HTN emergencies

Question 1

What is the blood pressure when HTN emergencies occur?

Answer 1

exceeding 180 / 120 ,

but can occur at even lower levels in patients who blood pressure had not been previously high

Question 2

consequences of uncontrolled BP?

Answer 2

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

Question 3

What is indicated in neurologic emergencies ?

Answer 3

Rapid BP reduction

Question 4

What are examples of neurologic emergencies? (HTN)

Answer 4

hypertensive encephalopathy

acute ischemic stroke

acute intracerebral hemorrhage

subarachnoid hemorrhage

Question 5

In hypertensive encephalopathy, the treatment guidelines are to reduce the ___ 25% over _ hours.

Answer 5

MAP ( mean arterial pressure)

8 hours

Question 6

What are the preferred medications that are for reducing MAP in HTN encephalopathy?

Answer 6

Labetalol , Nicardipine, Esmolol ( selective beta-1)

Question 7

What should be avoided in hypertensive encephalopathy, when trying to reduce MAP?

Answer 7

Nitroprusside and Hydralazine

they are not affective

Question 8

What are the preferred medications for a acute ischemic stroke?

Answer 8

Labetalol and Nicardipine

Question 9

After treatment with ___________, the SBP should be maintained < ___ mmHg and the DBP at < ___ mmHg for 24 hours?

Answer 9

fibrinolysis

less then 180 ( systolic)

less then 105 ( Diastolic)

Question 10

For acute intracerebral hemorrhage, the preferred medications are _______, ___________, and _______.

Answer 10

labetalol, nicardipine, and esmolol

Question 11

What medications do you want to avoid during an acute intracerebral hemorrhage?

Answer 11

Nitroprusside, Hydralazine

Question 12

The treatment is based on ________ or ____________ evidence of increased intracranial pressure ( ICP )

Answer 12

clinical, radiographic

Question 13

If there are signs of increased ICP, maintain the ___ just below ___ mmHg for the first 24 hours.

Answer 13

MAP
just below 130

or SBP <180 mmHg

Question 14

In patients w/o increased ICP, maintain the MAP < ___ mmHg for the first 24 hours after symptom onset.

Answer 14

110

or BP < 160 mmHg

Question 15

MAP is considered to be the _________ pressure seen by organs in the body

Answer 15

perfusion

Question 16

MAP = DP + ___ EDV ( SP - DP)

Answer 16

1/3

Question 17

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

Answer 17

acute intracerebral hemorrhage

6 hours

Question 18

What are the preferred medications for subarachnoid hemorrhage ? What should be avoided?

Answer 18

Nicardipine, Labetalol, Esmolol

AVOID Nitroprusside and Hydralazine - because they cause vasodilator effects

Question 19

in a subarachnoid hemorrhage, maintain the SBP ____ mmHg until the aneurysm is treated or ________ _________ occurs.

Answer 19

< 160 mmHg

cerebral vasospasm - until they can go in and coral it and take care of the aneurysm

Question 20

Rapid BP reduction is also indicated in cardiovascular emergencies, such as?

Answer 20

aortic dissection, acute coronary syndrome, and acute heart failure

Question 21

In aortic dissection, the preferred medications are ?

Answer 21

LEMNN

Labetalol
Nicardipine
Nitroprusside (with beta-blocker)
Esmolol
Morphine Sulfate ( has vasodilation effects - we reduce preload and the BP)

Question 22

For acute coronary syndrome, what are the preferred drugs?

Answer 22

beta blockers and nitroglycerin are the preferred drugs

Question 23

When is treatment indicated for acute coronary syndrome?

Answer 23

if SBP is > 160 mmHg
and/or
the DBP is > 100 mmHg

Question 24

What do you want to reduce the BP by during acute coronary syndrome treatment?

Answer 24

20-30% of baseline

Question 25

When are thrombolytics contraindicated during acute coronary syndrome?

Answer 25

if the BP is >185 / 100 mmHg

Question 26

In acute congestive heart failure the preferred medications are?

Answer 26

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

Question 27

What are the preferred drugs for cocaine toxicity Pheochromocytome?

Answer 27

Diazepam, phentolamine (alpha antagonist), and nitroglycerin/nitroprusside are the preferred drugs.

Question 28

What drugs do you want to avoid in cocaine toxicity Pheochromocytome?

Answer 28

Avoid beta-adrenergic antagonists - avoid BB’s

Question 29

What rarely requires specific treatment from cocaine toxicity?

Answer 29

Hypertension and tachycardia

Question 30

what are the preferred agents for cocaine-associated acute coronary syndromes

Answer 30

Alpha-adrenergic antagonists

Phentolamine (Regitine) is a reversible nonselective alpha adrenergic antagonist

Question 31

_______________ treatment guidelines are similar to that of cocaine toxicity.

Answer 31

Pheochromocytoma

Question 32

If Pheochromocytoma, only after what can beta blockers be added for BP control ?

Answer 32

only after alpha blockade

Question 33

What is Pheochromocytoma?

Answer 33

A neuroendocrine tumor of the medulla of the adrenal glands

Secretes high amounts of catecholamines, mostly norepinephrine, plus epinephrine

Question 34

What are the preferred medications for preeclampsia and eclampsia ?

Answer 34

NHL

The preferred medications are Hydralazine, Labetalol, and Nifedipine.

Question 35

What are the medications that you want to avoid if preeclampsia and eclampsia?

Answer 35

Avoid - Nitroprusside, ACEI, esmolol

Question 36

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.

Answer 36

SBP should be < 160 mmHg

and

DBP should be < 110 mmHg

Question 37

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?

Answer 37

150 / 100 mmHg

Question 38

What should patients be treated with if they have eclampsia or preeclampsia to avoid seizures?

Answer 38

IV magnesium sulfate