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Transcript of Hypertensive Crisis
Taken from 1/1/16 to 5/31/17
71 calls total with patients considered to be in hypertensive crisis.
These patients meet the hypertensive criteria of >/=180 SBP and/or >/=130 DBP
~16 interfacility patients within the same date range were transferred with some sort of antihypertensive medication
Acute MI with hypertension
Hypertension with brain hemorrhage
Hypertension with ischemic stroke
Hypersensitivity to beta blockers
Heart block (2nd or 3rd degree)
Mechanism of Action
Labetalol is a selective alpha 1 adrenergic and non-selective beta-adrenergic antagonist. It competitively binds to alpha-1-adrenergic receptors in vascular smooth muscle, inhibiting the adrenergic stimulation of endothelial cell function and peripheral vasoconstriction. This agent also binds to beta-receptors in the bronchial and vascular smooth muscle, decreasing adrenergic stimulation. The result is a decrease in resting and exercise heart rates, cardiac output, and in both systolic and diastolic blood pressure, resulting in vasodilation and negative chronotropic and inotropic cardiac effects.
Produces decreases in BP without reflex tachycardia or significant reduction in heart rate through a mixture of alpha blocking and beta blocking effects
Well compensated heart failure
Peripheral Vascular Disease
BP of >/= 180 systolic and/or >/= 120-130 diastolic
Presence of Impending Organ Damage
Symptomatic: Chest pain, headache, shortness of breath
Intensive BP reduction (target <140 systolic) early in the treatment of patients with intracerebral hemorrhage appears to lessen the absolute growth of hematomas.
Lowering BP in patients with brain hemorrhage helps to prevent rebleeding or worsening of the bleed.
Physician from receiving hospital will give the actual target BP for the patient.
Labetalol doses between 5-25mg lowered systolic BP by 6-19% and diastolic BP by 3-26%
It is better to keep the patients BP higher, between 180-220 systolic to keep cerebral perfusion up.
BP should be gradually lowered.
Physician at facility will likely give dosing instructions and BP or MAP range goals.
20mg over two minutes (max dose of 300mg)
Additional doses of 40-80mg can be given at 10 min. intervals until desired BP is achieved or max of 300mg reached.
1-2mg/min IV infusion
Heart conditions(i.e. CHF, bradycardia, or peripheral vascular disease): worsens poor circulation peripherally, lowers BP
Diabetes: may hide the symptoms of low blood sugar(tachycardia) and the beta-2 blockade can cause hypoglycemia
Respiratory: may cause bronchoconstriction in people with asthma and other respiratory disease since it is non-selective and acts on beta-1 and beta-2 adrenergic receptors.
Liver disease: Effects ALT levels in the liver sometimes causing drug induced hepatitis.
Pregnancy: Labetalol crosses the placental barrier. The effects the drug will have on the mother can pass to the child. Causes increased risk of hypoglycemia in the baby at birth.
100mg in 20ml at Boundtree- $10.51
200mg in 40ml at Boundtree- $7.97
100mg in 20ml at St. Nicks pharmacy- $2.57
Backorder for 100mg in 20ml at St. Nicks pharmacy- $10