HTN Crisis Flashcards
what determines a hypertensive emergency?
- BP > 180/120
- acute target organ damage
- life threatening
- dec. BP now
- IV drugs
what determines a hypertensive urgency?
- BP > 180/120
- no organ damage
- not life threatening
- dec. BP over days
- oral drugs
what are the severe symptoms of a hypertensive crisis?
- HA
- chest pain
- SOB
- back pain
- numbness/weakness
- change in vision
- difficulty speaking
what are risk factors for getting HTN crisis?
- women
- obese
- CV disease history
- lots of BP meds
- nonadherence
what are some common causes of HTN crisis?
- chronic HTN
- med non-adherence
- med/ substance related
- prego
- renal disease
- endocrine disorders
what drugs cause HTN crisis?
- corticosteroids
- decongestants
- oral contraceptives
- NSAIDs
what is the BP goal for a HTN emergency ? hours 1,2-6,6-28
hour 1 : reduce by max of 25%
hour 2-6: reduce <160/110-110
hour 6-48: reduce to goal
what should HTN urgency be treated with?
- nothing IV
- ACE/ARB
- clonidine
- have used hydralazine and SL but should be avoided
what are the pros/ons of nicardipine and what is its formulation?
Pros: lower AE risk
Cons: no use with aortics stenosis, titrate caution with renal/hepatic impairment
IV titratable
what are the pros/ons of clevidipine and what is its formulation?
Pro: lack of accumulation in organ impairment
Con: no use with severe aortic stenosis, has soy/egg
IV titratable
what are the pros/ons of nitro and what is its formulation?
Pro: good for coronary ischemia
Con: tolerance with prolonged use; no with PDE-5
IV titrated infusion
what are the pros/ons of nitroprusside and what is its formulation?
Pro: titrated
Con: cuation with ICP, hypotension and hypovolemia, cyanide toxicity, HA and reflex TC
IV titrated infusion
what are the pros/ons of hydralazine and what is its formulation?
Pro: bradycardia use
Con: no titration, less predictable PK, rebound TC
IV push
what are the pros/ons of labetolol and what is its formulation?
Pro: dec. HR and BP
Con: dec. HR, CI with severe bradycardia, reactive airway disease, and ADHF
IV push to titrated infusion
what are the pros/ons of esmolol and what is its formulation?
Pro: dec HR, cardioselective
Con: not monotherapy for BP, avoid in severe bradycardia and ADHF, cause extravasation injuries
IV titrated infusion
what are the pros/ons of enalaprilat and what is its formulation?
Pro: emergencies with renin excess
Con: delayed onset/peak, CI in AKI, hyperkalemia, acute MI, renal artery stenosis, prego
IV push
what are the pros/ons of clonidine and what is its formulation?
Pro: PO when IV not available
Con: used inapp. in HTN emergency often, delayed onset, can cause hypertensive crisis on withdrawal
PO
what is the preferred agent for the comorbidity of acute aortic dissection ( SBP rapid lowered to 100-120)?
BB then vasodilator (nicardipine, ect.)
what is the preferred agent for the comorbidity of acute HF with pulmonary edema?
nitroprusside, nitro in combo with diuretics; nicardapine and clevidipine are accetpable
– NO BB OR NON-DHP CCBs
what is the preferred agent for the comorbidity of acute intracerebral hemorrhage or acute ischemic stroke?
labetolol, nicardapine, clevidipine
what is the preferred agent for the comorbidity of acute coronary syndrome?
esmolol, labetolol, nitro, nicardapine, or SNP
– CAUTION with non-DHP CCBs
– AVOID BB if reduced EF, HR < 60, SBP < 100, 2nd/3rd degree heart block or reactive airway disease
what is the preferred agent for the comorbidity of acute kidney injury?
most IV HTN acceptable
–CAUTION with SNP
–AVOID Ace/Arb
what is the preferred agent for the comorbidity of eclampsia or preeclampsia?
labetolol, nicardapine, hydralazine
CI: Ace/Arb/ SNP
what is the preferred agent for the comorbidity of HTN encephalopathy?
most IV HTN agents are acceptable
what is the preferred agent for the comorbidity of pheochromocytoma crisis?
BBs and/or nicardipine or clevidipine
–AVOID unopposed B-Blockade (phentolamine)
