Nitroprusside
Almost from its first reported use in humans in 1928, sodium nitroprusside (SNP) has been characterized as either villain or hero, depending on the clinician's assessment of the drug's risk-benefit ratio regarding cyanide toxicity - Jeffrey A. Friederich MD & John F. Butterworth MD
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Hypertensive Emergency: Pearls and Pitfalls...
Historically, nitroprusside was extensively used due to its potent venous and arterial dilating properties that allowed for a wide applicability to various hypertenisve emergencies. However, given safety and administration concerns, nitroprusside has largely fallen out of favor. The rapid, profound, and precipitous drop in BP seen with nitroprusside has resulted in hypotension related fatalities, which warranted the FDA to add a black box warning... The unpredictable, yet potentially severe drop in BP warrants patients to receive ICU level care with continuous monitoring through a dedicated arterial line. Unfortunately this labor intensive monitoring is not feasible in the ED.
Resources
Sodium Nitroprusside Twenty Years and Counting
Almost from its first reported use in humans in 1928, sodium nitroprusside (SNP) has been characterized as either villain or hero, depending on the clinician's assessment of the drug's risk-benefit ratio regarding cyanide toxicity. Not until 1955 was the safety of short-term SNP infusion established for treatment of severe hypertension.
The Nitric Oxide (NO) Donor Sodium Nitroprusside (SNP) and Its Potential for the Schizophrenia Therapy: Lights and Shadows
Sodium nitroprusside (SNP) is a NO donor and is proposed as a promising novel compound for the treatment of schizophrenia.
Hypertensive Emergency: Pearls and Pitfalls...
Nitroprusside dilates the large capacitance vessels in the central nervous system which can result in detrimental spikes in ICP. Therefore, nitroprusside should be avoided in hypertensive encephalopathy, acute ischemic, or hemorrhagic strokes.1,2 Nitroprusside should be avoided in the setting of an acute MI or patients with ischemic heart disease.
Life in the Fastlane
Dilates both resistance & capacitance vessels by direction on vascular smooth muscle.
Nitroprusside
Depending on the desired concentration, the solution containing 50 mg of sodium nitroprusside injection must be further diluted in 250 mL to 1000 mL of sterile 5% dextrose injection. The diluted solution should be protected from light, using the supplied opaque sleeve, aluminum foil, or other opaque material. It is not necessary to cover the infusion drip chamber or the tubing.
RK.md
Sodium nitroprusside (SNP, Nipride/Nitropress) is a short-acting, intravenous antihypertensive that directly acts on venous AND arteriolar smooth muscle to cause vasodilation decreasing preload, afterload, and left ventricular (LV) impedance.
ScienceDirect
Sodium nitroprusside is a short-acting direct vasodilator, requiring a constant intravenous infusion that can decrease BP in all patients irrespective of hypertension severity.
StatPearls
Sodium nitroprusside (SNP) is a potent vasodilator that first gained FDA approval for the treatment of severe hypertension in 1974. First discovered in 1849 by Playfair, its applications in human medicine can be traced back to the early 1920s, with the first safety and efficacy data published in 1955
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