Enalaprilat IV Vasotec

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1. Enalaprilat is an ACE-inhibitor with a rapid onset of action (15 min) and long duration of action (11 hours). It is ideal for patients with heart failure or accelerated-malignant hypertension.

2. Initial dose, 1.25 mg IVP (over 2-5 min) q6h, then increase up to 5 mg q6h. Reduce dose in azotemic patients. Contraindicated in bilateral renal artery stenosis.

E. Esmolol (Brevibloc) is a non-selective beta-blocker with a 1-2 min onset of action and short duration of 10 min. The dose is 500 mcg/kg/min x 1 min, then 50 mcg/kg/min; max 300 mcg/kg/min IV infusion.

F. Hydralazine is a preload and afterload reducing agent. It is ideal in hypertension due to eclampsia. Reflex tachycardia is common. The dose is 20 mg IV/IM q4-6h.

G. Nicardipine (Cardene IV) is a calcium channel blocker. It is contrain-dicated in presence of CHF. Tachycardia and headache are common. The onset of action is 10 min, and the duration is 2-4 hours. The dose is 5 mg/hr continuous infusion, up to 15 mg/hr.

H. Fenoldopam (Corlopam) is a vasodilator. It may cause reflex tachycardia and headaches. The onset of action is 2-3 min, and the duration is 30 min. The dose is 0.01 mcg/kg/min IV infustion titrated, up to 0.3 mcg/kg/min.

I. Phentolamine (Regitine) is an intravenous alpha-adrenergic antagonist used in excess catecholamine states, such as pheochromocytomas, rebound hypertension due to withdrawal of clonidine, and drug ingestions. The dose is 2-5 mg IV every 5 to 10 minutes.

J. Trimethaphan (Arfonad) is a ganglionic-blocking agent. It is useful in dissecting aortic aneurysm when beta-blockers are contraindicated; however, it is rarely used because most physicians are more familiar with nitroprusside. The dosage of trimethoprim is 0.3-3 mg/min IV infusion.

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