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Cardiovascular > HTN Part 2 > Flashcards

HTN Part 2 Flashcards

1
Q

f/u visits should be at ____ intervals until BP is at goal

A

4-6 wk

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2
Q

should expect to see a BP reduction of __ mmHg per agent added at optimum dose

A

10 mmHg

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3
Q

Consider ____ a patient’s antihypertensive therapy
Evaluate _____ that could benefit from specific antihypertensive drugs

A

individualizing
comorbid conditions

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4
Q

two categories of hypertensive crises

A
  1. urgency
  2. emergency
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5
Q

Severe HTN, but NO sx
BP >220/125 mmHg or >180 and/or 120
No evidence of acute target-organ damage
Typically a result of poorly controlled chronic HTN
what type of HTN crisis?

A

urgency

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6
Q

how to approach HTN urgency

A

Evaluation should include a thorough H&P to evaluate for s/s of organ damage
May also obtain a BMP, UA, and EKG
Rarely requires emergent therapy / monitoring

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7
Q

goal of HTN urgency tx

A

reduce BP within hours

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8
Q

5 in office agents available for HTN urgencies

A

Clonidine (Catapres)
Captopril (Capoten)
Metoprolol Tartrate (Lopressor)
Hydralazine
Nifedipine

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9
Q

onset of top 3 quickest HTN urgency meds

A
  1. Hydralazine - 10 min
  2. Nifedipine - 15 min
  3. Captopril - 15-30 min
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10
Q

which HTN urgency tx has a SE of sedation
rebound HTN may occur

A

clonidine

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11
Q

which HTN urgency tx has a SE of excessive hypotension

A

captopril

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12
Q

which HTN urgency tx has a SE of excessive hypotension, bradycardia

A

metoprolol tartrate

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13
Q

which HTN urgency tx has SE of tachycardia, HA, GI

A

hydralazine

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14
Q

which HTN urgency tx has SE of Excessive hypotension, tachycardia, headache, angina, myocardial infarction, stroke
Response unpredictable

A

Nifedipine

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15
Q

Severe HTN WITH signs and/or symptoms of end-organ damage
BP typically >220/130
what type of HTN crisis?

A

HTN emergency

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16
Q

initial evaluation of HTN emergency

A

Problem-focused H&P
CBC, CMP, EKG CXR, CT head (w/o 1st), UA, UDS, and so on
Individualized based on complication you suspect

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17
Q

why would you need CT w/o contrast first when evaluation a HTN emergency?

A

potential hemorrhagic stroke, do not more pressure

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18
Q

goals of HTN emergency TX (3)

A
  1. Parenteral therapy
  2. Lower BP by no more than 25% in first 2 hrs
  3. BP of 160/100 over next 2-6 hrs
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19
Q

HTN emergency of Ischemic CVA BP goal

A

SBP between 180-200 mmHg with slow reduction

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20
Q

HTN emergency of Hemorrhagic CVA BP goal

A

SBP is <140 mmHg

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21
Q

HTN emergency of Aortic Dissection BP goal

A

SBP <120 mmHg

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22
Q

HTN emergency of MI BP goal

A

will need anticoagulation and oxygen; typically use NTG for BP reduction, but no set goal

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23
Q

tx pharm options/classes for HTN emergency (5)

A
  1. BB
  2. CCB
  3. ACE inhibitors
  4. Direct vasodilators
  5. Nitrates
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24
Q

what is the caution with just using vasodilators

A
  • Open up vasculature = reduces preload = reduces stroke volume
  • preload and contractility will increase to keep CO up = Rebound tachycardia
  • = more stress on an already ischemic heart
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25
Q

why are BB and CCBs typically 1st line with cardiac involvement

A

they act to reduce the stress on the heart and limit the rebound tachycardia

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26
Q

Nicardipine

A

dihydropyridine - CCB

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27
Q

SE of Nicardipine

A
  1. Hypotension
  2. tachycardia
  3. HA
  4. Possible myocardial ischemia
28
Q

Clevidipine

29
Q

SE of Clevidipine

30
Q

which HTN emergency med tx is known for Lipid emulsion
CI in pts with allergy to soy or egg

A

Clevidipine

31
Q

Labetalol

A

Beta- and alpha-blocker

32
Q

SE of labetalol

A

GI, hypotension, bronchospasm, bradycardia, heart block.

33
Q

avoid labetalol in who?

A

acute LV systolic dysfunction, asthma

34
Q

what HTN emergency meds may be continued orally

A

labetalol
enalaprilat

35
Q

Esmolol

36
Q

SE of esmolol

A

Bradycardia, nausea.

37
Q

avoid esmolol in who?

A

Avoid in acute LV systolic dysfunction, asthma. Weak antihypertensive.

38
Q

Fenoldopam

A

Dopamine receptor agonist

39
Q

SE of Fenoldopam

A
  1. Reflex tachycardia
  2. hypotension
  3. increased intraocular pressure
40
Q

which HTN emergency med may protect kidney function

A

Fenoldopam

41
Q

SE of Enalaprilat

A

Excessive hypotension.

42
Q

what HTN emergency med is an additive with diuretics, may be continued orally

A

Enalaprilat

43
Q

SE of furosemide

A

Hypokalemia, hypotension.

44
Q

which HTN emergency med is an adjunct to vasodilator

A

Furosemide

45
Q

SE of Nitroglycerin

A
  1. HA
  2. N
  3. hypotension
  4. bradycardia
  5. Tolerance may develop
46
Q

which HTN emergency med may be useful primarily with myocardial ischemia.

A

Nitroglycerin

47
Q

which HTN emergency med is known for thiocyanate and cyanide toxicity, therefore is no longer a first-line agent

A

nitroprusside
SE: GI, CNS; thiocyanate and cyanide toxicity, especially with renal and hepatic insufficiency; Decreased cerebral blood flow, increased intracranial pressure

48
Q

CO increases by ?% during pregnancy

A

40%
Mostly d/t increased stroke volume

49
Q

HR increased by ~10 bpm during what trimester

50
Q

BP tends to ____ during the ____ trimester d/t _____

A

decrease
2nd
decrease in systemic vascular resistance

51
Q

abnormal BP in pregnant pts

A

≥ 140/90

52
Q

criteria to diagnose HTN During Pregnancy

A

two elevated readings at least 4 hours apart

53
Q

HTN (BP ≥ 140/90) after 20 weeks gestation w/o pre-existing HTN or proteinuria
what type of HTN pregnancy

A

Gestational

54
Q

new onset HTN (BP ≥ 140/90) and proteinuria (24h urinary protein >300 mg/24h or creatinine ratio ≥0.3) after 20 weeks gestation
what type of HTN pregnancy

A

preeclampsia

55
Q

HTN (BP ≥ 140/90) before 20 weeks gestation or longer than 12 weeks postpartum
what type of HTN pregnancy

A

Chronic
Preeclampsia superimposed on chronic HTN

56
Q

what HTN meds are CI for HTN during pregnancy

A

ACEIs and ARBs

57
Q

acute BP tx for HTN pregnancy

A

IV labetalol, IV hydralazine, oral immediate-release nifedipine

58
Q

chronic BP tx for HTN pregnancy

A

labetalol, ER nifedipine, or methyldopa

59
Q

target BP for HTN pregnancy

A

130-150/80-100
NOT recommended to reduce BP by more than 25% over 2 hours like the rest

60
Q

the failure to reach BP control in patients who are adherent to full doses of an appropriate 3-drug regimen, including a diuretic

A

Resistant HTN
Medication noncompliance is a major issue

61
Q

What should be do for patients with resistant hypertension?

A

Rule out secondary causes
Check for white-coat HTN
Consider switching diuretic to aldosterone receptor blocker (spironolactone)
Refer to a HTN specialist (Nephrology or Cardiology)

62
Q

causes of resistant HTN (5)

A
  1. Improper bp measurement
  2. Volume overload and pseudotolerance
    - Excess sodium intake
    - Volume retention from kidney disease
    - Inadequate diuretic therapy
  3. Associated conditions
    - Obesity
    - Excess alcohol intake
  4. Identifiable/Secondary causes of hypertension
  5. Drug-induced or other causes
63
Q

slowest Hypertensive Urgency Treatment

A

Clonidine - 30-60 minutes
Hydralazine - 10-80 min

64
Q

quickest Hypertensive Emergency tx

A
  1. Esmolol - 1-2 mins
  2. Nicardipine - 1–5 min

Nitroprusside no longer first line

65
Q

slowest HTN emergency tx

A

Enalaprilat (Vasotec)
Furosemide (Lasix)
both 15 min

Cardiovascular (24 decks)

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