Apresoline ® Antihypertensive agent
INDICATIONS
- In essential and early malignant hypertension, as well as in hypertensive
emergencies associated with pregnancy and in hypertension which exists
or recurs after sympathectomy.
- IV use indicated only for conditions in which drugs cannot be taken
orally or when there is an urgent need to lower blood pressure.
ADMINISTRATION
- For IV use: reconstitute ampoule with 1 mL of SWFI.
- IV direct: physician or RN; blood pressure monitoring.
Physician to be present for first dose. Dilute dose in 20 mL of NS
and inject slowly. To avoid hypotension, injection should be stopped
frequently when blood pressure is falling.
- Chamber (preferred): blood pressure monitoring. Physician to
be present for start of first dose. Dilute dose in 50 mL of NS and
infuse over 15 minutes.
- Infusion (preferred): blood pressure monitoring. Physician
to be present for start of first dose. Dilute 100 mg in 500 mL to
1000 mL of NS. Give slowly and adjust rate according to the blood
pressure response.
- IM.
POTENTIAL ADMINISTRATION HAZARDS
- Postural hypotension, circulatory collapse, dizziness, flushing.
- Tachycardia, angina, nausea and vomiting.
- Depression, anxiety, severe headache, neuropathy.
- Influenza-like syndrome; rheumatoid arthritis syndrome; lupus syndrome
(after lengthy use).
- Increased cerebral ischemia in predisposed patients.
DOSAGE
- Usual adult dose: 5-20 mg (up to 40 mg has been used).
Repeat as needed.
- Infusion: 0.05-0.3 mg/min.
- Preeclampsia, eclampsia: initial dose of 5-10 mg, followed by 5-20
mg every 20-30 minutes as required or may infuse at rate of 0.5-10 mg/hr.
- Pediatrics: 0.1 to 0.2 mg/kg (maximum 20 mg) repeated q4-6h
up to 1.7 mg to 3.5 mg/kg/day or 50-100 mg/m2/day in 4 to 6 divided doses.
- IM: 10-50 mg.
COMPATIBILITY, STABILITY
- Compatible with NS, Ringer's, RL, sodium lactate 1/6 M solutions
for 24 hours.
- Stable for 1 week at RT diluted in NS at a concentration of 0.027-0.35
mg/mL.
- Due to slow reaction between dextrose-containing solutions and hydralazine,
a yellowish colour ensues which does not alter hypotensive effects.
Nevertheless, manufacturer no longer recommends a dextrose-containing solution
as a diluent.
MISCELLANEOUS
- Fall in BP may be dramatic after IV use.
- Contraindicated in angina pectoris because of reflex tachycardia
and coronary steal.
- 20-25 mg IV is approximately equal to 75-100 mg oral hydralazine.
- After IV administration the effect begins within 5-20 minutes.
Maximum effect seen in 10-80 minutes and lasts for 2-6 hours.
- Effect begins within 10-30 minutes after IM administration.
REFERENCES
1, 2, 4, 82, 90, 143, 156, 157, 323.
05-05
Narcotic analgesic
INDICATIONS
- Supplement to anesthesia.
- In patients with acute pulmonary edema for its cardiovascular and
anxiolytic effects.
- Relief of moderate to severe acute and chronic pain.
- Analgesic of choice for pain associated with myocardial infarction.
- To decrease voluntary respiratory control in patients on respirators.
ADMINISTRATION
- IV direct: physician or RN. Respiratory support. Dilute
dose to 10 mL and inject very slowly, at a rate of 3 mg/min.
- Chamber: dilute dose in 50 to 100 mL NS or D5W.
- Infusion: Standard concentration is 1 or 2 mg/mL in D5W or
NS via an infusion pump. Patients on high doses may require concentration
of 10 mg/mL.
- SC, IM.
POTENTIAL ADMINISTRATION HAZARDS
- Respiratory depression (Antidote: naloxone) and to a lesser degree
circulatory depression including orthostatic hypotension (increased incidence
with rapid IV administration).
- Bradycardia (Antidote: atropine).
- Increased intracranial pressure.
- Nausea, vomiting, constipation.
- Dizziness, mental clouding, sedation.
- Pruritus; allergic phenomena.
DOSAGE
Adults:
- IV direct: 2.5-15 mg. Doses may be repeated q2-4h prn until
analgesia is achieved.
- Chamber: 5-25 mg.
- Infusion (cancer pain): initiate at 0.8-10 mg/hr; increase stepwise
until analgesia is achieved; in severe chronic pain, maintenance doses
have ranged from 0.8-80 mg/hr, although higher doses (e.g., 150 mg/hr)
have occasionally been required.
- SC, IM: 2.5-20 mg q2-6h prn.
Pediatrics:
- Intermittent IV: 0.05-0.2 mg/kg/dose q2-4h.
- Infusion: 0.01-2.6 mg/kg/hr.
- SC, IM: 0.1-0.2 mg/kg/dose q4h prn.
COMPATIBILITY, STABILITY
- At concentrations of 0.04-0.4 mg/mL, stable for 7 days at RT or refrigerated
diluted in D5W or NS in PVC containers.
- At a concentration of 5 mg/mL in NS or D5W, stable for 30 days at
RT in PVC containers.
MISCELLANEOUS
- Caution in patients with convulsive disorders, cranial injuries,
respiratory insufficiency, cardiac arrhythmias, reduced blood volume and
in children and elderly or debilitated patients.
- Only morphine products formulated for epidural or intrathecal use
should be administered in this manner.
REFERENCES
1, 2, 4, 9, 40, 82, 187, 190, 370.
05-05