HTN part 2 Flashcards
fill in dots where the appropriate diuretic coincides with the condition/risk factor
If you studied the first HTN brainscape then you should pretty much know everything on this chart
how often do you follow up with HTN patients
6-12 months
How often do you obtain an EKG on a HTN pt
every 2-4 years
what is hypertensive urgency
severe HTN with NO symptoms
what is the criteria for hypertensive urgency
BP > 220/125 mmHg¹ (180/120)
No evidence of acute target-organ damage
No symptoms!
what should you obtain from a patient with hypertensive urgency
- a thorough H&P to evaluate for s/s of organ damage
- BMP
- UA
- EKG
fill in the pink spots for what is important to check for in each portion of the PE!
fill in the pink spots for what each PE finding can indicate!
How do you treat hypertensive urgency
ORAL therapy OUTpatient
GOAL - reduce BP within hours
give in office agent if available such as:
* Clonidine (Catapres)
* Captopril (Capoten)
* Metoprolol Tartrate (Lopressor)
* Hydralazine
what is the MOA, onset and DOA of clonidine
Central sympatholytic
30-60 min onset
6-8hrs DOA
what are the adverse effects and additional comments for clonidine
sedation
comment: may cause rebound HTN
what is the MOA, Onset and DOA of captopril
ACE
15-30min onset
4-6 hrs DOA
what is the adverse effects of captropril
excessive hypotension
what is the MOA, onset and duration of action for metoprolol tartrae
Beta blocker
20-60 min
5-6 hours
what are the adverse effects of metoprolol tartrate
excessive hypotension
bradycardia
what is the MOA, onset and duration of action of hydralazine
vasodilator
10-80 minutes
up to 12 hours
what are the adverse effects of hydralazine
tachycardia
headache
GI effects
what are the MOA, onset and DOA of nifedipine
CCB
15 minutes
2-6 hours
what are the adverse effects and comments for nifedipine
excessive hypotension
tachycardia
HA
angina
MI
stroke
comment: response is unpredictable!
what is hypertensive emergency
severe HTN with s/s of end-organ damage.
TRUE MEDICAL EMERGENCY
BP must be lowered ASAP to preserve organ function and life
what is blood pressure limit for hypertensive emergency
> 220/130
what should the initial evaluation of a patient with hypertensive emergency look like
- problem focused H&P
- CBC
- CMP
- EKG
- CXR
- CT head w/o contrast
- UA
- UDS
(individualized based on suspected complication)
what is the goal of treatment in hypertensive emergency
Lower BP by no more than 25% in the first 2 hours.
then goal BP of 160/100 over the next 2-6 hours
what type of therapy is used for hypertensive emergency
parenteral therapy
What do goals for managing BP in hypertensive emergencies vary depend on
depedning on the organ involved!
what are the specific goals for the following:
Ischemic CVA
Hemorrhagic CVA
Aortic Dissection
MI
- Ischemic CVA - SBP between 180-200 mmHg with slow reduction
- Hemorrhagic CVA - target SBP is <140 mmHg
- Aortic Dissection - goal SBP <120 mmHg
- MI - will need anticoagulation and oxygen; typically use NTG for BP reduction, but no set goal
what are typically the first two agents used in hypertensive emergencies
Beta blockers and CCB
could also use: ACEi, Direct vasodilators, Nitrates
What are the calcium channel blockers used in hypertensive emergency
nicardipine
clevidipine
what is the onset and duration of action of nicardipine
1-5 minutes
3-6 hours