Pediatric emergency medicine trisk 0763 0763

Phentolamine is an α-adrenergic receptor antagonist whose use should be limited
to treatment of hypertension associated with catecholamine-induced hypertensive
crises, as seen with pheochromocytoma or sympathomimetic toxicity. Dosing
recommendations vary widely. Some recommend 0.05 to 0.1 mg/kg/dose
intravenously to a maximum of 5 mg, and others recommend a pediatric dose of 1
mg administered intravenously or intramuscularly, repeated as needed to achieve
appropriate blood pressure control.
Enalaprilat
Enalaprilat is an angiotensin-converting enzyme inhibitor that can be useful in
high renin states. It is contraindicated for use in patients with bilateral renal artery
stenosis. Because of the high incidence of renovascular disease in the pediatric
population, and limited pediatric experience with its use, caution must be
exercised before using this agent for the treatment of severe hypertension in the
ED. It should be administered at a dose of 0.05 to 0.1 mg/kg intravenously up to a
maximum of 1.25 mg.
Fenoldopam
Fenoldopam is a selective dopamine agonist causing vasodilation of the renal,
coronary, cerebral, and splanchnic vasculature, resulting in a decrease in mean
arterial pressure. The use of fenoldopam in pediatric patients has increased in
recent years. Its use has been reported for controlled perioperative hypotension
and in the intensive care setting when conventional therapy has failed.
Recent reports in children showed that although fenoldopam resulted in a
decrease in blood pressure levels, this required higher doses than for adults and
the decrease was less than that observed in adults. Peak effects are observed
within 15 minutes, with steady-state serum levels achieved in 30 to 60 minutes.
Initial infusion rates of 0.2 to 0.8 μg/kg/min are recommended. Side effects
include reflex tachycardia, increased intracranial pressure, and increased
intraocular pressure. Although pediatric experience with fenoldopam is limited, it
appears to be a reasonable alternative when more conventional therapies fail.
Clevidipine
Clevidipine is an ultra–short-acting third-generation dihydropyridine calcium

channel antagonist. It has high specificity for arteriolar smooth muscle, reducing
peripheral resistance while increasing stroke volume and cardiac output. Its halflife is approximately 1 minute with more rapid onset and offset than even
nicardipine, which eases titration, and is metabolized in plasma, independent of