What are the 3 black box warnings for nitroprusside? - 1. Must be diluted after reconstituted
2. Can cause severe hypotension --> irreversible ischemia
3. Cyanide poisoning
What are the clinical manifestations of cyanide poisoning? - Red venous blood, confusion, dyspnea
How can cyanide poisoning be off set for high risk patients? - Administer thiosulfate
Who is at risk for cyanide poisoning? - - patients with hepatic/renal impairment
-malnourished patients
-patients taking diuretics
-patients who recently had surgery
Thiosulfate combines with cyanide to form thiocyanate. What are the manifestations of the mild
toxicities associated with thiocyanate? - Tinnitus, miosis, interference with iodine uptake in thyroid
What is the indication for prescribing nitro pressure? - HTN crisis (210/120mmHg)
How does nitroprusside decrease BP? - Decreases preload (by dilating veins more than arteries),
decreases after load (by decreasing MAP), decreases coronary artery constriction
Prior to administering...stabilize these two things (if indicated) - Anemia and hypovolemia (via
anesthetic)
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