{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Podcast 592:\u00a0 Rapid Antihypertensives","description":"Contributor: Ramnik Dhaliwal, MD, JD Educational Pearls:  Nitrates   Nitroprusside: becomes effective in under a minute, and becomes ineffective 10 minutes after stopping it.&amp;nbsp;   Nitroprusside can metabolize into cyanide leading to toxicity, however this is rare.   Nitroglycerin: predominately causes vasodilation but some arterial dilation as well; preferred agent in patients with volume overload\/CHF   Adrenergic Blocking Agents   Labetalol: alpha\/beta-blocking agent with a rapid onset of 5 minutes or less given as bolus or intravenous drip Esmolol: cardioselective beta blocker with rapid onset and short duration of action making it easily titratable Hydralazine: direct arterial dilator;&amp;nbsp; patient dependent response that can be unpredictable. Use with caution in patients with CAD or an aortic dissection because there will be a reflexive increase in heart rate to combat the arteriolar dilation.   Calcium Channel Blockers   Nicardipine: Given as an IV infusion starting at 5g\/hr up to 15g\/hr. This drug has a slower onset of action making it difficult to titrate and it has a longer serum elimination half-life (3-6 hours) Clevidipine: rapid onset and short duration of action;&amp;nbsp; Reduces BP without affecting cardiac filling pressures but can cause reflex tachycardia    References )Wani-Parekh P, Blanco-Garcia C, Mendez M, Mukherjee D. Guide of Hypertensive Crisis Pharmacotherapy. Cardiovasc Hematol Disord Drug Targets. 2017;17(1):52-57. doi:10.2174\/1871529X16666161220142020 Suneja M, Sanders ML. Hypertensive Emergency. Med Clin North Am. 2017;101(3):465-478. doi:10.1016\/j.mcna.2016.12.007 Maloberti A, Cassano G, Capsoni N, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. High Blood Press Cardiovasc Prev. 2018;25(2):177-189. doi:10.1007\/s40292-018-0261-4 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD   ","author_name":"Emergency Medical Minute","author_url":"https:\/\/www.emergencymedicalminute.com","html":"<iframe title=\"Libsyn Player\" style=\"border: none\" src=\"\/\/html5-player.libsyn.com\/embed\/episode\/id\/15833132\/height\/90\/theme\/custom\/thumbnail\/yes\/direction\/forward\/render-playlist\/no\/custom-color\/fa102a\/\" height=\"90\" width=\"600\" scrolling=\"no\"  allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen><\/iframe>","thumbnail_url":"https:\/\/assets.libsyn.com\/secure\/content\/82459430"}