Hypertensive Crisis Flashcards
What is Hypertensive Crisis?
Urgency or Emergency
What is Urgency Hypertensive Crisis?
SBP > 180 and/or DBP > 120 with NO EVIDENCE of target organ damage
What is Emergency Hypertensive Crisis?
SBP > 180 and/or DBP > 120 with EVIDENCE of target organ damage
What are the signs and symptoms target organ damage?
-Cardiac Ischemia [chest pain, arm numbness, SOB]
-Acute Kidney Injury [decrease urine output, dehydration, vomiting]
-Stroke
-Changes in vision
-Acute pulmonary edema
How many people have Hypertension in America?
About 30% of Americans have HTN
-About 1-2% have a HTN Crisis\
What are the causes of Hypertension Crisis?
Chronic HTN [Increase risk of HTN Crisis], Medication Non-adherence Increase risk of HTN Crisis], Medication and Substance Related, Pregnancy, Renal Disease, Endocrine Disorder
What are the initial work-up steps?
Find out the patients PMH
-Physical: signs and symptoms
-Labs: BUN, Scr, LFT, Electrolytes
-Test: EKG
What are the signs and symptoms of HTN Crisis?
Anxiety, Blurred Vision, Chest Pain, Nausea and Vomiting, Headache.
What are the special situation within a Hypertensive Crisis?
Pre-eclampsia [Pregnancy], Pheochromocytoma Crisis [Neoendocrine Tumor], Aortic Dissection [Tear in the aortia]
What is the goals of therapy for Urgency?
Restart or Start oral medication
-ensure a follow up
What is the goals of therapy for Emergency?
-Hour 1: reduce BP by 25%
-Hours 2 to 6: reduce BP to <160/110
-Hours 6 to 48: reduce BP to goal
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What is the goals of therapy for Special Situations?
-Pre-eclampsia: reduce SBP to <140 in the first hour
-Pheochromocytmia: reduce SBP to <140 in the first hour
-Aortic Dissection: reduce SBP to <120 in the first hour
Why don’t we want to lower BP to patient’s goal if they are having a stoke?
Because you still want blood to get to the brain
What are the rapid-acting oral agents used in Urgency?
Captopril [ACEi], Clonidine [A2 Agonist], Nicardipine [CCB], Labetalol [Nonselective BB]
What is the dosing for Captopril? What are the side effect of Captopril?
-Dosing: 25mg repeated 1-2 hours as needed
-SE: Hyperkalemia, Renal Failure, Angioedema
What is the dosing for Clonidine? What are the side effects of Clonidine?
-Dosing: 0.1-0.2mg, repeat 0.1mg every hour as needed [max of 0.7mg]
-SE: Dry Mouth, Orthostatic Hypotension, Sedation
What is the dosing for Nicardipine? What are the side effects of Nicardipine?
Dosing: 30mg repeated every 8 hours as needed
-SE: HA, Flushing, Dizziness, Palpitations
What is the dosing for Labetalol? What are the side effects for Labetalol?
-Dosing: 200mg repeated every 3-4 hours as needed
-SE: Bradycardia, Fatigue, Dizziness
What are the classes used in Hypertensive Emergency?
DHP CCBs, Direct Vasodilators, Beta-Blockers, and a few miscellaneous
What is the dosing about Nicardipine? What are the side effects for Nicardipine?
-Dosing: 5-15mg/hr titrated every 5 mins
-SE: Contraindicated in aortic stenosis
What is the dosing of Clevidipine? What are the cons about Clevidipine?
-Dosing: 1-32mg/hr titrated every 90 secs
-Cons: Afib, expensive, soy/egg allergy
What is the dosing of Nitroprusside? What are the cons about Nitroprusside?
-Dosing: 0.3-10mcg/kg/min
-Cons: Tachyphylaxis
What is the dosing of Nitroglycerin? What are the pro of Nitroglycerin?
-Dosing: 5-20mcg/min titrated every 3-5 mins
-Pros: Pulmonary Edema
What is the dosing of Hydralazine? What are the pros of Hydralazine?
-Dosing: 10-20 mg via infusion repeated every 4-6 hours as needed
-Pros: Safe in pregnancy
What is the dosing of Labetalol? What are the cons of Labetalol?
-Dosing: Up to 20mg IV bolus every 10 mins or 0.5-2.0mg/min IV infusion
-Cons: Avoid in HF & bradycardia
-Pro: Can use in pregnancy
What is the dosing of Esmolol? What are the cons of Esmolol?
-Dosing: 500mcg/kg IV bolus q5m or 50-100mcg/kg/min IV infusion
-Con: Avoid in HF & bradycardia
-Pro: good in Aortic Dissection
What is the dosing of Phentolamine? What are the pros of Phentolamine?
-Dosing: 5mg IV bolus with additional 5mg bolus q10m as needed
-Pro: good of Pheochromocytoma
What is the dosing of Fenoldopam? What is the Pros and Cons for Fenoldopam?
-Doing: 0.1-1.6mcg/kg/min titrated every 15 mins
-Pros: used in renal failure
-Cons: Contraindicated in glaucoma, sulfa allegey
What is the dosing of Enalaprilat? What are the Pros and Cons of Enalaprilat?
-Doing: 1.25mg over 5 mins titrated by 5mg every 6 hours as needed
-Cons: acute MI, pregnancy
