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PHRM 844 Therapeutics > Exam 6 - Hypertensive Crisis Garver > Flashcards

Exam 6 - Hypertensive Crisis Garver Flashcards

1
Q

what are the two criteria for hypertensive urgency?

A

-systolic BP > 180 and/or diastolic BP > 120
-no evidence of target organ damage

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2
Q

what are the two criteria for hypertensive emergency?

A

-systolic BP > 180 and/or diastolic BP > 120
-evidence of target organ damage (new or worsening)

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3
Q

true or false: during hypertensive urgency, we need to refer to the emergency department and immediately reduce pt’s BP

A

false (this would be true for hypertensive emergency)

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4
Q

what are the goals of therapy for pt with hypertensive emergency at hour 1, hours 2-6, and hours 6-48?

A

hour 1: reduce BP by max 25%
hour 2-6: reduce BP <160/100-110
hours 6-48: reduce BP to goal (goal will vary based on patient)

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5
Q

if a pt’s BP is 224/136, what would be the lowest BP we could drop it to in the first hour?

A

168/102 (max 25% reduction)

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6
Q

hypertensive emergency should be treated with ______ meds

a. oral
b. IV

A

b. IV

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7
Q

CI for nicardipine and clevidipine

a. reactive airway disease
b. severe bradycardia
c. severe aortic stenosis
d. AKI

A

c. severe aortic stenosis

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8
Q

which has a faster onset and shorter duration of action?

a. nicardipine
b. clevidipine

A

b. clevidipine

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9
Q

which DHP CCB is usually preferred for hypertensive emergency?

a. nicardipine
b. clevidipine

A

a. nicardipine (due to less adverse effects)

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10
Q

which DHP CCB can induce A-fib?

a. nicardipine
b. clevidipine

A

b. clevidipine

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11
Q

which DHP CCB is titrable?

a. nicardipine
b. clevidipine
c. both
d. neither

A

c. both

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12
Q

which DHP CCB do we need to titrate cautiously in pts with renal/hepatic impairment?

a. nicardipine
b. clevidipine

A

a. nicardipine

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13
Q

which vasodilator is beneficial in coronary ischemia?

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

A

a. nitroglycerin

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14
Q

which vasodilator may be used in pts with bradycardia?

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

A

c. hydralazine

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15
Q

which has the quickest onset of action and shortest duration of action?

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

A

b. sodium nitroprusside

(onset is seconds, lasts 2-3 minutes)

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16
Q

which vasodilator has the slowest onset of action (10-20 min) and the longest duration of action (60-240 min)?

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

A

c. hydralazine

17
Q

which of the following meds increase intracranial pressure? SELECT ALL THAT APPLY

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

A

a, b

18
Q

which beta blocker is available as both IV push and IV infusion?

a. labetalol
b. esmolol

A

a. labetalol

19
Q

which beta blocker affects heart rate but not BP?

a. labetalol
b. esmolol

A

b. esmolol (labetalol will dec HR and BP, esmolol will only dec HR)

20
Q

which beta blocker has the slower onset (5-10 min) and longer duration of action (180-360 min)?

a. labetalol
b. esmolol

A

a. labetalol

21
Q

which is cardioselective and is tolerable in reactive airway diseases?

a. labetalol
b. esmolol

A

b. esmolol

22
Q

which is CI with severe bradycardia, ADHF (acute decompensated heart failure), and reactive airway disease?

a. labetalol
b. esmolol

A

a. labetalol

23
Q

true or false: esmolol is used as monotherapy for BP reduction

A

false

24
Q

what is the only oral drug we talked about for hypertensive crisis?

A

clonidine

25
Q

which is CI in AKI, hyperkalemia, acute MI, bilateral renal artery stenosis, and pregnancy?

a. clonidine
b. enalaprilat
c. hydralazine
d. nicardipine

A

b. enalaprilat

26
Q

what drug class is clonidine in?

A

alpha 2 agonist

27
Q

which drug may be beneficial in emergencies related to renin excess?

a. clevidipine
b. nitroglycerin
c. hydralazine
d. enalaprilat

A

d. enalaprilat

28
Q

which med is most likely to cause bradycardia as a side effect?

a. nicardipine
b. sodium nitroprusside
c. labetalol
d. enalaprilat

A

c. labetalol

29
Q

Which medication is not available as a titratable IV infusion?

a. Hydralazine
b. Clevidipine
c. Labetalol
d. Nitroglycerin

A

a. Hydralazine

30
Q

pharmacotherapy for acute decomp HF with pulmonary edema (2)

A

-nitroglycerin or SNP (nicardipine and clevidipine are acceptable alternatives)
-avoid beta blockers and non-DHP CCBs

31
Q

for HTN treatment for a pt with an aortic dissection, what meds do we initiate?

A

beta blocker then vasodilator (ex. nicardipine, clevidipine, SNP)

32
Q

which is not one of the preferred agents for acute coronary syndromes?

a. esmolol
b. labetalol
c. SNP
d. nitroglycerin
e. hydralazine
f. nicardipine

A

e. hydralazine

33
Q

for acute coronary syndromes, what drug class should be avoided in the setting of reduced EF, HR < 60 bpm, SBP < 100 mmHg, 2nd or 3rd degree heart block, or reactive airway disease?

A

beta blockers

34
Q

most IV antihypertensives are acceptable for pts with AKI, except

a. SNP
b. nitroglycerin
c. enalaprilat
d. labetalol

A

c. enalaprilat

(use caution with SNP)

35
Q

for pts with eclampsia/severe pre-eclampsia, what 3 drugs are preferred for antihypertensive treatment?

A

hydralazine
labetalol
nicardipine

36
Q

2 drugs that are CI for pts with eclampsia

A

enalaprilat and SNP

37
Q

what 3 drugs are preferred for pt with stroke (intracranial hemorrhage/ischemic)?

A

nicardipine
clevidipine
labetalol

(nitrate not an option due to inc ICP)

38
Q

JR is in the ER for hypertensive emergency. BP is 190/120 mmHg and pulse is 78 bpm. PMH includes HTN, prediabetes, and asthma. His CMP results indicate that he has an AKI. Which of the following represents the BEST regimen to manage this patient’s HTN?

a. Enalaprilat 1.25 mg IV push
b. Clonidine 0.2 mg PO
c. Nicardipine 5 mg/hr IV infusion
d. Esmolol 50 mcg/kg/minute IV infusion

A

c. Nicardipine 5 mg/hr IV infusion

(A. is CI in AKI; B. is oral so would take too long; D. esmolol does not impact BP and is only used adjunct for BP reduction)

39
Q

_____ meds are preferred if treating a patient with hypertensive urgency

a. oral
b. IV

A

a. oral

PHRM 844 Therapeutics (28 decks)

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