Sodium Nitroprusside

1. Therapeutic Effects
   1. Binds to nitrate receptor producing a cascade effect causing relaxation of vascular smooth muscle, more arterial than venous.
   2. Increases intracranial blood volume and thus pressure.

2. Indications
   1. Hypertension.
   2. Heart failure and cardiogenic shock when invasive monitoring available.

3. Contraindications/Precautions
   1. Hypotension.
   2. Elevated intracranial pressure.

4. Side Effects
   1. Cyanide toxicity (breakdown product of nipride).
   2. Hypotension.
   3. Rebound hypertension when discontinued.
   4. Increased ICP.
   5. Tachycardia, dizziness, hypoxia.
   6. Nausea, vomiting, sweating, restlessness, headache, coma probably related to Cyanide toxicity.

5. Administration and Dosage
   1. Dose: 0.5-10 mcg/kg/minute
   2. Mix: Usual mix is 50gm in 250 cc. Mix yields 50,000 mcg in 250 cc or 200 mcg/cc.