Diferencia entre revisiones de «Nitroprusside»
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==Background== | ==Background== | ||
Sodium nitroprusside is primarily used as a potent vasodilator. | *Sodium nitroprusside is primarily used as a potent vasodilator. | ||
*Works predominantly in arterioles and venules as a result of its breakdown to nitric oxide (NO).<ref>"nitroprusside sodium (Rx) - Nipride, Nitropress, more..". Medscape Reference. WebMD. Retrieved 20 November 2013.</ref> | |||
*Nitric oxide reduces both total peripheral resistance and venous return, thus decreasing both preload and afterload | |||
*Thiocyanate level when checking for toxicity | |||
== Adult Dosing == | ==Adult Dosing== | ||
*Start 0.5 mcg/kg/min IV, increasing 0.5 mcg/kg/min q5 min | |||
*Usual dosage 3-4 mcg/kg/min IV | |||
*Max dose 10 mcg/kg/min for 10 min | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Start 0.3 mcg/kg/min IV, max 10 mcg/kg/min for 10 min | |||
== Contraindications == | ==Contraindications== | ||
*Pregnancy | |||
*[[ICH]] - theoretical concern for raising [[ICP]] via cerebral vasodilation, consider [[nicardipine]] instead<ref>Suri MF et al. A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage. Neurocrit Care. 2009;11(1):50-5. doi: 10.1007/s12028-009-9192-1. Epub 2009 Feb 18.</ref> | |||
*Aortic coarctation | |||
*Arteriovenous shunt | |||
*Existing cyanide toxicity | |||
*High output heart failure | |||
*Lack of arterial line monitoring | |||
== | ===Maximum Dose Rate=== | ||
*Infusion at maximum dose rate of 10 mcg/kg/min should never last for more than 10 minutes | |||
*If blood pressure is not controlled after 10 minutes of infusion at max rate, immediately terminate infusion | |||
== Mechanism of Action == | ==Indications== | ||
*[[Hypertensive emergency]] | |||
*[[CHF]], low output | |||
==Mechanism of Action== | |||
Potent arteriolar dilation from its active metabolite, nitric oxide (NO). | Potent arteriolar dilation from its active metabolite, nitric oxide (NO). | ||
== Adverse Drug Reactions == | ==Adverse Drug Reactions== | ||
*[[Cyanide|Cyanide toxicity]] | *[[Cyanide|Cyanide toxicity]] | ||
== Kinetics == | ==Kinetics== | ||
*Cyanide and thiocyanate metabolites potentially toxic | |||
*Metabolized via liver CYP450, excreted via urine | |||
*Half life 2 min | |||
*However, thiocyanate half life is 3 days | |||
==Indications by Condition== | |||
''The following table is automatically generated from disease/condition pages across WikEM.'' | |||
{{#ask:[[Has DrugName::Nitroprusside]] | |||
|?Has Indication=Indication | |||
|?Has Dose=Dose | |||
|?Has Context=Context | |||
|?Has Route=Route | |||
|?Has Population=Population | |||
|format=table | |||
|headers=plain | |||
|mainlabel=- | |||
|sort=Has Indication | |||
|limit=50 | |||
}} | |||
==See Also== | ==See Also== | ||
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<references/> | <references/> | ||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Pharmacology]] | |||
Revisión actual - 09:13 22 mar 2026
Background
- Sodium nitroprusside is primarily used as a potent vasodilator.
- Works predominantly in arterioles and venules as a result of its breakdown to nitric oxide (NO).[1]
- Nitric oxide reduces both total peripheral resistance and venous return, thus decreasing both preload and afterload
- Thiocyanate level when checking for toxicity
Adult Dosing
- Start 0.5 mcg/kg/min IV, increasing 0.5 mcg/kg/min q5 min
- Usual dosage 3-4 mcg/kg/min IV
- Max dose 10 mcg/kg/min for 10 min
Pediatric Dosing
- Start 0.3 mcg/kg/min IV, max 10 mcg/kg/min for 10 min
Contraindications
- Pregnancy
- ICH - theoretical concern for raising ICP via cerebral vasodilation, consider nicardipine instead[2]
- Aortic coarctation
- Arteriovenous shunt
- Existing cyanide toxicity
- High output heart failure
- Lack of arterial line monitoring
Maximum Dose Rate
- Infusion at maximum dose rate of 10 mcg/kg/min should never last for more than 10 minutes
- If blood pressure is not controlled after 10 minutes of infusion at max rate, immediately terminate infusion
Indications
- Hypertensive emergency
- CHF, low output
Mechanism of Action
Potent arteriolar dilation from its active metabolite, nitric oxide (NO).
Adverse Drug Reactions
Kinetics
- Cyanide and thiocyanate metabolites potentially toxic
- Metabolized via liver CYP450, excreted via urine
- Half life 2 min
- However, thiocyanate half life is 3 days
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Congestive heart failure | 0.3 mcg/kg/min IV drip | Afterload reduction (if HTN or NTG ineffective) | IV drip | Adult |
| Hemolytic uremic syndrome | 0.3-0.5 mcg/kg/min | Antihypertensive (severe) | IV drip | Pediatric |
| Hypertensive emergency | 0.25-10 mcg/kg/min | Antihypertensive | IV drip | Adult |
| Monoamine oxidase inhibitor toxicity | 1mcg/kg/min IV, titrate up | Hypertension | IV | Adult |
| Nontraumatic thoracic aortic dissection | 0.3-0.5mcg/kg/min | Blood pressure control (vasodilator) after beta-blockade | IV | Adult |
See Also
- ↑ "nitroprusside sodium (Rx) - Nipride, Nitropress, more..". Medscape Reference. WebMD. Retrieved 20 November 2013.
- ↑ Suri MF et al. A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage. Neurocrit Care. 2009;11(1):50-5. doi: 10.1007/s12028-009-9192-1. Epub 2009 Feb 18.