- Preeclampsia:
- Definition: SBP >140 or DBP >90 mm Hg with proteinuria (>300 mg/24 hr or a urine protein/creatinine >0.3 or dipstick 1+)
- Occurs >20 wk gestation - 4 wk postpartum
- Headache, vision changes, peripheral edema, RUQ pain
- Complications: Eclampsia, HELLP
- Goal: SBP 130-150 mm Hg and DBP 80-100 mm Hg
- Drug of choice: Labetalol, nicardipine, hydralazine, magnesium
- Consult obstetrics
- Esmolol:
- β1-blockade
- Onset 60s, duration 10-20 min
- Avoid in AHF, COPD, heart block
- Labetalol:
- Combined α- and β-blocker
- Onset 2-5 min, duration 2-6 hr
- No reflex tachycardia due to β-blockade
- Avoid in: COPD, AHF, bradycardia
- Clevidipine:
- Third-generation dihydropyridine CCB
- Onset 2-4 min, duration 5-15 min
- Elimination independent of liver/renal function
- Avoid in allergies to soy or egg products, defective lipid metabolism, AFib
- Nicardipine:
- Second generation dihydropyridine CCB
- Onset 5-15 min, duration 4-6 hr
- Avoid in: AHF, coronary ischemia
- Nitroglycerin:
- Venous > arteriolar dilation
- Onset 2-5 min, duration 10-20 min
- Perfuses coronaries, decreasing ischemia
- Causes reflex tachycardia, tachyphylaxis, methemoglobinemia
- Nitroprusside:
- Short-acting arterial and venous dilator
- Onset 3 s, duration 1-2 min
- Complications:
- Reflex tachycardia, “coronary steal,” increase ICP
- Cyanide toxicity after prolonged use
- Avoid in pregnancy, renal failure (relative)
- Hydralazine:
- Arteriolar dilator
- Onset 5-15 min, duration 3-10 hr
- Hypotensive effect may be less predictable
- Safe in pregnancy
- Enalaprilat:
- ACE inhibitor
- Onset 0.5-4 hr, duration 6 hr
- Avoid in: Pregnancy, AMI
- Fenoldopam:
- Selective postsynaptic dopaminergic receptor agonist (DA1)
- Onset 5-15 min, duration 1-4 hr
- No reflex tachycardia
- Maintains renal perfusion
- Avoid in: Glaucoma
- Phentolamine:
- α1-blocker, peripheral vasodilator
- Onset 1-2 min, duration 10-30 min
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