NCLEX Review Guide: Miscellaneous Vasodilators

Hydralazine (Apresoline)

• Direct-acting arterial vasodilator that reduces peripheral vascular resistance by relaxing smooth muscle in arteriolar walls
• Primarily used for hypertensive crisis and severe hypertension, especially in pregnancy (preeclampsia)
• Common side effects include reflex tachycardia, headache, and fluid retention
• Long-term use may cause drug-induced lupus syndrome with positive ANA

Minoxidil (Loniten)

• Potent direct vasodilator reserved for severe, refractory hypertension when other medications fail
• Causes significant fluid retention and hirsutism (excessive hair growth)
• Must be given with diuretic and beta-blocker to counteract side effects
• Topical form (Rogaine) used for male pattern baldness

Nitroprusside (Nipride)

• IV vasodilator for hypertensive emergencies with immediate onset and short duration
• Dilates both arteries and veins, rapidly reducing preload and afterload
• Risk of cyanide toxicity with prolonged use or high doses
• Requires continuous cardiac monitoring and frequent BP checks

Assessment and Monitoring

1. Monitor vital signs frequently, especially blood pressure and heart rate
2. Assess for signs of orthostatic hypotension
3. Monitor fluid balance and daily weights
4. Check for peripheral edema and signs of heart failure
5. Monitor laboratory values: electrolytes, BUN, creatinine

High-Yield NCLEX Points

• Safety first: Always monitor BP before and after administration
• Understand the difference between hypertensive urgency vs emergency
• Know antidotes: Nitrites and thiosulfate for cyanide poisoning
• Recognize that vasodilators often cause compensatory tachycardia

Common Pitfalls