HTN emergencies Flashcards
What is the blood pressure when HTN emergencies occur?
exceeding 180 / 120 ,
but can occur at even lower levels in patients who blood pressure had not been previously high
consequences of uncontrolled BP?
Stroke Loss of consciousness Memory loss Heart attack Damage to the eyes and kidneys Loss of kidney function Aortic dissection Angina (unstable chest pain) Pulmonary edema (fluid backup in the lungs) Eclampsia
What is indicated in neurologic emergencies ?
Rapid BP reduction
What are examples of neurologic emergencies? (HTN)
hypertensive encephalopathy
acute ischemic stroke
acute intracerebral hemorrhage
subarachnoid hemorrhage
In hypertensive encephalopathy, the treatment guidelines are to reduce the ___ 25% over _ hours.
MAP ( mean arterial pressure)
8 hours
What are the preferred medications that are for reducing MAP in HTN encephalopathy?
Labetalol , Nicardipine, Esmolol ( selective beta-1)
What should be avoided in hypertensive encephalopathy, when trying to reduce MAP?
Nitroprusside and Hydralazine
they are not affective
What are the preferred medications for a acute ischemic stroke?
Labetalol and Nicardipine
After treatment with ___________, the SBP should be maintained < ___ mmHg and the DBP at < ___ mmHg for 24 hours?
fibrinolysis
less then 180 ( systolic)
less then 105 ( Diastolic)
For acute intracerebral hemorrhage, the preferred medications are _______, ___________, and _______.
labetalol, nicardipine, and esmolol
What medications do you want to avoid during an acute intracerebral hemorrhage?
Nitroprusside, Hydralazine
The treatment is based on ________ or ____________ evidence of increased intracranial pressure ( ICP )
clinical, radiographic
If there are signs of increased ICP, maintain the ___ just below ___ mmHg for the first 24 hours.
MAP
just below 130
or SBP <180 mmHg
In patients w/o increased ICP, maintain the MAP < ___ mmHg for the first 24 hours after symptom onset.
110
or BP < 160 mmHg
MAP is considered to be the _________ pressure seen by organs in the body
perfusion
MAP = DP + ___ EDV ( SP - DP)
1/3
Recent evidence shows that in cases of _____ _____________ ___________, early intensive BP control is well tolerated and can reduce hematoma growth in patients treated within _ hours after the onset of intracerebral hemorrhage
acute intracerebral hemorrhage
6 hours
What are the preferred medications for subarachnoid hemorrhage ? What should be avoided?
Nicardipine, Labetalol, Esmolol
AVOID Nitroprusside and Hydralazine - because they cause vasodilator effects
in a subarachnoid hemorrhage, maintain the SBP ____ mmHg until the aneurysm is treated or ________ _________ occurs.
< 160 mmHg
cerebral vasospasm - until they can go in and coral it and take care of the aneurysm
Rapid BP reduction is also indicated in cardiovascular emergencies, such as?
aortic dissection, acute coronary syndrome, and acute heart failure
In aortic dissection, the preferred medications are ?
LEMNN
Labetalol Nicardipine Nitroprusside (with beta-blocker) Esmolol Morphine Sulfate ( has vasodilation effects - we reduce preload and the BP)
For acute coronary syndrome, what are the preferred drugs?
beta blockers and nitroglycerin are the preferred drugs
When is treatment indicated for acute coronary syndrome?
if SBP is > 160 mmHg
and/or
the DBP is > 100 mmHg
What do you want to reduce the BP by during acute coronary syndrome treatment?
20-30% of baseline