Nicardipine IV Drip Protocol Concentration
Mix 20 mg of nicardipine in 80 mL to 100 mL of normal saline (NSS).
This results in a concentration of 0.2 mg/mL.
Infusion Rate
Administer between 10-70 mL/hour, adjusting based on the patient's blood pressure and clinical condition.
Titrate by 5 mL/hour every 5-15 minutes to achieve the desired systolic blood pressure (SBP).
Target SBP
Maintain systolic blood pressure (SBP) ≤ 160 mmHg (adjust further based on specific clinical scenarios or comorbidities).
In hypertensive emergencies, aim to reduce mean arterial pressure (MAP) by no more than 25% within the first hour, then a gradual reduction over the next 2-6 hours.
Mechanism of Action
Nicardipine is a dihydropyridine calcium channel blocker that acts as a vasodilator to lower blood pressure by:
Blocking L-type calcium channels: Inhibits calcium influx, primarily in vascular smooth muscle cells.
Inducing arterial vasodilation: Reduces systemic vascular resistance (afterload), effectively decreasing blood pressure.
Indications
Nicardipine is primarily indicated for:
Hypertensive emergencies
Chronic hypertension (oral formulation)
Angina pectoris: Dilates coronary arteries, improving myocardial oxygen supply.
Comparison with Other Calcium Channel Blockers
Verapamil/Diltiazem: Affect cardiac conduction and heart rate, making them suitable for atrial fibrillation or arrhythmia management.
Nicardipine: Lacks significant action on the sinoatrial (SA) or atrioventricular (AV) nodes, focusing instead on vascular effects.
Preparation and Administration
Preparation
Mix 20 mg of nicardipine in 80-100 mL NSS (0.2 mg/mL).
Ensure thorough mixing of the solution.
Administration
Start infusion at 10-15 mL/hour.
Titrate by 5 mL/hour every 5-15 minutes to achieve the target BP.
Maximum rate: 70 mL/hour.
Example Dose Calculation
Initial Rate: 15 mL/hour = 3 mg/hour.
Adjustment: Increase to 20 mL/hour = 4 mg/hour.
Max Dose: 70 mL/hour = 14 mg/hour.
Monitoring and Safety
Blood Pressure and Heart Rate
Continuous monitoring is critical.
Avoid overshooting target BP, which can result in hypotension.
Infusion Site
Monitor for signs of phlebitis or extravasation.
Common Side Effects
Hypotension: Excessive vasodilation.
Reflex tachycardia: Compensatory mechanism for decreased BP.
Headache, flushing, dizziness: Due to systemic vasodilation.
Key Considerations
Use an IV pump for precise control of infusion rates.
Individualize BP targets based on patient-specific factors.
Gradual adjustment is essential to prevent ischemia or other complications.
Comentarios