You'd think I would know this by now, since I've worked on a tele unit for almost a year- but hey better late than never to ask, right?
We seem to be running a special on people admitted with hypertensive urgency, and I'm wondering what the tier of BP medications are. It seems like I see our old friend Metoprolol as the old standby on the PRN list quite often, along with hydralazine. Occasionally I see Clonidine in there too. I've overheard on more than one occasion co-workers saying that Metoprolol does nothing, lowers the heart rate, sure, but does very little for the BP, and what little it does, lasts very short.
So of the three, which one is the "big guns"? I'm aware that the strength of the dose matters, of course. If someone has a blood pressure that meets the doc's criteria for PRN administration of more than one of those choices (usually for the hydralazine the SBP needs to be >160, occasionally 180). So say someone is 175/110- and meets the criteria for all three of the above mentioned medications- do I go for the biggie first or for a moderate? Obviously if they're sitting at 194/130 I'm not too worried about bottoming anyone out so I'd go for the most effective selection. Naturally I'm going to take into consideration the dose, and how close in proximity we are to the end of shift, and what we have for scheduled BP meds (we can give a.m. medications an hour earlier than scheduled, and with the MD's blessing we can give them even 1.5 hours early).
Any takers on this one? Anybody? Anybody?