Hypertension part 2 Flashcards
AKI
BP Target
Reduce by less than or equal to 25% in 1st hour
Reduce to 160/110 in hours 2 through 6
Reduce to normotensive over next 24 - 48 hours
Most IV antihypertensives are acceptable
Use caution with prolonged use of sodium nitroprusside due to renal clearance of the toxic metabolite thiocyanate
Avoid _____________ due to the risk of worsening AKI
avoid enalaprilat
Decompensated HF + pulmonary Edema
BP Target
Reduce by ≤ 25% in 1st hour
Reduce to 160/110 in hours 2 through 6
Reduce to normotensive over next 24 - 48 hours
IV Antihypertensive Selection
Nitroglycerin or sodium nitroprusside (nicardipine and clevidipine are acceptable alternatives)
Avoid ____________and non-DHB CCBs like verapamil and diltiazem
Avoid beta blockers and non-DHB CCBs
Aortic Dissection
BP Target
SBP ≤ 120 mm Hg within 1st hour (ideally within 20 minutes)
HR Target
HR < _____ beats per minute
<60
Treatment of aortic dissection
Initiate ________ 1st (esmolol)
Then a _________ (e.g., nicardipine, clevidipine, or nitroprusside) to prevent reflex tachycardia
initiate B-blocker
then vasodilator
Intracranial hemorrhage=brain bleed
BP Target
If SBP > 220 mm Hg
Lower and monitor
If SBP 150 – 220 mm Hg
SBP < 140 mm Hg in 60 minutes
IV Antihypertensive Selection
Nicardipine
Clevidipine
Labetalol
Ischemic stroke
BP Target
If receiving fibrinolytic:
BP < 185/110 mm Hg before starting fibrinolytic
Then < 180/105 mm Hg during fibrinolytic
If not receiving fibrinolytic:
SBP < 220 mm Hg
IV Antihypertensive Selection
Nicardipine
Clevidipine
Labetalol
Hypertensive encephalopathy
BP Target
Reduce by ≤ 25% in 1st hour
Reduce to 160/110 in hours 2 through 6
Reduce to normotensive over next 24 - 48 hours
IV Antihypertensive Selection
Most IV antihypertensives are acceptable
ACS(Acute coronary syndrome)
BP Target
Reduce by ≤ 25% in 1st hour
Reduce to 160/110 in hours 2 through 6
Reduce to normotensive over next 24 - 48 hours
ACS treat with IV Antihypertensive Selection
Esmolol
Labetalol
Nitroglycerin
Nicardipine
Sodium nitroprusside
Use caution with non-DHB CCBs
Avoid β-blockers in the setting of reduced ejection fraction, bradycardia (HR < 60 bpm), hypotension (SBP < 100 mm Hg), poor peripheral perfusion, second or third-degree heart block, or reactive airway disease
Retinopathy
BP Target
Reduce by ≤ 25% in 1st hour
Reduce to 160/110 in hours 2 through 6
Reduce to normotensive over next 24 - 48 hours
IV Antihypertensive Selection
Most IV antihypertensives are acceptable
Avoid __________
avoid fenoldopam
250-500 mcg/kg/min IV bolus (optional), and then 50-100 mcg/kg/min IV infusion; may repeat bolus after 5 minutes or increase infusion to 300 mcg/min
Titrate infusion by 50 mcg/kg/min no more than every 4 minutes until at goal
Esmolol
10-20 mg IV every 4-6 hours
(maximum dose: 40 mg)
Hydralazine
10-20 IV bolus followed by 20-80 mg every 10 minutes until BP controlled followed by 0.5-2 mg/min IV infusion
Increase infusion by 0.5 mg/min every 15 minutes until at goal
Labetalol
2.5-5 mg/hr IV infusion
Increase infusion by 2.5 mg/hr every 5-15 minutes until at goal
Nicardipine
5-200 mcg/min IV infusion
Increase infusion by 5 mcg/min every 3-5 minutes; if no response at a dose of 20 mcg/min, increase infusion by 10-20 mcg/min every 3-5 minutes until at goal
nitroglycerin
0.25-10 mcg/kg/min IV infusion
Increase infusion by 0.5 mg/kg/min every 3 minutes until at goal
Sodium nitroprusside
