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Management of Hypertension in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Jesse Kane, Clive Goulbourne, Hal A. Skopicki
Nicardipine is a highly vascular selective CCB with an onset of action in 5–15 min, a duration of action of 4–6 h and a half-life of approximately 8 h.64 Of note, nicardipine has been shown to reduce both cardiac and cerebral ischemia.65 The CCB clevidipine appears to be safe and efficacious in lowering acute BP to control hypertensive HF. In a randomized, open-label, active-controlled trial of patients presenting with presumed acute HF and an SBP ≥160 mmHg, IV clevidipine, when compared with nicardipine and additional nitroglycerin, achieved target BP more often and was less likely to require additional therapy for treating BP.66 Common side effects are headache, abdominal pain, flushing, myalgia, and nausea.
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Treatment of hypertension in pregnancy with nicardipine was more effective than metoprolol in decreasing blood pressure, and neonatal outcomes were not different (Jannet et al., 1994). One study of 40 pregnant women with hypertension reported that intravenous nicardipine “seems to be safe” (Carbonne et al., 1993). Nicardipine was not teratogenic in rats given an oral dose many times the recommended human dose (Sato et al., 1979). The Swedish Birth Defects Registry included only three infants exposed to nicardipine during the first trimester (Kallen, 2019).
Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Nicardipine is a dihydropyridine calcium channel blocker that mostly acts as a vasodilator. It has fewer negative inotropic effects than nifedipine. Its primary use is for postoperative hypertension and during pregnancy. Dosages are increased every 15 minutes to the maximum dose, and the drug can cause flushing, headache, and tachycardia. It may decrease the GFR if the patient is renal-insufficient.
Incidence and clinical manifestation of iatrogenic opioid withdrawal syndrome in mechanically ventilated patients
Published in Current Medical Research and Opinion, 2021
Suthinee Taesotikul, Pitchaya Dilokpattanamongkol, Viratch Tangsujaritvijit, Chuthamanee Suthisisang
Regarding a change of blood pressure, the withdrawal group showed a trend of higher MAP than the non-withdrawal group as shown in Figure 2. MAP in the withdrawal group increased significantly at 16–20 h after fentanyl discontinuation or rate reduction and sustained higher than MAP in the non-withdrawal group. In contrast, MAP in the non-withdrawal group remained the same after fentanyl discontinuation or rate reduction. However, two participants in the non-withdrawal group presented with unexpected surge of MAP. The first one had a MAP rising from 87 to 106 mmHg (22% increment from baseline) after rate reduction of 60 µg fentanyl per hour. Pupil dilation and first-episode generalized tonic-clonic seizure were also presented in this case. The latter one had MAP rising from 90 to 112 mmHg (24% increment from baseline) along with pupil dilation and lacrimation after rate reduction of 20 µg fentanyl per hour. Both patients received a low infusion rate of intravenous nicardipine (from 0.5 to 3.4 mg per hour) for 15 and 49 h without switching to oral antihypertensive agents. The details of the clinical manifestations of these two patients are shown in the online data supplement (supplementary Table 4E).
Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup
Published in Clinical Toxicology, 2021
Anselm Wong, Robert S. Hoffman, Steven J. Walsh, Darren M. Roberts, Sophie Gosselin, Timothy E. Bunchman, Sofia Kebede, Valery Lavergne, Marc Ghannoum
As shown in Table 3, amlodipine, diltiazem, bepridil, felodipine, isradipine, mibefradil, nifedipine, nisoldipine, and verapamil were considered not dialyzable regardless of the ECTR used, with variable levels of evidence. This was supported by several reports containing robust pharmacokinetic data. No dialyzability grading was possible for nicardipine and nitrendipine. The comparison of apparent half-lives during and off ECTR was an unreliable criterion to assess dialyzability for CCBs because of the likelihood that their large volumes of distribution and ongoing absorption could have other impacts on the concentration-time profile both before and after ECTR [218]. Therefore, this criterion (Alternative criterion 2, Table 2, Supplemental material) was not used in the final grading of evidence, although it was presented with an asterisk in Table 3 if this information was available. The dialyzability of metabolites appears to be higher than that of the parent drugs because of their higher water solubility [42,46,203], although this finding was inconsistent throughout the literature [23,31,61,155,162,205,219]. Norverapamil clearance during MARS® was only 3.6 mL/min [198]. Although some data were limited (e.g., dialyzability of diltiazem with hemodialysis), the panel believed it was unlikely that these modalities would have shown appreciable dialyzability had these studies been performed.
Temporary Visual Loss Due to Posterior Reversible Encephalopathy Syndrome in the Case of an End-Stage Renal Disease Patient
Published in Neuro-Ophthalmology, 2018
Michael Chia-Yen Chou, Chia-Yi Lee, Shih-Chun Chao
At ICU, blood examination was nonspecific except for mildly elevated C-reactive protein (CRP) level. Cerebrospinal fluid sample was obtained and analysed; cell count and biochemistry were within normal range except for mild non-significant elevation of glucose and protein levels (78 and 46 mg/dL, respectively), and microbial staining and culture were negative. Magnetic resonance imaging (MRI) was performed. Diffusion-weighted (DW) images were compatible with CT findings, which was negative for posterior circulation infarction (Figure 2). Multiple hyperintense signal change at both cerebral watershed areas and at periventricular, parieto-occipital, cerebellar, and brainstem areas were visualised in FLAIR (fluid-attenuated inversion recovery) images (Figure 3). Magnetic resonance angiography showed patent vessels without narrowing or aneurysmal dilatation (Figure 4). After consultation with the radiologist, PRES was diagnosed. Intravenous nicardipine was given for control of blood pressure, and the patient reported improvement of visual symptoms.