In a recent article, you noted that immediate-release nifedipine shouldn't be given for acute episodes of extreme hypertension. I'd like to point out a condition that's an exception to this general rule: autonomic dysreflexia, a potentially fatal condition.

People with spinal cord injury at or above the level of the sixth thoracic vertebra are at risk for autonomic dysreflexia, which occurs when a noxious stimulus causes a constellation of autonomic responses, including hypertension. If the patient doesn't respond quickly to nonpharmacologic interventions, the practitioner may give an antihypertensive drug, such as nifedipine or a nitrate, in a form that ensures rapid onset and short duration of action. If nifedipine is given, it should be an immediate-release capsule and the patient should be instructed to bite and swallow it.

ANGELA MEAGHER, RN, BScN

Halifax, Nova Scotia