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PHRM 844 Exam 6 (new material) > HTN Crisis > Flashcards

HTN Crisis Flashcards

1
Q

what determines a hypertensive emergency?

A
  1. BP > 180/120
  2. acute target organ damage
  3. life threatening
  4. dec. BP now
  5. IV drugs
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2
Q

what determines a hypertensive urgency?

A
  1. BP > 180/120
  2. no organ damage
  3. not life threatening
  4. dec. BP over days
  5. oral drugs
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3
Q

what are the severe symptoms of a hypertensive crisis?

A
  1. HA
  2. chest pain
  3. SOB
  4. back pain
  5. numbness/weakness
  6. change in vision
  7. difficulty speaking
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4
Q

what are risk factors for getting HTN crisis?

A
  1. women
  2. obese
  3. CV disease history
  4. lots of BP meds
  5. nonadherence
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5
Q

what are some common causes of HTN crisis?

A
  1. chronic HTN
  2. med non-adherence
  3. med/ substance related
  4. prego
  5. renal disease
  6. endocrine disorders
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6
Q

what drugs cause HTN crisis?

A
  1. corticosteroids
  2. decongestants
  3. oral contraceptives
  4. NSAIDs
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7
Q

what is the BP goal for a HTN emergency ? hours 1,2-6,6-28

A

hour 1 : reduce by max of 25%
hour 2-6: reduce <160/110-110
hour 6-48: reduce to goal

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8
Q

what should HTN urgency be treated with?

A
  1. nothing IV
  2. ACE/ARB
  3. clonidine
  4. have used hydralazine and SL but should be avoided
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9
Q

what are the pros/ons of nicardipine and what is its formulation?

A

Pros: lower AE risk
Cons: no use with aortics stenosis, titrate caution with renal/hepatic impairment
IV titratable

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10
Q

what are the pros/ons of clevidipine and what is its formulation?

A

Pro: lack of accumulation in organ impairment
Con: no use with severe aortic stenosis, has soy/egg
IV titratable

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11
Q

what are the pros/ons of nitro and what is its formulation?

A

Pro: good for coronary ischemia
Con: tolerance with prolonged use; no with PDE-5
IV titrated infusion

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12
Q

what are the pros/ons of nitroprusside and what is its formulation?

A

Pro: titrated
Con: cuation with ICP, hypotension and hypovolemia, cyanide toxicity, HA and reflex TC
IV titrated infusion

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13
Q

what are the pros/ons of hydralazine and what is its formulation?

A

Pro: bradycardia use
Con: no titration, less predictable PK, rebound TC
IV push

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14
Q

what are the pros/ons of labetolol and what is its formulation?

A

Pro: dec. HR and BP
Con: dec. HR, CI with severe bradycardia, reactive airway disease, and ADHF
IV push to titrated infusion

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15
Q

what are the pros/ons of esmolol and what is its formulation?

A

Pro: dec HR, cardioselective
Con: not monotherapy for BP, avoid in severe bradycardia and ADHF, cause extravasation injuries
IV titrated infusion

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16
Q

what are the pros/ons of enalaprilat and what is its formulation?

A

Pro: emergencies with renin excess
Con: delayed onset/peak, CI in AKI, hyperkalemia, acute MI, renal artery stenosis, prego
IV push

17
Q

what are the pros/ons of clonidine and what is its formulation?

A

Pro: PO when IV not available
Con: used inapp. in HTN emergency often, delayed onset, can cause hypertensive crisis on withdrawal
PO

18
Q

what is the preferred agent for the comorbidity of acute aortic dissection ( SBP rapid lowered to 100-120)?

A

BB then vasodilator (nicardipine, ect.)

19
Q

what is the preferred agent for the comorbidity of acute HF with pulmonary edema?

A

nitroprusside, nitro in combo with diuretics; nicardapine and clevidipine are accetpable
– NO BB OR NON-DHP CCBs

20
Q

what is the preferred agent for the comorbidity of acute intracerebral hemorrhage or acute ischemic stroke?

A

labetolol, nicardapine, clevidipine

21
Q

what is the preferred agent for the comorbidity of acute coronary syndrome?

A

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

22
Q

what is the preferred agent for the comorbidity of acute kidney injury?

A

most IV HTN acceptable
–CAUTION with SNP
–AVOID Ace/Arb

23
Q

what is the preferred agent for the comorbidity of eclampsia or preeclampsia?

A

labetolol, nicardapine, hydralazine
CI: Ace/Arb/ SNP

24
Q

what is the preferred agent for the comorbidity of HTN encephalopathy?

A

most IV HTN agents are acceptable

25
Q

what is the preferred agent for the comorbidity of pheochromocytoma crisis?

A

BBs and/or nicardipine or clevidipine
–AVOID unopposed B-Blockade (phentolamine)

PHRM 844 Exam 6 (new material) (3 decks)

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