Drugs
Mechanism of
Action
Labetolol
Alpha 1 and
Beta 1 & 2
receptor
blockers
Esmolol
Beta 1 receptor
blocker, little or no
B2 except @ high
doses. No ISA
Uses
Mild to severe
HTN or
hypertensive
emergencies
SVT, A-fib, Aflutter, HTN
Onset
2-5 minutes
2-10 minutes
Metoprolol
B1 competetive
inhibitor. No
ISA
Hydralazine
Direct
vasodilation
of arterial
smooth
muscle.
Decreases
diastolic >
systolic,
increases
HR, CO ,
SV, also
causes Na
and H20
retention.
Nitroglycerin
Organic nitrate:
vasodilating
agent, releases
tension on
vascular smooth
muscle and
dilates peripheral
veins and
arteries.
Converted to
nitric oxide
intracellularly
Increases cGMP
in smooth
muscle.
Decreases
preload and
afterload
Ventricular
Moderate to HTN, CHF, MI
arrythmias,
severe HTN, with
HTN, angina,
precomplications,
A-flutter, A-fib, eclampsia,
Angina
symptomatic tx with
of hypertropic
isosorbide
subaortic
dinitrate in
stenosis
African
American in
CHF
20 minutes
5-20
immediate
minutes
Nitroprusside
Direct arterial and
peripheral
vasodilation
Hypertensive
crisis, CHF
< 2 minutes
Peak
5-15 minutes
Duration
Metabolism
2-4 hours
Hepatic
10-30 minutes
Red blood cell
esterases
5-8 hours
Hepatic
T 1/2
Excretion
Dose
5.5 hours
urine
Up 20mg,
0.25mg/kg,
may use 4080mg in 10
minutes
intervals, max
dose of 300mg
9 minutes
urine
Loading:
500mcg/kg over 1
minute. Follow wit
a 50mcg/kg/minutes
over 4 minutes. Can
rebolus with
500mcg/kg over 1
minutes and
increase infusion to
100mcg/kg/minute.
Usual dosage range
is 50200mcg/kg/min
Cardiogenic shock,
uncompensated
CHF, bradycardia,
Contraindications Cardiogenic
shock,
uncompensated
10-80
minutes
2-6 hours
Hepatic
immediate
3-8 hours
urine
5mg q 2-3
minutes for 3
doses for MI
2-4 hours
urine
5-20mg
1-4 minutes
urine
Start 5mcg/min,
then can increase
5mcg until get to
20mcg/min, if no
change, then can
start increasing
by 10mcg
intervals up to
100-200mcg
Cardiogenic
shock,
uncompensated
Severe AS
Hepatic ,rbc’s,
vascular walls
1-10 minutes
Hepatic cyanide
prussic acid
thiocyanate
(monitor acid/base
status-acidosis of
cyanide toxicity).
Drug is broken
down by UV light
so must be
wrapped in foil.
<10 minutes
urine
Initial: 0.30.5mcg/kg/minute.
Increase by 0.5
mcg/kg/minute.
Usual dose is 3
mcg/kg/min. Up to
10mcg/kg/min
Coarctation of
aorta, caution in
increased ICP.
Most common
Side effects
CHF,
bradycardia,
pulmonary
edema, heart
block
pulmonary edema,
heart block
Orthostatic
hypotension,
dizzyness
Hypotension,
diaphoresis, nausea
CHF,
bradycardia,
pulmonary
edema, heart
block, severe
COPD, syst bp
<100, AV
conduction
ABN
Fatigue,
dizziness,
weakness
H/A,
palpation,
tachycardia,
lupus like
syndrome
Hypotension,
tachyarrythmias,
rash xerostomia,
lightheadedness,
H/A
H/A, palpitations,
hypotension,
thyroid
suppression,
metheglobinemia,
cyanide toxicity