Acute Hypertensive Crisis Flashcards

1
Q

Hypertensive Emergency vs Urgency

A

Urgency
-SBP > 180
-DBP > 120

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

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2
Q

Common Presenting Subjective Symptoms

A

-SOB
-Pain
-HA
-Altered mental status
-Focal neurological deficit

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3
Q

Goals of Therapy

A
  1. Resolve clinical symptoms
  2. Prevent end organ damage or worsening of organ damage
  3. Achieve specified BP goals
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4
Q

Hypertensive Urgency TX

A
  1. Reinstitute/intensify ORAL ant-HTN therapy and arrange follow up
  2. Optional: PRN dosing of short acting meds
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5
Q

Short-acting Oral Blood Pressure Medications for Optional Urgency TX

A

Clonidine
-fast, in clinic but brady/sedation

Captopril
-fast, titrate but AKI/hyperkalemia

Labetalol
-vasodilating, but brady/long half life

Minoxidil
-vasodilator, but edema/reflex tachy

MLCC

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6
Q

Hypertensive Emergency TX

A
  1. Admit to ICU
  2. Aortic dis/preclampsia/pheo?
    *YES = decrease to SBP < 140 in first hour or < 120 if aortic dis
    *NO = decrease by max 25% in first hour then to 160/100-110 over 2-6 hours then normal in 24-48 hours
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7
Q

Nitroglycerin (IV)

A

For emergency (HET)

AE: Headache, Tachyphylaxis

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8
Q

Nitroprusside (IV)

A

For emergency (CEC)

AE: Cyanide toxicity, Coronary steal

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9
Q

Hydralazine (IV, PO)

A

For emergency

AE: Tachycardia

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10
Q

Enalaprilat

A

For emergency

AE: AKI

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11
Q

Fenoldopam

A

For emergency (PIE)

AE: Increased intraocular pressure

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12
Q

CCBs for Emergency

A

DHPs preferred because of vascular selectivity

Nicardipine: reflex tachy/HA (most common)

Clevidipine: soy/egg allergies, ↑ triglycerides

Diltiazem, Verapamil (not really used)

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13
Q

Intravenous Beta Blockers (EM)

A

Esmolol, Labetalol, Metoprolol

-all decrease HR

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14
Q

Preferred Agents in EM

A

LABETALOL preferred IV push unless
*acute HR, bradycardia, or possibly asthma/COPD -BACH

NICARDIPINE preferred IV continuous

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15
Q

Acute Myocardial Infarction

A

nitroglycerin; esmolol, labetalol, metoprolol (M for MELN)

NOT nitroprusside

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16
Q

Acute Decompensated Heart Failure

A

nitroglycerin; nitroprusside

NOT BB/nonDHP

17
Q

Aortic Dissection

A

nitroprusside or nicardipine + [esmolol or labetalol] (to prevent reflex tachycardia) DAL PEN

NOT hydralazine, minoxidil

18
Q

Acute Kidney Injury

A

nicardipine, clevidipine, labetalol (P for pines, PAKIL)

NOT diuretics, ACE inhibitors, nitroprusside

19
Q

Hyperadrenergic States

A

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

NOT BB w/o alpha

20
Q

Preeclampsia

A

Magnesium + [labetalol or nicardipine or hydralazine]

NOT diuretics; ACE inhibitors, nitroprusside

21
Q

Hemorrhagic Stroke

A

SBP < 220
-Mild: Goal 130-150 (NOT lower)
-Sev: Rec 130-150

SBP >=220
-Rec 130-150
-Use IV

Preferred: Nicardipine, Labetalol

22
Q

Ischemic Stroke

A

Candidate for IV thrombolysis?

YES = lower to < 185/110 before tpa

NO
= BP < 220/110: ix in 2-3d no benefit
= BP >= 220/110: decrease by 15% in 24 hours (target < 220)

Preferred: Nicardipine, Labetalol