Why would someone be on both a levo and a SNP drip?

Answer 1

Only seen this combo used once, and it was for a case of cardiogenic shock with a really nasty case of pulm edema. Was the "brainchild" of a cardiologist and a pulmonologist who actually decided to work together for once. It's really tricky from a dosing and nsg perspective. I don't like relying on SGs, but had a well placed one in this case that didn't let us down.
It was really rather effective...but nervewracking!

Answer 2

SNP = nitroprusside.

As far as the combination, i agree that's odd, since the two drugs kinda counteract each other. SNP is primarily an arterial vasodilator, while Levo primarily is a vasoconstrictor with a little bit of extra boost to contractility. Now, if it was nitroglycerin, that would be different because 1. you would get improved collateral flow from the nitroglycerin that you don't get from the nipride. and 2. as a venodilator, you would get a drop in preload, decreasing the work of the heart. So, one could argue that the nitroglycerin could be used for cardioprotection while the levo is used to maintain perfusion/blood pressure (although too much levo will also increase the work of the heart).

Honestly, I can't think of why you would be on both drips... doesn't mean that there isn't some rationale for it though.

The idea of using it for severe cardiac failure with pulmonary edema is intriguing, but I'm still not sure I see the logic. Maybe an inotrope like milrinone combined with a vasopressor like Levo makes sense. Maybe if you're worried about PA pressures/ right heart failure, but while nitroglycerin has some effect on pulmonary vasoconstriction, I'd think that it wouldn't be all that effective, especially compared to nitric oxide, iloprost etc. Off-loading the heart might help by moving you to a more favorable portion of the starling curve, but once again, to do that, I'd use nitroglycerin, not nipride.

Answer 3

what's SNP? i'm a doc... don't know that abbreviation.... is it nitroprusside or another nitro drip?

okay, thanks to the anesthesiologist who answered after me... i'm a an internist and hospitalist/intensivist... never seen nitroprusside written as "SNP"... but agree with both previous answers - an unlikely combo ... suspect it's from cardiogenic shock with pulmonary edema... though don't think i'd run both of those without a swan.... Is there a head injury involved?

Answer 4

Severe Congestive Cardiac Failure - maybe a nasty acute pulmonary oedema

but you're right - it's an odd combination.