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Therapeutics P3 Spring > Hypertensive Crises > Flashcards

Hypertensive Crises Flashcards

1
Q

Hypertensive Crisis

A

acute condition of very high blood pressure
- systolic > 180
- diastolic > 120

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2
Q

Hypertensive Urgency

A

A hypertensive crisis without evidence of new or worsening organ damage

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3
Q

Hypertensive Emergency

A

A hypertensive crisis with evidence of new or worsening organ damage

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4
Q

Hypertensive urgency: time frame

A

lower BP slowly during the first 24-48 hrs
no need for ICU admission

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5
Q

Hypertensive emergency: timeline

A

1st hr: decrease DBP by 10-15% or MAP by 25% with goal of DBP >/= 100

2-6 hrs: SBP 160 and/or DBP 100-110

6-24 hrs: maintain above goals

24-48 hrs: gradually decrease BP to normal outpatient goal

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6
Q

Aortic dissection: definition

A

a tear that occurs in the inner layer of the aorta. Blood surges through the tear causing the inner and middle layers to separate, normal blood flow slows, and the aorta may rupture

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7
Q

Aortic dissection: BP target/timing

A

SBP </= 120 within the first hour
HR < 60 BPM

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8
Q

Aortic dissection: IV antihypertensive selection

A

Beta blocker (esmolol)
Vasodilator (nicardipine, clevidipine, nitroprusside)

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9
Q

Ischemic stroke: definition

A

blood clot that blocks or narrows an artery of the brain, reducing blood flow causing tissue ischemia/death

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10
Q

Ischemic stroke: BP target/timing

A

BP < 185/110 before fibrinolytic and < 180/105 during fibrinolytic infusion

if no fibrinolytic: SBP < 220

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11
Q

Ischemic stroke: IV antihypertensive selection

A

Nicardipine
Clevidipine
Labetalol

Avoid sodium nitroprusside

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12
Q

Hemorrhagic stroke: definition

A

rupture of a weakened blood vessel causing bleeding into the surrounding brain

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13
Q

Hemorrhagic stroke: BP target/timing

A

If SBP > 220: lower with infusion and monitor

If SBP 150-220: < 140 within 1 hr

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14
Q

Hemorrhagic stroke: IV antihypertensive selection

A

Clevidipine
Labetalol
Nicardipine

Avoid sodium nitroprusside

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15
Q

Severe Pre-eclampsia definition

A

severe new-onset hypertension after 20 weeks gestation (SBP > 160 or DBP > 100) + proteinura

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16
Q

Eclampsia definition

A

a convulsive condition progressed by pre-eclampsia

17
Q

SPE or Eclampsia: BP target/timing

A

SBP < 140 within 1 hr

18
Q

SPE or Eclampsia: IV antihypertensive selection

A

hydralazine
labetalol
nicardipine

Avoid: RAAS inhibitors and sodium nitroprusside

19
Q

Vasodilators:

A

Sodium nitroprusside
Nitroglycerin
Hydralazine

20
Q

Sodium nitroprusside

A

Onset: 2 min
Duration: 1-10 min
Dosing: IV 0.25-10 mcg/kg/min
ADE: hypotension, N/V, muscle twitching, cyanide toxicity with LTU
Pearls: caution in high intracranial pressure and CKD

21
Q

Nitroglycerin

A

Onset: immediate
Duration: 3-5 min
Dose: 5-200 mcg/min IV
ADE: hypotension, HA, methemoglobinemia, tolerance with LTU
Pearls: most often used with coronary ischemia

22
Q

Hydralazine

A

Onset: 10-80 min
Duration: up to 12 hrs
Dosing: IV bolus 10-20 mg Q4-6H
ADE: Hypotension, tachycardia, flushing, HA
Pearls: not often used due to variable onset, safe for use in pregnancy

23
Q

Beta blockers used in HTN crises

A

labetalol
metoprolol
esmolol

24
Q

Labetalol

A

Onset: 5-10 min
Duration: 180-360 min
Dosing:
- bolus: 10-20 mg IV Q10 min
- infusion: 0.5-2 mg/min
ADE:
- hypotension
- bradycardia/heart block
- orthostatic hypotension
Pearls:
- most used in HTN emergencies
- safe in pregnancy
- caution in acute HF

25
Q

Metoprolol

A

Onset: 5-20 min
Duration: 120-360 min
Dosing: bolus 5-15 mg Q5-15 min
ADE:
- hypotension
- bradycardia/heart block
Pearls:
- caution in acute HF

26
Q

Esmolol

A

Onset: 1-2 min
Duration: 10-20 min
Dosing:
- Bolus: 250-500 mcg/kg/min
- infusion: 50-100 mcg/kg/min
ADE:
- hypotension
- bradycardia/heart block
Pearls:
- drug of choice in aortic dissection
- caution in acute HF

27
Q

DHP Calcium Channel Blockers

A

Clevidipine
Nicardipine

28
Q

Clevidipine

A

Onset: 2-4 min
Duration: 5-15 min
Dosing: 1-2 mg/hr IV infusion
ADE:
- hypotension
- HA
- tachycardia
- hypertriglyceridemia (lipid formulation)
Pearls:
- used in most hypertensive emergencies
- caution with coronary ischemia
- CI with soy/egg allergy

29
Q

Nicardipine

A

Onset: 5-10 min
Duration: 15-30 min
Dosing: 2.5-5 mg/hr IV infusion
ADE:
- hypotension
- tachycardia
- HA
- flushing
- local phlebitis
Pearls:
- most hypertensive emergencies
- not generally used in acute HF
- caution with coronary ischemia

30
Q

Enalaprilat

A

IV ACE inhibitor
Onset: 15-30 min
Duration: 360-720 min
Dosing: 1.25-5 mcg IV Q6H
ADE: hypotension
Pearls:
- caution in acute HF
- avoid in acute MI, eclampsia, and AKI

31
Q

Fenoldopam

A

dopamine receptor agonist
Onset: less than 5 min
Duration: 30 min
Dosing: 0.1-0.3 mcg/kg/min IV infusion
ADE:
- hypotension
- tachycardia
- HA
- nausea
- flushing
Pearls:
- avoid in galucoma

Therapeutics P3 Spring (32 decks)

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