HTN Crisis - Resident Flashcards
Define HTN Urgency
BP > 180/120
Define HTN Emergency
BP > 180/120
&
Evidence of target organ dysfunction
what organs are normally affected by HTN crisis and the symptom that goes with it
LUNGS - SOB
BRAIN - altered mental status
HEART - ECG changes
Kidneys - ACUTESCr changes
what kinds of SCr changes make it known that there has been some end organ damage to the kidney in HTN crisis
ACUTE CHANGES
if SCr normally < 3 - any 0.5 increase in SCr = acute kidney damage
if SCr normally > 3 - any 1 increase in SCr = acute kidney damage
what is main symptom of HTN urgency
HA
what are the main symptoms of HTN emergency
- N/V
- Chest pain
- SOB
- HA
- Back pain
- Blurry vision
what are some cause of HTN emergencies
- essential HTN
- Renal disease
- Pregnancy
- Drugs
- CNS disorders
- Endocrine disorders
Goals of therapy for HTN Urgency:
get BP to < 160/110
*DO NOT reduce MAP by no more than 25% within 1st 24 hrs using oral therapy
Goals of therapy for HTN emergency:
MAP reduction of ~10% during 1st hour then more 15% within next 2 - 3 hours using PARENTERAL THERAPY
HTN Urgency - use oral or parenteral?
ORAL
HTN emergency - use oral or parenteral?
parenteral
what agents can be used for HTN urgency
- Captopril
- Nicardipine
- Labetalol
- Clonidine
Onset of action for Captopril
15 - 20 minutes
Route of admin for captopril?
ORAL! 9can be sublingual
Dosing for Captopril (HTN URGENCY)
initial 25 mg;
Repeat in 90 - 120 minutes PRN
Onset of action of Nicardipine
0.5 - 2 hours
Dosing for Nicardipine (HTN URGENCY)
30 mg (initial) Q8h prn
Onset of action for Labetalol
1 - 2 hrs
Dosing for Labetalol (HTN URGENCY)
initial 200 mg
Repeat in 3 - 4 hrs prn
Onset of action of Clonidine
15 - 30 minutes
Dosing of Clonidine (HTN URGENCY)
- 1 - 0.2 mg
* repeat 0.1 mg QH until goal BP - max of 0.7 mg/day
what to do if HTN emergency and pt is having a stroke….
do not lower BP right away - dont want decrease brain perfusion
what types of agents are used for HTN emergency
- Sodium Nitroprusside
- Nicardipine
- Esmolol
- labetalol
- nitroglycerin
ADEs of Sodium nitroprusside
N/V
thiocyanate toxicity
dosing for sodium nitroprusside (HTN EMERGENCY)
0.3 - 0.5 mcg/kg/min
MAX 2 mcg/kg/min
dosing for nicardipine (HTN EMERGENCY)
5 - 15 mg/hr IV infusion
onset of action for sodium nitroprusside (HTN EMERGENCY)
immediate
onset of action for nicardipine (HTN EMERGENCY)
1 - 5 minutes
dosing for Esmolol (HTN EMERGENCY)
500 microg/kg IV bolus
OR
50 - 100 microg/kg/min IV infusion
dosing for Labetalol (HTN EMERGENCY)
20 - 80 mg IV bolus Q 10 mins
or
0.5 - 2.0 mg/min IV infusion
Which drug is as effective as nitroprusside w/out cyanide risk; easier administration
Nicardipine
which drug is best for coronary artery disease and anxiety
Esmolol
which drug is best for brain syndromes and pregnancy
Labetalol
which drug is good for CHF and angina; not great for HTN emergency
Nitroglycerin
