Cardiovascular Drugs and Medications Q 39
In a 50-year-old widower who had a transient ischemic attack, what is the most common vasodilator used for his treatment?
A. norepinephrine
B. dopamine (Intropin)
C. papaverine (Pavabid)
D. nitroprusside (Nitropress)
Correct Answer: D. nitroprusside (Nitropress)
Nitroprusside (Nitropress) is used in this situation. Sodium nitroprusside (SNP) is a potent vasodilator that first gained FDA approval for the treatment of severe hypertension in 1974. From a hemodynamic perspective, the net result is a decrease in systemic vascular resistance (afterload), ventricular filling pressures, and systemic blood pressure with an increase in cardiac output. A and B are sympathomimetics used to treat hypotension.
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. Also, norepinephrine generally has more predictive pharmacologic properties than other alpha agonists. This predictive quality, in combination with some of its beta-agonism (which improves cardiac function relative to pure alpha agonists), makes norepinephrine a widely used vasoactive agent.
Option B: Dopamine (DA) is a peripheral vaso stimulant used to treat low blood pressure, low heart rate, and cardiac arrest, especially in acute neonatal cases via a continuous intravenous drip. Indications for DA include maintenance of blood pressure for chronic congestive heart failure, trauma, renal failure, and even open-heart surgery and shock from myocardial infarction or septicemia. DA administration in low doses may also be beneficial to manage hypotension, low cardiac output, and inadequate organ perfusion (often indicated by low urine production).
Option C: Papaverine is contraindicated in myocardial depressant states. Papaverine is a vasodilator that relaxes smooth muscles in the blood vessels to help them dilate (widen). This lowers blood pressure and allows blood to flow more easily through the veins and arteries. Papaverine is used to treat many conditions that cause spasms of smooth muscle.