Acute Hypertensive Crisis Uncontrolled HTN √

Question 1

What defines hypertensive crisis

Answer 1

> 180 SBP and/or >120 DBP

Question 2

name 4 cause of HTN Crisis

Answer 2

Clonidine withdraw
Serotonin Syndrome
non-medication adherence
recreational drugs

Question 3

Do all patients have symptoms?

Answer 3

No patients can be asymptomatic

Question 4

what are the 4 symptoms of HTN crisis

Answer 4

Confusion/Headache
Blurred Vision
Chest pain
NV

Question 5

What are 4 signs of organ dmg

Answer 5

Stroke
heart attack, HF, Aortic Dissection
Retinopathy
Renal failure

Question 6

flow chart of HTN crisis

Answer 6

Question 7

htn emergency vs urgency

Answer 7

Organ Damage becomes an emergency

Question 8

What to do with HTN Urgency

Answer 8

Start or up oral therapy
then follow up 2-4 weeks later

Question 9

What to do with HTN Emergency (No Eclampsia or Aortic Dissection)

Answer 9

Reduce BP below 180/120 but not excceding 25%
then 160/110-100 over the next 2-6 hrs
then normal 24-48hrs

Question 10

BP goal for preclampsia

Answer 10

Reduce BP to <140 SBP in the first hour

Question 11

What are the 3 treatment goals for Aortic dissection?

Answer 11

<120 SBP in the first hour
HR to 80-60 bpm
Pain Control

Question 12

3 Sign and Symptoms of Aortic Dissection

Answer 12

Knife-like pain in either the stomach or chest
Elevated kidney and liver
loss of pulse in extremities

Question 13

Risk Factors for Aortic Dissection

Answer 13

1. Uncontrolled HTN
2. Illicit drugs
3. Weightlifting
4. Trauma
5. Genetic conditions

Question 14

How to treat Aortic Dissection

Answer 14

Esmolol 500mcg/kg bolus then 50mcg/kg/min infusion
Labetalol 20mg bolus then 10mg/HR infusion

Question 15

why do we use esmolol more often

Answer 15

Esmolol is more on hand while labetalol would need to be compounded

Question 16

When would I use IV vasodilators in the treatment of Aortic Dissection?

Answer 16

additional BP control

Question 17

How would I titrate Esmolol

Answer 17

25-50mcg/kg/min every min till at goal
MAX 300mcg/kg/min

Question 18

How would I titrate Labetalol?

Answer 18

up or down 10-20mg/min every 15 mins till at goal
MAX of 120mg

Question 19

Esmolol and Labetalol 2 side effect and contraindications

Answer 19

Bradycardia and Hypotension
can worse CHF symptoms

X An Active Airway Disease
caution in HFRef

Question 20

What meds for Aortic Dissection can we control HR if Esmolol and Labetalol need help

Answer 20

Nicardipine
Clevidipine
Nitroprusside

Question 21

Nicardipine Titration

Answer 21

Start 2-5mg/hour, T 1-5 mg/hr every 2 mins
MAX 15

Question 22

Clevidipine Titration

Answer 22

Start 2-4mg/hour, T 2-4mg/hour every 1 mins
MAX 32

Question 23

Nitroprusside Titration

Answer 23

Start 0.25-.5mcg/kg/min, T 0.25mcg/kg/min every 2 mins
MAX of 3mcg/kg/min

Question 24

If I need more than 2 days of IV vasodilators can i use Nitroprusside?

Answer 24

No bc of Tachyphylaxis

Question 25

3 side effects of IV vasodilators?

Answer 25

Hypotension headache rebound tachy

Question 26

What AD to watch out for with Clevidipine

Answer 26

Triglycerdimia

Question 27

When cant I use Clevidipine?

Answer 27

Soy allergy

Question 28

When can I not use Nitroprusside

Answer 28

Hepatic and Renal failure due to cyanide toxic X pregnancy X ACS

Question 29

Can you give Nitroprusside to renal/hepatic pts?

Answer 29

yes but need to limit

Question 30

Preeclampsia signs and symptoms

Answer 30

Headache chest pain liver and kidney failure blurred vison NV

Question 31

Follow-up thearpy for Aortic Dissection

Answer 31

Not sure if we have to know this

Question 32

what is the best drug to treat preeclampsia?

Answer 32

4 mg mag sulfate over 30mins then 2gm/hr titration

Question 33

Mag titration?

Answer 33

none can keep giving bolus MAX safe for levels 4.2-8.4 mg/dL

Question 34

Mag sulfate Adverse effects

Answer 34

None until you reach >8.4 mag then watch for respiratory depression, heart attack loss of tendon reflexes CAUTION in kidneys (still can use just monitor)

Question 35

Labetalol vs hydralazie for preeclampsia

Answer 35

Labetalol can be used in pt that have an ACS Hydralazine can be used in pt who have active airway disease and HEFref

Question 36

Which HTN crisis can you use Hydralazine for

Answer 36

only Preclampsia

Question 37

Hydralazine 3 ad and 2 cautions

Answer 37

Reflex tach lupus with >300 grams/day hypotension symptoms X ACS X Aortic Dissection

Question 38

Hydralazine dose

Answer 38

5-20mg/ 4-8hrs or prn with >120 SBP

Question 39

Treatment for ACS HTN crisis

Answer 39

IV Nitroglycerin 10-20mcg/min

Question 40

Nitroglycerin Titration

Answer 40

5-10mcg/min every 5 mins max 200mcg/min

Question 41

What do watch out for with IV nitrate 3 things

Answer 41

Tachyphylaxis like Nitroprusside Rebound Tachycardia right ventricular infarct

Question 42

Acute decomposition heart failure HTN crisis Treatment

Answer 42

Nitroprusside 0.25-.5mcg/min Nitroglycerin 10-20mcg/min

Question 43

Which drug can we use to treat AKI HTN crisis

Answer 43

CHIL Clevedipine 2-4 mg/hr Hydralazine 5-20mg every 4-8 hrs no continuous infusion IV Nicardipine 2-5mg/hr Labetalol Bolus 20mg then 10mg/hr