Hypertensive Crisis

Question 1

what is hypertensive urgency

Answer 1

> 180/120
no evidence of target organ damage

Question 2

what is hypertensive emergency

Answer 2

> 180/120
evidence of target organ damage

Question 3

symptoms of target organ damage

Answer 3

headache
chest pain
shortness of breath
back pain
numbness/weakness
change in vision
difficulty speaking

Question 4

what are the common causes of hypertensive emergency

Answer 4

chronic HTN
medication non-adherence
medication/substance related
pregnancy
renal disease
endocrine disorders

Question 5

goals of hypertensive urgency

Answer 5

restart/intensify antihypertensive therapy
treat anxiety if applicable

Question 6

what NOT to do with hypertensive urgency

Answer 6

don’t send to ER
don’t immediately reduce BP
don’t hospitalize

Question 7

goals of hypertensive emergency

Answer 7

hour 1: reduce BP by max of 25%
hour 2-6: reduce BP < 160/100-110
hour 6-48: reduce BP to goal

Question 8

what to do in hypertensive emergency

Answer 8

refer to ER
hospital admission
IV antihypertensive

Question 9

what types of medications should be used to treat hypertensive emergency

Answer 9

-IV meds
-fast onset/offset
-predictable pk
-minimal AE

Question 10

nicardipine pros

Answer 10

titratable
low risk of AE

Question 11

nicardipine cons

Answer 11

contraindicated in severe aortic stenosis
titrate cautiously with renal/hepatic impairment
reflex tachycardia

Question 12

clevidipine pros

Answer 12

titratable
worse AE

Question 13

clevidipine cons

Answer 13

contraindicated in severe aortic stenosis
lipid formula (CI with soy/egg allergy)
change IV every 12 hours
induces AFib

Question 14

nitroglycerin pros

Answer 14

titratable
beneficial in coronary ischemia

Question 15

sodium nitroprusside pros

Answer 15

titratable

Question 16

nitrates cons

Answer 16

tolerance with prolonged use (max 24-48 hrs)
dose-limiting headache and reflex tachycardia
caution with high ICP
excessive hypotension in hypovolemia
nitroprusside only (cyanide toxicity)

Question 17

hydralazine pros

Answer 17

can be used in bradycardia

Question 18

hydralazine cons

Answer 18

not titratable
less predictable
rebound tachycardia

Question 19

labetalol pros

Answer 19

decreases HR and BP
titratable

Question 20

labetalol cons

Answer 20

CI with severe bradycardia, ADHF, reactive airway diseases

Question 21

esmolol pros

Answer 21

decreases HR
cardioselective (good for reactive airway diseases)

Question 22

esmolol cons

Answer 22

adjunct therapy not mono
avoid in severe bradycardia and ADHF

Question 23

enalaprilat pros

Answer 23

beneficial in emergencies related to renin excess

Question 24

enalaprilat cons

Answer 24

delayed onset and peak
CI in AKI, hyperkalemia, acute MI, pregnancy

Question 25

clonidine pros

Answer 25

PO option

Question 26

clonidine cons

Answer 26

often inappropriate in HTN emergency
delayed onset
can cause hypertensive crisis on withdrawal

Question 27

how does decompensated HF with PE affect drug therapy

Answer 27

prefer nitrates
avoid BB and non DHPs

Question 28

how does aortic dissection affect drug choice

Answer 28

start BB then vasodilator
lower BP quickly and prevent tachycardia

Question 29

how does acute coronary syndrome affect drug choice

Answer 29

IV drip drugs
avoid BB or non-DHP

Question 30

how does AKI affect drug choice

Answer 30

most IV choices are acceptable
avoid enalaprilat

Question 31

how does eclampsia affect drug choice

Answer 31

first choice is hydralazine, labetalol, or nicardipine
CI with enalaprilat and nitroprusside

Question 32

how does stroke affect drug choice

Answer 32

want nicardipine, clevidipine, or labetalol