nitroprusside

High Alert

Hypertensive crises.
Controlled hypotension during anesthesia.
Cardiac pump failure or cardiogenic shock (as monotherapy or in combination with dopamine).

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
↓cerebral perfusion.

Use Cautiously in:

Renal impairment (↑ risk of thiocyanate accumulation);
Hepatic impairment (↑ risk of cyanide accumulation);
Hypothyroidism;
Hyponatremia;
Vitamin B deficiency;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Geri: Older adults may have ↑ sensitivity to drug effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: dyspnea, HYPOTENSION, palpitations

EENT: blurred vision, tinnitus

F and E: acidosis

GI: abdominal pain, nausea, vomiting

Local: phlebitis

Neuro: dizziness, headache, restlessness

Misc: CYANIDE TOXICITY, thiocyanate toxicity

Interactions ⬆ ⬇

Drug-drug:

↑hypotensive effect with ganglionic blocking agents, general anesthetics, and other antihypertensives.
Estrogens and sympathomimetics may ↓ the response to nitroprusside.

Availability ⬆ ⬇

(Generic available)

Premixed infusion: 20 mg/100 mL 0.9% NaCl; 50 mg/100 mL 0.9% NaCl
Solution for injection: 25 mg/mL

Route/Dosage ⬆ ⬇

IV (Adults and Children ): 0.3 mcg/kg/min initially; may ↑ as needed up to 10 mcg/kg/min (usual dose is 3 mcg/kg/min; not to exceed 10 min of therapy at 10 mcg/kg/min infusion rate).

US Brand Names ⬆ ⬇

Nipride RTU, ~~Nitropress~~

Action ⬆ ⬇

Produces peripheral vasodilation by a direct action on venous and arteriolar smooth muscle.

Therapeutic effects:

Rapid lowering of BP.
Decreased cardiac preload and afterload.

Classifications ⬆ ⬇

Therapeutic Classification: antihypertensives

Pharmacologic Classification: vasodilators

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Rapidly metabolized in RBCs and tissues to cyanide and subsequently by the liver to thiocyanate.

Half-Life: 2 min.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

( hypotensive effect)

ROUTE		ONSET		PEAK		DURATION
IV		immediate		rapid		1–10 min

Patient/Family Teaching ⬆ ⬇

Explain purpose of nitroprusside to patient.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Advise patient to report the onset of tinnitus, dyspnea, dizziness, headache, or blurred vision immediately.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇