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Therapeutics II > HTN Crisis > Flashcards

HTN Crisis Flashcards

1
Q

HTN crisis BP

A

> 180/120

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2
Q

emergency HTN crisis if

A

-acute organ damage
-life threatening

-need to lower BP NOW w IV Rxs

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3
Q

Urgent HTN crisis

A

-no acute organ damage
-not life threatening

-lower BP over days w ORAL meds

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4
Q

HTN crisis sx

A

-headache
-chest pain
-SOB
-back pain
-numbness/weakness
-change in vision
-difficulty speaking

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5
Q

HTN crisis risk factors

A

-HTN (30% population, 1-3% have crisis)
-obesity
-female
-hx of CVD
-more HTN meds
-nonadherence to meds

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6
Q

Common causes of crisis

A

-chronic HTN
-med non-adherence
-Rx related
-pregnancy
-renal disease
-endocrine disorders

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7
Q

Medication causes of HTN (2’)

A

-amphetamines
-corticosteroids!!
-decongestants!!
-estrogen contraceptives
-NSAIDs

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8
Q

Goals of therapy

A

-Hour 1: reduce BP upto 25%
-Hours 2-6: reduce BP < 160/100-110
-hours 6-48: reduce to goal

-stroke, aortic disection, eclampsia, pheochromocytoma crisis

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9
Q

Why BP should be lowered gradually

A

-autoregulation
-rebound HTN prolly

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10
Q

HTN emergency tx

A

-IV
-fast onset/offset
-ACEi
-ARB
-BB
-CCB

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11
Q

ACEi tx for HTN emergency

A

-lisinopril 1hr
-benazepril 2h
-Enalapril 1h
-captopril 15-30 min

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12
Q

ARB for HTN emergency

A

-Losartan onset 1WEEK!! or 6hr BOOO!
-irbesartan 2h
-valsartan 2h
-Telmisartan 3h

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13
Q

BB for HTN emergency

A

-metoprolol T 1h
-nebivolol 6 h
-cervedilol 1h
-labetalol 20min-2h

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14
Q

CCB for HTN emergency

A

-Diltiazem 15-60min
-Verapamil 1h
-Amlodipine 24h BOOO!
-Nifedipine 20 min

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15
Q

HTN urgency tx

A

-ACEi or ARB oral
-Clonidine 0.2mg by mouth 1 dose
-long term watch for rebound HTN w missed doses
-can use CCBs, vasodilators, BBs

-AVOID:
-anything IV
-hydralazine
-nifedipine sublingual (heart block and death)

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16
Q

DHP CCBs IV

A

-nicardipine 2.5-15mg/h
-clevidipine 1-32mg/h

-AVOID in aortic stenosis

17
Q

Nicardipine IV

A

-2.5-15mg/h
-lower SE
-DHP CCB
-AVOID in severe aortic stenosis
-CI renal/hepatic impairment
-reflex tachycardia

18
Q

Clevidipine

A

-1-32mg/h
-pro: lack of accumulation in organ impairment
-AVOID in severe aortic stenosis
-lipid (soy/egg allergy, inc TGs, clean lines)
-induces AFIB

19
Q

Vasodilators IV

A

-nitroglycerin 5-200mcg/min
-sodium nitroprusside 0.25-10mcg/kg/min
-hydralazine 10-20mg IV q4-6h

20
Q

Nitroglycerin IV

A

-5-200mcg/min
-good in coronary ischemia
-tolerance
-PDE5i interactions
-HA and reflex tachycardia
-CI high ICP
-hypotension in hypovolemia

21
Q

Sodium nitroprusside

A

-0.25-10mcg/kg/min
-tolerance
-PDE5i interaction
-HA and reflex tachycardia
-CI high ICP
-hypotension in hypovolemia
-cyanide toxicity

22
Q

Hydralazine

A

-10-20mg IV push q4-6h
-can use in bradycardia
-not titratable
-less predictable
-rebound tachycardia

23
Q

IV BB

A

-labetolol 10-20mg push, 20-80mg q10min
-esmolol (dosing varies)

24
Q

Labetalol

A

-10-20mg push, 20-80mg q10min
-dec HR and BP
-not infusion
-dec HR
-CI: bradycardia, ADHF, reactive airway disease

25
Q

Esmolol

A

-dosing varies
-dec HR
-can be used in reactive airway disease
-NOT monitherapy
-AVOID in bradycardia and ADHF
-can cause extravasation injuries

26
Q

Enalaprilat

A

-1.25-5mg push q6h
-maybe beneficial in renin excess
-delayed onset
-CI AKI, hyperkalemia, acute MI, renal stenosis, pregnancy

27
Q

Clonidine

A

-0.1-0.2mg PO q1h (max 0.7mg)
-delayed onset
-can cause HTN crisis on withdrawal

28
Q

Phentolamine

A

-a1 blocker
-counteracts catecholamine excess (nor/epinephrine, dopamine) in pheochromatocytoma, MAOI interactions, cocaine/amphetamine use)

-SE:
-hypotension
-tachycardia
-arrhytmias

29
Q

HTN crisis tx in acute aortic dissectino

A

-BB then vasodilator (nicardipine, nitroprusside, clevidipine)
-lower BP quickly and prevent reflex tachycardia

30
Q

HTN crisis tc in acute HF w PE

A

-nitroprusside, nitroglycerin in combo w diuretics
-nicardipine and clevidipine

-AVOID BB and nonDHP CCBs

31
Q

HTN crisis in acute intracerebral hemmorrhage or stroke

A

-labetalol, nicardipine, clevidipine

32
Q

HTN crisis tx in Acute Coronary Syndromes

A

-esmolol, labetolol, nitroglycerin, nicardipine, nitroprusside
-caution: nonDHP CCBs
-AVOID BBs if reduced EF, HR<60, SBP<100, heart block, or reactive airway disease

33
Q

HTN crisis in acute kidney injury

A

-most IV acceptable
-Caution: nitroprusside
-AVOID: ACEi/ARBs

34
Q

HTN crisis in eclampsia

A

-labetolol, nicardipine, hydralazine
-AVOID ACEi/ARB and nitroprusside

35
Q

HTN crisis in HTN encephalopathy

A

-most IV fine

36
Q

HTN crisis in Pheochromocytoma crisis

A

-BB +/- nicardipine or clevidipine
-AVOID unopposed BB
-historically: phentolamine

37
Q

Which med should be avoided in pt w soy allergy

38
Q

Which med is not available as IV infusion

Therapeutics II (55 decks)

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