Glyceryl trinitrate and isosorbide dinitrate reduce both preload and afterload. At higher dose the afterload effect becomes more prominent.

Tolerance to nitrates usually commences within 24-36h unless intermittent oral dosing is used. Progressive increases in dose are required to achieve the same effect.

Prolonged (>24-36h) dose-related administration of sodium nitroprusside can rarely produce a metabolic acidosis related to cyanide accumulation.

ACE inhibitor tablets can be crushed and given either SL or via a nasogastric tube.

Dopaminergic drugs improve splanchnic blood flow though clinical benefits are unproved.

Hydralazine has an unpredictable effect on blood pressure and, if given IV, should be used with caution.


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