Acute Hypertensive Crisis Flashcards

1
Q

What defines hypertensive crisis

A

> 180 SBP and/or >120 DBP

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2
Q

name 4 cause of HTN Crisis

A

Clonidine withdraw
Serotonin Syndrome
non-medication adherence
recreational drugs

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3
Q

Do all patients have symptoms?

A

No patients can be asymptomatic

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4
Q

what are the 4 symptoms of HTN crisis

A

Confusion/Headache
Blurred Vision
Chest pain
NV

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5
Q

What are 4 complications from acute HTN crisis

A

Stroke
heart attack, HF, Aortic Dissection
Retinopathy
Renal failure

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6
Q

flow chart of HTN crisis

A
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7
Q

htn emergency vs urgency

A

Organ Damage becomes an emergency

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8
Q

What to do with HTN Urgency

A

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

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9
Q

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

A

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

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10
Q

BP goal for preclampsia

A

Reduce BP to <140 SBP in the first hour

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11
Q

What are the 3 treatment goals for Aortic dissection?

A

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

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12
Q

3 Sign and Symptoms of Aortic Dissection

A

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

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13
Q

How to treat Aortic Dissection

A

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

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14
Q

why do we use esmolol more often

A

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

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15
Q

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

A

additional BP control

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16
Q

How would I titrate Esmolol

A

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

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17
Q

How would I titrate Labetalol?

A

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

18
Q

Esmolol and Labetalol 2 side effect and contraindications

A

Bradycardia and Hypotension
can worse CHF symptoms

X An Active Airway Disease
caution in HFRef

19
Q

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

A

Nicardipine
Clevidipine
Nitroprusside

20
Q

Nicardipine Titration

A

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

21
Q

Clevidipine Titration

A

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

22
Q

Nitroprusside Titration

A

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

23
Q

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

A

No bc of Tachyphylaxis

24
Q

3 side effects of IV vasodilators?

A

Hypotension
headache
rebound tachy

25
Q

What to watch out for with Clevidipine

A

Triglycerdimia

26
Q

When cant I use Clevidipine?

A

Soy allergy

27
Q

When can I not use Nitroprusside

A

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

28
Q

Can you give Nitroprusside to renal/heptic pts?

A

yes but need to limit

29
Q

Preeclampsia signs and symptoms

A

Headache
chest pain
liver and kidney failure
blurred vison
NV

30
Q

what is the best drug to treat preeclampsia?

A

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

31
Q

Mag titration?

A

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

32
Q

Mag sulfate Adverse effects

A

None until you reach 8.4+ mag
then watch for respiratory depression, heart attach loss of tendon reflexes
CAUTION in kidneys

33
Q

Labetalol vs hydralazie for preeclampsia

A

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

34
Q

Which HTN crisis can you use Hydralazine for

A

only Preclampsia

35
Q

Hydralazine 3 ad and 2 cautions

A

Reflex tach
lupus with >300 grams/day
hypotension symptoms

X ACS
X Aortic Dissection

36
Q

Hydralazine dose

A

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

37
Q

Treatment for ACS HTN crisis

A

IV Nitroglycerin 10-20mcg/min

38
Q

Nitroglycerin Titration

A

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

39
Q

What do watch out for with IV nitrate 3 things

A

Tachyphylaxis like Nitroprusside
Rebound Tachycardia
right ventricular infarct

40
Q

Acute decomposition heart failure HTN crisis Treatment

A

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

41
Q

Which drug can we use to treat AKI HTN crisis

A

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