Thoracic Aneurysm Medication

Updated: Oct 01, 2015
  • Author: Bret P Nelson, MD; Chief Editor: Erik D Schraga, MD  more...
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Medication

Medication Summary

The goal of medical therapy is to reduce the pulse pressure (dP/dt) within the aorta. Reducing the heart rate, the blood pressure (BP), pain, and anxiety are the mainstays of therapy.

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Antihypertensive agents

Class Summary

These agents are used to reduce arterial pressure. Short-acting IV beta blockade and nitrates are very effective in reducing the dP/dt, especially in the ascending aorta. Consider calcium channel blockade in patients with contraindications to beta blockade.

Esmolol (Brevibloc)

Ultra–short-acting beta1-blocker particularly useful in patients with labile arterial pressure because it can be abruptly discontinued if necessary. Typically used in conjunction with nitroprusside. May be useful as a means to test beta-blocker safety and tolerance in patients with history of obstructive pulmonary disease who are at uncertain risk of bronchospasm from beta blockade. Elimination half-life is 9 min. The objective is a target heart rate of 55-65 bpm.

Labetalol (Normodyne, Trandate)

Blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing BP.

Metoprolol (Lopressor)

Selective beta1-adrenergic receptor blocker that decreases automaticity of contractions. During IV administration, carefully monitor BP, heart rate, and ECG. When considering conversion from IV to PO dosage forms, use ratio of 2.5 mg PO to 1 mg IV metoprolol.

Propranolol (Inderal, Betachron E-R)

Class II antiarrhythmic nonselective beta-adrenergic receptor blocker. Has membrane-stabilizing activity and decreases automaticity of contractions. Not a first-line agent in the treatment of hypertensive emergencies. Do not administer IV in hypertensive emergencies.

Nitroprusside (Nipride, Nitropress)

Causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle, thus reducing peripheral resistance. Commonly used IV because of rapid onset and short duration of action. Easily titratable to reach desired effect. Light sensitive; both bottle and tubing should be wrapped in aluminum foil. Prior to initiating, administer beta-blocker to counteract physiologic response of reflex tachycardia that occurs when nitroprusside is used alone. This physiologic response increases shear forces against aortic wall, thus increasing dP/dT.

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Analgesics

Class Summary

Analgesics are used to control pain and to decrease sympathetic tone.

Morphine sulfate (Astramorph, Infumorph)

DOC for narcotic analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Like fentanyl, morphine sulfate is easily titrated to desired level of pain control. If administered IV, may be dosed in a number of ways; commonly titrated until desired effect obtained.

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