Exam 6 - Hypertensive Crisis Garver

Question 1

what are the two criteria for hypertensive urgency?

Answer 1

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

Question 2

what are the two criteria for hypertensive emergency?

Answer 2

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

Question 3

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

Answer 3

false (this would be true for hypertensive emergency)

Question 4

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

Answer 4

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)

Question 5

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

Answer 5

168/102 (max 25% reduction)

Question 6

hypertensive emergency should be treated with ______ meds

a. oral
b. IV

Answer 6

b. IV

Question 7

CI for nicardipine and clevidipine

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

Answer 7

c. severe aortic stenosis

Question 8

which has a faster onset and shorter duration of action?

a. nicardipine
b. clevidipine

Answer 8

b. clevidipine

Question 9

which DHP CCB is usually preferred for hypertensive emergency?

a. nicardipine
b. clevidipine

Answer 9

a. nicardipine (due to less adverse effects)

Question 10

which DHP CCB can induce A-fib?

a. nicardipine
b. clevidipine

Answer 10

b. clevidipine

Question 11

which DHP CCB is titrable?

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

Answer 11

c. both

Question 12

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

a. nicardipine
b. clevidipine

Answer 12

a. nicardipine

Question 13

which vasodilator is beneficial in coronary ischemia?

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

Answer 13

a. nitroglycerin

Question 14

which vasodilator may be used in pts with bradycardia?

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

Answer 14

c. hydralazine

Question 15

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

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

Answer 15

b. sodium nitroprusside

(onset is seconds, lasts 2-3 minutes)

Question 16

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

Answer 16

c. hydralazine

Question 17

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

a. nitroglycerin
b. sodium nitroprusside
c. hydralazine

Answer 17

a, b

Question 18

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

a. labetalol
b. esmolol

Answer 18

a. labetalol

Question 19

which beta blocker affects heart rate but not BP?

a. labetalol
b. esmolol

Answer 19

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

Question 20

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

a. labetalol
b. esmolol

Answer 20

a. labetalol

Question 21

which is cardioselective and is tolerable in reactive airway diseases?

a. labetalol
b. esmolol

Answer 21

b. esmolol

Question 22

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

a. labetalol
b. esmolol

Answer 22

a. labetalol

Question 23

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

Answer 23

false

Question 24

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

Answer 24

clonidine

Question 25

which is CI in AKI, hyperkalemia, acute MI, bilateral renal artery stenosis, and pregnancy? a. clonidine b. enalaprilat c. hydralazine d. nicardipine

Answer 25

b. enalaprilat

Question 26

what drug class is clonidine in?

Answer 26

alpha 2 agonist

Question 27

which drug may be beneficial in emergencies related to renin excess? a. clevidipine b. nitroglycerin c. hydralazine d. enalaprilat

Answer 27

d. enalaprilat

Question 28

which med is most likely to cause bradycardia as a side effect? a. nicardipine b. sodium nitroprusside c. labetalol d. enalaprilat

Answer 28

c. labetalol

Question 29

Which medication is not available as a titratable IV infusion? a. Hydralazine b. Clevidipine c. Labetalol d. Nitroglycerin

Answer 29

a. Hydralazine

Question 30

pharmacotherapy for acute decomp HF with pulmonary edema (2)

Answer 30

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

Question 31

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

Answer 31

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

Question 32

which is not one of the preferred agents for acute coronary syndromes? a. esmolol b. labetalol c. SNP d. nitroglycerin e. hydralazine f. nicardipine

Answer 32

e. hydralazine

Question 33

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?

Answer 33

beta blockers

Question 34

most IV antihypertensives are acceptable for pts with AKI, except a. SNP b. nitroglycerin c. enalaprilat d. labetalol

Answer 34

c. enalaprilat (use caution with SNP)

Question 35

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

Answer 35

hydralazine labetalol nicardipine

Question 36

2 drugs that are CI for pts with eclampsia

Answer 36

enalaprilat and SNP

Question 37

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

Answer 37

nicardipine clevidipine labetalol (nitrate not an option due to inc ICP)

Question 38

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

Answer 38

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)

Question 39

_____ meds are preferred if treating a patient with hypertensive urgency a. oral b. IV

Answer 39

a. oral