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Medication | Dose and Route | Mechanism of action | Duration of action | Adverse effects | Contraindications and precautions |
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Sodium nitroprusside | 0.5–10 μg/kg/min I.V | Acts by releasing nitric oxide | 1-2 minutes | hypotension, palpitations, headache, nausea, vomiting, raised intracranial pressure, thiocyanate and cyanide toxicity, thyroid suppression | Intracranial hypertension |
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Nicardipine | 1–3 μg/kg/min IV | Calcium Channel Blocker | 15–30 minutes; may last for up to 3-4 hrs | flushing, hypotension, palpitations, angina, syncope, peripheral edema, headache, vomiting | requires large fluid volume |
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Esmolol | 125–500 μg/kg/min intravenously | Beta-blocker | 10–20 minutes | bradycardia, hypotension, bronchoconstriction, skin necrosis after extravasation, Raynaud’s phenomenon | Asthma, congestive cardiac failure, cocaine toxicity |
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Labetalol | 0.25–3 mg/kg/hr intravenously | Combined alpha and beta blocker | Up to 4 hrs | bradycardia, hypotension, atrioventricular conduction disturbances, headache, bronchospasm, nasal congestion | |
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Hydralazine | 0.1–0.6 mg/kg/dose every 4–6 hrs intravenously | Direct vasodilatation of arterioles | 1–4 hrs | palpitations, flushing, tachycardia, fever, rash, headache, arthralgia, SLE-like syndrome, positive ANA, peripheral neuropathy | |
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Fenoldopam | 0.8–1.2 μg/kg/min intravenously | Dopamine D1 receptor agonist | 1 hr | tachycardia, hypotension, flushing, headache, hypokalemia, nasal congestion | |
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Phentolamine | 0.05–0.1 mg/kg/dose Intravenously (maximum of 5 mg per dose) | Alpha-adrenergic blocker | 15–30 minutes | tachycardia, palpitations, hypotension, flushing, headache, nasal congestion, exacerbation of peptic ulcer | |
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Enalaprilat | 5–10 mcg/kg/dose every 8–24 hrs intravenously | Angiotensin-converting enzyme inhibitor | 4–6 hrs | hypotension, hyperkalemia, oliguria, rash, angioedema, agranulocytosis, neutropenia, cough, fatal hepatic necrosis (rare) | patients with supra-renal aortic stenosis and bilateral renal stenosis; most valuable in neonatal hypertension |
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Nifedipine | 0.1–0.25 mg/kg/dose every 4–6 hrs (maximum 10 mg/dose) oral | Calcium channel blocker | 4–8 hrs | Flushing, hypotension, tachycardia, palpitations, syncope, peripheral edema, headache, thrombocytopenia, rash, urticaria, elevated liver enzymes | |
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Clonidine | 0.05–0.1 mg/dose orally | Central alpha-agonist | 6–8 hrs | bradycardia, hypotension, rebound hypertension with abrupt withdrawal, sedation, dry mouth, | Avoid sudden discontinuation |
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Minoxidil | 0.1-0.2 mg/kg/day (maximum 5 mg/day) orally | Hyperpolarization of K+ channels resulting in smooth muscle relaxation | Up to 24 hrs | tachycardia, fluid retention, rash, headache, weight gain, pulmonary edema, Stevens-Johnson syndrome, photosensitivity | Pericardial effusion |
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Losartan | dose for less than 6 years is not established; for children >6 years 0.7 mg/kg once daily (maximum dose 100 mg/day) orally | Angiotensin II receptor blocker | 24 hrs | hypotension, chest pain, hyperkalemia, elevation in BUN/Creatinine, headache, fever, syncope, diarrhea, flu-like illness | Patient with suprarenal aortic stenosis and bilateral renal stenosis. |
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Clevidipine | 0.5–3.5 mcg/kg/min intravenously | L-type calcium Channel blocker | up to 15 minutes | Headache, nausea, vomiting, hypotension | Patients with lipid disorders and egg and soy protein allergies |
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