Blood pressure and rate control
Nitroprusside (Nipride) drip
Nipride, Nitropress, SNP
Dosing
| Start | 0.3–0.5 mcg/kg/min |
|---|---|
| Titrate | Every few minutes by arterial line |
| Maximum | 10 mcg/kg/min; stop if BP is not controlled after 10 minutes at the maximum |
| Common bags | 50 mg in 250 mL (200 mcg/mL); 100 mg in 250 mL (400 mcg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Protect from light
- Mix in D5W; dedicated line
Watch for
- Cyanide: metabolic acidosis, rising lactate, high venous O₂
- Thiocyanate in kidney failure
- Raises ICP
Nitroprusside: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Aortic Dissection and Hypertensive EmergencyAortic dissection: Beta-blocker FIRST (esmolol or labetalol), then a vasodilator (nicardipine, clevidipine or nitroprusside) if BP stays high
- Hemodynamic NormalsMeasuring flow and oxygen: thermodilution, Fick, SvO₂: Low SvO₂: delivery is not meeting demand (low output, hemoglobin or SaO₂, or fever, shivering, seizures, pain, work of breathing). High SvO₂ above 80%: tissues are not extracting (sepsis, cyanide from nitroprusside, hypothermia, left-to-right shunt) or a wedged catheter is sampling arterialized blood. A normal ScvO₂ does not exclude hypoperfus
- Obstetric EmergenciesDrugs in pregnancy in the ICU: Nitroprusside: Brief rescue only: Fetal cyanide toxicity
Practice Aortic Dissection and Hypertensive Emergency questions free19 exam-style questions with rationales on the topic where nitroprusside comes up most. No account or download needed.
Other blood pressure and rate control
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.