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Therapeutics I > HTN Crisis > Flashcards

HTN Crisis Flashcards

1
Q

What is a HTN crisis?

A

> 180/120

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2
Q

What are the risk factors of HTN crisis?

A
  1. Female sex
  2. Age
  3. Black
  4. Low income
  5. Medication non-adherence
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3
Q

What is the patho of HTN crisis?

A
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4
Q

What is the most common pharmacological causes that could lead to HTN crisis?

A

Withdrawn of AHTN therapy (b-blockers, clonidine)

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5
Q

Discuss the signs and symptoms of HTN emergency?

A
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6
Q

What are the steps for HTN emergency treatment?

A

First hour: Decrease in DBP by 10-15% or MAP by 25% with goal DBP ≥100 mmHg
2-6 hr: SBP 160 and/or DBP 100-110
24-48 hr: Outpatient BP goals

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7
Q

What are the exceptions of HTN emergency treatments?

A
  1. Acute aortic dissection
  2. Stroke
  3. Pregnancy (severe preeclampsia or eclampsia)
  4. Pheochromocytoma crisis
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8
Q

What is the dosage form of HTN emergency treatments? Onset? Duration?

A

IV
Fast
Low DOA → increased titration

Most are titrations and weight based

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9
Q

What is the fastest drug for emergency?

A

Nitroprusside

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10
Q

What is nitroprusside? MOA? ADRs? CIs? Indications?

A

MOA: Potent arterial and venous VD that leads to smooth muscle relaxation
Coronary steal and increased ICP
ADR: Acute MI and ICP elevation
CI: Cyanide toxicity with long duration of high doses (72 hr)
Renal and liver failure
Indication: All

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11
Q

Nitroglycerin? MOA? ADR? CI? Indication?

A

MOA: venous vasodilator with no coronary steal
ADR: Tachyphylaxis (24-48hr) with lacking nitrate-free intervals, flushing, HA, erythema
CI: PDE3is
Indication: MI/ACS and ADF w/ pulmonary edema

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12
Q

Hydralazine? MOA? ADR? CI? Indication?

A

MOA: Peripheral arterial VD
ADR: Rebound tachycardia, HA, lupuslike syndrome
CI:
Indication: Pregnancy

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13
Q

Nicardipine? MOA? Pros and cons? Indications?

A

Crosses the BBB → cerebral vasodilation
Metabolized by CYP
Cheaper than clevidipine
Requires large volume adminsitration

Most indications especially strokes

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14
Q

Clividipine? MOA? Pros and cons? Indications?

A

Inhibits calcium influx in vascular smooth muscle

Lipid emulsion → expire in 12 hr → monitor TAG → caution in soy or egg allergies

Better BP variability profile, less volume administered

Faster BP attainment

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15
Q

What are b1 antagonists used? Indications? MOA?

A
  1. Esmolol (rapid onset, short duration, titratable):
  2. Metoprolol (IV push, slower onset, longer DOA): overaggressive correction:

Aortic dissection

Negative inotropic and chronotropic activity (not VD)

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16
Q

Labetalol? Indication? CI?

A

1:7 alpha to beta blockade
Infusion or push
Pregnancy, stroke, aortic dissection
Respiratory disease

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17
Q

What is the overall warning of beta blocker?

A

Avoid with ADHF, heart block, bradycardia

18
Q

Enalaprilat? Indication? CI?

A

IV ACEIs not easily titratable
Limited use due to slow onset and DOA

Pregnancy and renal dysfunction

19
Q

Phentolamine? MOA? Indications? ADRs?

A

Peripheral alpha 1 and 2 blockier → direct vasodialtion

Pheochromocytoma, catecholamine excess, cocaine, amphetamine induced HTN emergency

Rebound tachycardia

20
Q

Felodopam? MOA? Indications? ADRs?

A

Peripheral dopamine 1 agonist → arterial VD
CI: Anaphylaxis with sulfite allergies
ADR: Hypokalemia, flushing, increase IOP

21
Q

What is the difference between Type A and B aortic dissection?

A

A: ascending (surgical emergency)
B: aortic arch or descending aorta

22
Q

What is the treatment goal for aortic dissection?

A

Control BP and HR

HR <60 ASAP
SBP <120 and/or as low as clinically tolerated

Beta blockers used first, followed by VD if needed

23
Q

What are the 4 categories of pregnancy HTN?

A
  1. Chronic
  2. Gestational
  3. Preeclampsia
  4. Superimposed preeclampsia
24
Q

What is gestational HTN?

A

New-onset HTN >20 weeks gestation without proteinuria or other systemic findings

25
Q

Whaat is preeclampsia

A

≥140/90 on 2 separate occasions at least 4 hrs apart with proteinuria > 20 weeks gestation or presence of severe features

26
Q

What is superimposed preeclampsia?

A

Patient with HTN prior to pregnancy who now has preeclampsia

27
Q

What severe features are you looking for in pregnancy HTN?

A
  1. Thrombocytopenia
  2. Impaired LFTs
  3. New renal insufficiency
  4. Pulmonary edema
  5. New-onset cerebral or visual disturbances
28
Q

What is eclampsia?

A

Seizure onset in a woman with preeclampsia

29
Q

What is considered severe HTN in pregnancy?

A

> 160/110

30
Q

What is pregnancy treatment for HTN?

A

Delivery is only managed by eclampsia → Magnesium IV added to reduce seizure risk → IV AHTN for BP >160/110, preeclampsia/eclampsia or HTN emergency (Labetalol, hydralazine, CCB) → Goal

31
Q

What is goal of HTN pregnancy ?

A

Decrease MAP by 20-25% over minutes to hrs then to ultimate goal SBP<140

32
Q

When do you treat ischemic HTN?

A

Only treat BP if: using thrombolytics, other target organ damage present, >220/120

33
Q

What drugs do you use for Ischemic HTN uemergency?

A

Labetalol, nicardipine, clevidipine, hydralazin and enalaprilat

34
Q

What is hemorrhagic HTN emergency? Goal? Drugs?

A

Elevated BP → hematoma expansion → neurologic worsening

SBP 140-160

Nicardipine or clevidipine

35
Q

What is pheochromocytoma? Drugs?

A

Excess release of E and NE due to adrenal tumor

Pure alpha antagonist

Alternatives: phenoxybenzamine or doxzosin

36
Q

Drugs for cocaine induced HTN emergency?

A
  1. Benzos (central effect)
  2. Phentolamine (2nd line)
  3. CCB and VD (3rd line)
  4. Combo of a/b blockers if tachycardia arises
37
Q

What is the treatment for urgency?

A

Lower BP slowly using PO med → maintenance med → optimal use of quick onset med

38
Q

What are the quick onset med? Dose?

A
  1. Captopril: 25-50 mg, onset 15-30 min
  2. Clonidince: 0.2 mg, for HTN rebound with withdrawn
  3. Labetalol: 200-400 mg
  4. Hydralazine: 10 mg
39
Q

Why do we need to correct BP slowly?

A
  1. Cerebral ischemia
  2. Neurological decline
  3. End organ adjustment to chronic HTN
40
Q

How should you monitor and follow up with hypertensive emergency?

A
  1. ER → ICU
  2. Follow treatment goals and timelines
  3. Monitor improvements in end organ damage and side effects of medications
  4. IV → PO transition
41
Q

What are we looking for in HTN emergency monitoring?

A
  1. Target organ damage
  2. GIT is functional
  3. BP is near recommended goal for 2 consecutive readings
42
Q

How should you monitor and follow up with hypertensive urgency?

A

Therapeutics I (32 decks)

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