HTN3

Question 1

HTN emergency

Answer 1

Dont overshoot : dont decrease BP by more than 15-25% daily ( mostly within the first few hours ) otherwise hypoperfusion can lead to ischemic stroke

BP > 180/120 but no symptoms and no organ damage : no need for IV meds or ER
- gradually lower BP over 24-48 hours with oral HTN meds : captopril, clonidine, Labetolol, amlodipine

High BP with sx: severe headache, angina, blurry vision, kidney
IV hypertensive agents
DOC for MI : IV nitroglycerin

Question 2

Sodium nitroprusside ( nitropress )

Answer 2

Direct acting arterial and Venodilator

Rapid onset

Mix in D5W
Discard after 24 hours or if soln darkens turns orange dark brown blue ) blue means almost completely degraded to cyanaide

SE: headache, N/V , thiocyanate toxicity

Question 3

Cyanide antidote

Answer 3

Sodium nitrate 3% solution over 2- 4 mins then sodium thiosulfate

Question 4

Nicardipine

Answer 4

CCB ( IV Cardene)

Question 5

Fenoldopam Mesylate

Answer 5

Corlopam IV
MOA: selective DA 1 receptor agonist + diuresis

Decreases TPR and BP
Increases renal blood flow and diuresis

Useful in patients with renal HTN emergencies ( 6x more potent than dopamine renal vasodilation )

SE : tachycardia , HA flushing

Question 6

Loop diuretics are preferred in renal impairment over thiazides

Answer 6

T

For moderate to severe renal impairment use loops
Remember cant use thiazides if CrCl < 30

Question 7

Is HCTZ a cyp3a4 substrate?

Answer 7

NO

Question 8

How do NSAIDS increase BP?

Answer 8

Vasoconstriction on afferent arterioles and Na and water Retention —> ↑↑ BP

Question 9

What BP medication is contraindicated if you have bilateral renal artery stenosis ?

Answer 9

Ace inhibitors

Question 10

CCBs SE can cause unilateral edema

Answer 10

F

BILATERAL EDEMA

Unilateral Edema could be sign of DVT

Question 11

FLUSHING, headache, peripheral edema ( bilateral ) , lightheadedness are due to vasodilation from CCBs. Which CCB causes it the least?

Answer 11

Verapamil bc it has least effect on vasodilation

Dilt has equal effect on heart and arteries

DHP CCBs have effect on smooth muscle causing vasodilation

Question 12

Meds not to use when you have a sulfa allergy?

Answer 12

Thiazides, loops( except ethacryic acid ) , carbonic anhydrase inhibitors , SULFonamides, SULFonylureas,

Bc they all share chemical similarity in meds that cause a sulfa allergy

Question 13

Lasix available in what formulations

Answer 13

IV
IM
Oral tab
Oral soln

Question 14

Clevidipine IV ( lipid emulsion ) can be used for MI but is contraindicated with this allergy

Answer 14

Soy and egg

T

Same as propofol ( used for other things )
And YELLOW FEVER VACCINE