Hypertension part 3 Flashcards
Nicardipine is an IV calcium channel blocker
Nicardipine is a dihydropyridine
(The only two non-dihydropyridines is verapamil and diltiazem)
Why would we avoid beta blockers and nondihydropyridines? Don’t use these drugs in decompensated heart failure
If pt has pulmonary edema from heart failure in a hypertensive emergency don’t give pt diltiazem
What would be a good way to get blood pressure down and heart rate? ________
Beta blocker
Esmolol is a potent IV beta blocker and its only used in aortic dissection
Esmolol
____________= this is a drug that’s really effective at lowering blood pressure, its not stable for very long, its reactive to light and it turns into cyanide if it decays so you really have to mix and give it very quickly and it works really well but not sure if we really want to worry about cyanide toxicity if you have other things to worry about
Sodium nitroprusside=
Pulmonary edema is just fluid on the lungs…that would be an example of end organ damage
Now if its hypertensive emergency its IV antihypertensives
We can give IV enalaprilat which is an IV ACE inhibitor
If its hypertensive urgency we are not even going to talk about IV drugs we are going to talk about things like did they take their home meds, have they missed doses because nonadherence is a common driver
If doses aren’t optimized we can always give more of those meds,butwe aren’t as aggressive with urgency
If someone has a baseline serum creatinine of 1.5 and they come in and their creatinine is now 2 that sounds like that’s some potential new damage
What’s your normal serum creatinine? 1…its going to be pt specific so this is the idea of worsening end organ damage so how do you know if someone has chronic kidney disease
What is the biomarker that tells us that there’s damage ongoing in your kidney or if there is chronic disease of the kidney? Protein in the urine, serum creatinine
Decreasing blood pressure too quickly can cause a stroke or heart attack because in this case a pt’s body cannot adjust that quickly it will cause ischemia
the reason why we don’t drop someone’s blood pressure quickly is the body is somewhat reliant on that high perfusion, the high pressure to perfuse the organs so if you just drop the blood pressure you end up likely causing some ischemia because the body does not have great autoregulation mechanisms in place
What is the blood pressure you want to get pt to if pt has hypertension? <130/80
Don’t start with IV drugs if you have something low hanging like they haven’t taken their 40mg of lisinopril in 3 days
Autoregulation=body is able to compensate once you get to this critical point where your in the emergent state, the body is starting to lose its ability to compensate…autoregulation is king of the problem and because of that we see a bunch of organs commonly affected
If there is no presence of end organ damage its NOT hypertensive emergency
Don’t give 500mg of digoxin to pt you will kill them
