Cardiovascular Critical Care II
Medication
Indication
Special Consideration
Enalaprilat
Acute left
ventricular failure
Contraindicated in pregnancy acute myocardial infarction, unstented
bilateral renal artery stenosis
Caution in dose adjustments given slow onset and prolonged duration of
action
Phentolamine
Catecholamine
excess (e.g.,
pheochromocytoma)
Use in catecholamine-induced hypertensive emergency
Fenoldopam
Most indications
Risk of reflex tachycardia
Caution with glaucoma, sulfite sensitivity
Can cause hypokalemia, flushing
May increase ICP
ICP = intracranial pressure.
Certain populations require specific medication therapy approaches:
Pregnancy
| (a) | Definitions of hypertensive disorders in pregnancy (Obstet Gynecol 2013;122:1122-31; |
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Obstet Gynecol 2019;133:e26-50; Obstet Gynecol 2020;135:1492-5):
| (1) | Hypertension in pregnancy: SBP greater than or equal to 140 mm Hg or DBP greater |
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than or equal to 90 mm Hg, or both, measured on two occasions at least 4 hours apart
| (2) | Gestational hypertension: SBP greater than or equal to 140 mm Hg or DBP greater |
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than or equal to 90 mm Hg, or both, measured on two occasions at least 4 hours apart
diagnosed after 20 weeks of gestation and a previously normal BP
| (3) | Severe-range hypertension: SBP greater than or equal to 160 mm Hg or DBP greater |
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than or equal to 110 mm Hg, or both, measured on two occasions at least 4 hours apart
| (4) | Preeclampsia: Gestational hypertension or severe-range hypertension, in addition to |
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at least 1 of the following:
| (A) | Proteinuria (greater than or equal to 300 mg/24-hour urine, or protein:creatinine |
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greater than or equal to 0.3, or dipstick 2+ only if other quantitative methods not
available)
| (B) | Renal insufficiency (serum creatinine greater than 1.1 mg/dL or doubling of the |
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serum creatinine concentration in the absence of other renal disease)
| (C) | Thrombocytopenia (greater than 100 Γ109/L) |
|---|---|
| (D) | Impaired liver function (ALT/AST greater than or equal to two times upper limit |
of normal)
| (E) | Pulmonary edema |
|---|---|
| (F) | New-onset headache or visual disturbances (not caused by alternative diagnoses) |
| (5) | Preeclampsia with severe features: Severe-range hypertension and: |
| (A) | Renal insufficiency |
| (B) | Thrombocytopenia |
| (C) | Impaired liver function |
| (D) | Severe persistent right upper quadrant or epigastric pain unresponsive to |
medications
| (E) | Pulmonary edema |
|---|---|
| (F) | New-onset headache or visual disturbances |