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
When are thrombolytics contraindicated during acute coronary syndrome?
if the BP is >185 / 100 mmHg
In acute congestive heart failure the preferred medications are?
IV nitroglycerin or sublingual nitroglycerin
Treat with vasodilators (in addition to diuretics) for a SBP =140 mm Hg
we can get really aggressive wth nitro if the are HTN and CHF so we can tank the bP quickly - 4 or 5 tablets sublingual
What are the preferred drugs for cocaine toxicity Pheochromocytome?
Diazepam, phentolamine (alpha antagonist), and nitroglycerin/nitroprusside are the preferred drugs.
What drugs do you want to avoid in cocaine toxicity Pheochromocytome?
Avoid beta-adrenergic antagonists - avoid BB’s
What rarely requires specific treatment from cocaine toxicity?
Hypertension and tachycardia
what are the preferred agents for cocaine-associated acute coronary syndromes
Alpha-adrenergic antagonists
Phentolamine (Regitine) is a reversible nonselective alpha adrenergic antagonist
_______________ treatment guidelines are similar to that of cocaine toxicity.
Pheochromocytoma
If Pheochromocytoma, only after what can beta blockers be added for BP control ?
only after alpha blockade
What is Pheochromocytoma?
A neuroendocrine tumor of the medulla of the adrenal glands
Secretes high amounts of catecholamines, mostly norepinephrine, plus epinephrine
What are the preferred medications for preeclampsia and eclampsia ?
NHL
The preferred medications are Hydralazine, Labetalol, and Nifedipine.
What are the medications that you want to avoid if preeclampsia and eclampsia?
Avoid - Nitroprusside, ACEI, esmolol
In women with eclampsia or preeclampsia, the SBP should be _____ mm Hg and the DBP should be ____mm Hg in the antepartum and intrapartum periods.
SBP should be < 160 mmHg
and
DBP should be < 110 mmHg
In a pregnant woman with preeclampsia or eclampsia, if the platelet count is less than 100,000 cells mm^3, the BP should be maintained below what?
150 / 100 mmHg
What should patients be treated with if they have eclampsia or preeclampsia to avoid seizures?
IV magnesium sulfate
