HTN crisis Flashcards
Stoll
urgency characteristics
BP > 180/120
NO acute target organ damage
not life threatening
emergency characteristics
BP > 180/120
acute target organ damage
life threatening
goal of urgency
decrease BP over days
reinstitute/intensification of antihypertensive drug therapy
what is a patient specific condition that can affect urgency?
anxiety
treat if applicable
goal of emergency
decrease BP now
in hour 1, what is the goal BP?
reduce by max of 25%
in hours 2-6, what is the goal BP?
reduce to under 160/ 100-110
in hours 6-48, what is the goal BP?
reduce to previous goal
what are patient specific conditions that affect emergencies?
stroke
aortic dissection
severe eclampsia/preeclampsia
pheochromoctyoma crisis
what type of medications are used in urgencies?
oral
what drug classes are sued in urgencies?
ACEi
ARBs
B-blockers
CCB
what ACEis are used to treat urgencies?
Lisinopril
Benazepril
Enalapril
Captopril
what ARBs are used to treat urgencies?
losartan (onset of either 1 week or 6 hours)
Irbesartan
Valsartan
Telmisartan
what beta blockers are used in urgencies?
metoprolol tartrate
nebivolol
carvedilol
labetalol
what CCBs are used in urgencies?
diltiazem
verapamil
amlodipine (onset of either 24 hrs or 24-48 hrs)
nifedipine
what type of drugs are used in emergencies?
IV
what drug classes are used in emergencies
DHP CCBs
Vasodilators
B-blockers
ACEi
Alpha 2 agonists
what DHP CCBs are used in emergencies?
nicardipine
clevidipine
what vasodilators are used in emergencies?
Nitroglycerin
sodium nitroprusside
Hydralazine
what beta blockers are used in emergencies?
labetalol
esmolol
what ACEi are used in emergenices?
enalaprilat
what alpha-2 agonists are used in emergencies?
clonidine
what is phentolamine?
alpha 1 blocker
what is fenoldopam?
dopamine agonist
what drugs should be used in acute aortic dissection?
initiate BB then vasodilator to lower BP quickly and prevent reflex tachycardia
what drugs should be used in acute HF with pulmonary edema?
nitroprusside, nitroglycerin in combo with diuretics
alternative - nicardipine and clevidipine
what drugs should be avoided in acute HF?
Bblockers
non-DHP CCBs
what drugs should be used in intracerebral hemorrhage or acute ischemic stroke?
labetalol
nicardipine
clevidipine
what drugs should be used in acute coronary syndrome?
esmolol, labetalol, nitroglycerin, nicardipine, or sodium nitroprusside
what drugs should be avoided in acute coronary syndrome?
caution with non-DHP CCBs
avoid BB in the setting of reduced EF, HR under 60 bpm, SBP under 100 mmHg, 2nd or 2rd degree heart block, or reactive airway disease
what drugs should be used in AKI?
IV anithypertensive acceptable
what drugs should be avoided in AKI?
caution with sodium nitroprusside
avoid ACEi/ARBs
what drugs should be used in eclampsia/preeclampsia?
labetalol, nicardipine, hydralazine
what drugs are CI in eclampsia/preeclampsia?
any ACEi/ARB
nitroprusside
what drugs should be used in a hypertensive encephalopathy?
most IV acceptable
what drugs are used in a pheochromocytoma crisis?
B-blockers plus or minus nicardipine or clevidipine
historically phentolamine
