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Nitroprusside: |
Nitrate |
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IVP DOSING |
| ? mcg/kg/min |
Only give IVP if you're REALLY tired of being a nurse!!! |
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INFUSION DOSING |
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Titrate in 0.5-1 mcg/kg/min increments every 5-15 minutes. Reduce the dose for older people and those with renal issues... You'll find it very easy to evaluate the patient's responsiveness to this drug! Also, be sure and keep both the IV bag and your patient from going towards the light... |
0.1-5 mcg/kg/min |
Like
Nitroglycerine, Nitroprusside works by delivering an exogenous supply of nitric
oxide to vascular tissue, which plays a major role in relaxing vascular smooth
muscle, causing both arterial and venous dilation.
It is more or less equally effective in dilating both arterioles and
veins, and thus its effects are dramatic. Even a very small bolus can cause
severe hypotension.
Its onset is rapid (1-2min), and its loss of effect is
also very rapid (10min).
Its use is mainly restricted to acute and severe HTN and CHF.
Side Effects: HA, ¯ BP, HR, N/V, ICP, hypoxemia, CO2 retension, anxiety, flushing, acidosis. Thiocyanate and cyanide toxicity can occur rapidly with higer infusion rates, and length of time on drug. Check serum thiocyanate levels Q 72hrs, and be vigilant for symptoms which become likely with serum levels >100mcg/ml. Symptoms of toxicity are worsening hypotension, metabolic acidosis, dyspnea, impaired LOC, HA, N/V, and ataxia. Treatment is 1st with a 3% sodium nitrate solution at < 2.5cc/min up to 10-15cc, followed by sodium thiosulfate, 12.5g in 50cc of D5W over 10 minutes.
Contraindicated:
in hypotension, compensatory HTN (aortic stenosis, AV shunt), use of Viagra in
prior 24 hours.
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