Cystography Medication

Updated: Aug 27, 2020
  • Author: Wellman W Cheung, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce anxiety, morbidity, and prevent complications.

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Anxiolytics, Benzodiazepines

Class Summary

This drug class alleviates anxiety by prolonging the inhibitory effects of gamma-aminobutyrate (GABA), as well as other inhibitory neurotransmitters.

Midazolam

Midazolam is a short-acting benzodiazepine used for short-term sedation. It has been shown to be effective in reducing distress before voiding cystourethrography (VCUG) and does not interfere with the urodynamics being studied.

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Antihypertensives, Other

Class Summary

Given that autonomic dysreflexia is a rare but life-threatening complication, a fast-acting antihypertensive is useful, especially if arterial pressure remains elevated after stopping the procedure.

Esmolol (Brevibloc)

Esmolol is an ultra–short-acting beta2-blocker. It is particularly useful in patients with labile arterial pressure, especially if surgery is planned, because it can be discontinued abruptly if necessary. This agent is normally used in conjunction with nitroprusside. It may be useful as a means to test beta-blocker safety and tolerance in patients with a history of obstructive pulmonary disease who are at possible risk of bronchospasm from beta-blockade. The elimination half-life of esmolol is 9 minutes.

Labetalol (Trandate)

Labetalol blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure.

Propranolol (Inderal LA, InnoPran XL)

Propranolol is a class II antiarrhythmic nonselective beta-adrenergic receptor blocker. It has membrane-stabilizing activity and decreases the automaticity of contractions. Propranolol is not suitable for emergency treatment of hypertension. Do not administer propranolol intravenously in hypertensive emergencies.

Metoprolol (Lopressor, Toprol XL)

Metoprolol is a selective beta1-adrenergic receptor blocker that decreases the automaticity of contractions. During IV administration, carefully monitor the blood pressure, heart rate, and electrocardiogram (ECG). When considering conversion from intravenous to oral dosage forms, use the ratio of 1 mg IV to 2.5 mg PO metoprolol.

Nitroprusside (Nitropress)

Nitroprusside causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle, thus reducing peripheral resistance. It is commonly given intravenously because of its rapid onset and short duration of action. It is easily titratable to reach the desired effect.

Nitroprusside is light sensitive; both bottle and tubing should be wrapped in aluminum foil. Before initiating nitroprusside, administer a beta-blocker to counteract the physiologic response of reflex tachycardia that occurs when nitroprusside is used alone. This physiologic response increases shear forces against the aortic wall, thus increasing arterial pressure. The objective is to keep the heart rate at 60-80 bpm.

Nifedipine (Procardia)

Nifedipine is a calcium channel blocker that can be considered in cases in which beta-blockers are contraindicated, such as in patients with chronic obstructive pulmonary disease who have known bronchospasm or those with second- or third-degree atrioventricular block.

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