When monitoring a female client recently admitted for treatment of cocaine addiction, nurse Aaron notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:
A. Norepinephrine (Levophed) and Lidocaine (Xylocaine)
B. Nifedipine (Procardia) and Lidocaine.
C. Nitroglycerin (Nitro-Bid IV) and Esmolol (Brevibloc)
D. Nifedipine and Esmolol
Correct Answer: D. Nifedipine and Esmolol
This client requires a vasodilator, such as nifedipine, to treat hypertension, and a beta-adrenergic blocker, such as esmolol, to reduce the heart rate. Nifedipine is a calcium channel blocker that belongs to the dihydropyridine subclass. It is primarily used as an antihypertensive and antianginal medication. Esmolol (esmolol hydrochloride) is an intravenous cardioselective beta-1 adrenergic antagonist. Esmolol is FDA-approved for short-term duration use in control of supraventricular tachycardia, such as a rapid ventricular rate in patients with atrial fibrillation or atrial flutter.
Option A: Norepinephrine’s predominant use is as a peripheral vasoconstrictor. Specifically, the FDA has approved its use for blood pressure control in specific acute hypotensive states, as well as being a potential adjunct in the treatment of cardiac arrest with profound hypotension.
Option B: Lidocaine, an antiarrhythmic, isn’t indicated because the client doesn’t have an arrhythmia. The drug is commonly used for local anesthesia, often in combination with epinephrine (which acts as a vasopressor and extends its duration of action at a site by opposing the local vasodilatory effects of lidocaine).
Option C: Although nitroglycerin may be used to treat coronary vasospasm, it isn’t the drug of choice in hypertension. Nitroglycerin is a vasodilatory drug used primarily to provide relief from anginal chest pain. Nitroglycerin has been FDA approved since 2000 and was first sold by Pfizer under the brand name Nitrostat. It is currently FDA approved for the acute relief of an attack or acute prophylaxis of angina pectoris secondary to coronary artery disease.