Acute HTN Crisis

Question 1

Urgency vs Emergency

Answer 1

Urgency
-SBP > 180
-DBP > 120

Emergency
-SBP > 180
-DBP > 120
-AND acute organ injury (TIA, stroke, AKI, MI, encephalopathy)

Question 2

Etiology

Answer 2

-Non-adh to AH meds
-Drug withdrawal (BZD, alc)
-Anxiety, pain, delirium
-Volume overload
-Acute Stroke

Question 3

Urgency TX

Answer 3

-Reinstitute or intensify ORAL anti-HTN therapy
-PRN short-acting meds (optional)

Question 4

Emergency TX

Answer 4

Aortic dissection, preeclampsia, pheochromocytoma?

Yes
-Lower to SBP < 140 in 1st hour or < 120 in 20 min if AD

No
-Lower by 25% in 1st hour then to 160/110 over 2-6 hours then normal in 24-48 hours

Question 5

Clonidine

Answer 5

for Urgency

Fast, but bradycardia/sedation

BUS

Question 6

Captopril

Answer 6

for Urgency

Fast, but AKI/hyperK

Question 7

Labetalol

Answer 7

for Urgency

Vasodilating, but bradycardia + longer half-life

Question 8

Minoxidil

Answer 8

for Urgency

Vasodilator, but edema, reflex tachy

Question 9

Emergency TX for angina/HF/pulmonary edema

Answer 9

Nitroglycerin

AE: HA, tachyphylaxis

Question 10

Emergency TX for HF/AD

Answer 10

Nitroprusside

AE: coronary steal, cyanide tox

Question 11

Emergency TX for eclampsia/pre

Answer 11

Hydralazine

AE: tachycardia

Question 12

Emergency TX for HF (other)

Answer 12

Enalaprilat

AE: AKI

Question 13

Emergency TX for pheochromocytoma

Answer 13

Phentolamine

Question 14

Emergency TX for renal dysfunction

Answer 14

Fenoldopam

AE: high IOP

Question 15

CCBs for Emergency

Answer 15

Nicardipine: Most HTN em, stroke, CKD

Clevidipine: HTN em

Question 16

BBs for Emergency

Answer 16

Esmolol: AD, pre-op
(PEA)

Labetalol: stroke, drug use, clonidine wd (LSDC)

Metoprolol: pre-op, Afib (MAP)

Question 17

IV Push Preferred

Answer 17

Labetalol

Question 18

IV Continuous Preferred

Answer 18

Nicardipine

Question 19

Indication: MI

Answer 19

Nitroglycerin; esmolol, labetalol, metoprolol

Question 20

Acute Decompensated Heart Failure

Answer 20

Nitroglycerin; nitroprusside

Question 21

Aortic Dissection

Answer 21

Nitroprusside or
nicardipine + [esmolol or labetalol]

LAD PEN

Question 22

AKI

Answer 22

Nicardipine, clevidipine, labetalol

Question 23

Hyperadrenergic States

Answer 23

Phentolamine, nitroprusside, beta blockers w/ alpha activity (i.e. labetalol)

Question 24

Preeclampsia

Answer 24

Magnesium + [labetalol or nicardipine or hydralazine]