IV therapy were hypotension, asystole/cardiac arrest/EMD, VT, and cardiogenic shock. Adverse reactions occurring in at least 3% of patients include nausea. 

Hypotension Patients may develop sudden, severe hypotension after a single dose, whether given IV or IM. Therefore, patients receiving the drug should be supine monitor blood pressure closely during drug administration and several times thereafter until the blood pressure is stable. Have equipment for emergency resuscitation readily available. If pentamidine is administered IV, infuse over 60 minutes. 

Nowadays a broad spectrum of quite specific blood pressure lowering drugs is available which restricts the use of ganglion blockade. There are only a few situations in which the pharmacological blockade autonomous ganglia is clinically useful hypertensive emergencies, controlled hypotension in neurosurgery and in the treatment of pulmonary edema. 

If a patient s blood pressure is greatly increased, pharmacological treatment should be instituted. Treatments for MAOI-induced hypertension include administration of the calcium channel blocker nifedipine and use of drugs with a-adrenergic-blocking properties, such as phentolamine (5 mg intravenous). Because treatment with phentolamine may be associated with cardiac arrhythmias or severe hypotension, this approach should be carried out only in an emergency department setting. 

Cardiovascular effects. Hypotension and tachycardia occur in most patients taking clozapine. Cases of potentially fatal myocarditis and dilated cardiomyopathy have been reported in association with clozapine (Kilian et al. 1999). Myocarditis typically occurred within 3 weeks of starting clozapine, but cardiomyopathy may not be apparent for several years. Although rare, treatment-emergent myocarditis and cardiomyopathy occur at a reportedly higher incidence with clozapine than with other antipsychotics (Coulter et al. 2001). The mechanism by which clozapine may cause myocarditis has not been established, but some authors have speculated that clozapine may cause an immunoglobuhn E (IgE)-mediated type 1 hypersensitivity reaction (Kihan et al. 1999) or a hypereosinophilic syndrome (Hagg et al. 2001). 

Relative to other psychotropics, acute BZD treatment is associated with fewer unwanted effects. Sedation is usually the most prominent initial complication, subsiding in about a week as anxiolytic action emerges (186). Confusion, ataxia, excitement, agitation, transient hypotension, vertigo, and gastrointestinal distress may also occur in a small number of patients. 

Nitroprusside Releases nitric oxide Powerful vasodilation Hypertensive emergencies Parenteral short duration Toxicity Excessive hypotension, shock... 

Combined arteriolar and venodilator Releases NO spontaneously activates guanylyl cyclase Marked vasodilation reduces preload and afterload Acute cardiac decompensation hypertensive emergencies (malignant hypertension) IV only duration 1-2 min. Toxicity Excessive hypotension, thiocyanate and cyanide toxicity Interactions Additive with other vasodilators... 

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