Hypertensive Crisis Flashcards
nicardipine AE
- palpitation
- flushing
- HA
- dizziness
sodium nitroprusside special consideration
- liver/renal failure: metabolite accumulation
- cyanide toxicity with prolonged use
- elevation in ICP
- ***USE HAS FALLEN OUT OF FAVOR DUE TO RISKS
nicardipine is a
CCB
for acute stroke and most HTN crises
if a pt is having a stroke ___________
DO NOT LOWER BP
want to ensure adequate perfusion to the brain
pharmacologic tx considerations
- based on extent of end-organ damage
- use of IV medications
- should always be managed in ICU (need continuous BP monitoring)
- avoid extremely rapid decrease in BP (may consider in aortic dissection)
esmolol is a
beta 1 blocker
for aortic dissection, ACS
nitroglycerin is a
direct vasodilator
ACS, acute HF, pulmonary edema
oral anti-hypertensives
- captopril (ACEi)
- nicardipine (CCB)
- labetalol (alpha and beta 1 blocker)
- clonidine (alpha 2 agonist)
Phentolamine indication and special consideration
- catecholamine excess
- use with benzodiazepine is treating cocaine-induced HTN
BP pressure must be done ______ and in a __________
slowly ; controlled environment
Clonidine AE
- sedation
- dry mouth
- orthostatic hypotension
For hypertensive crises: When switching from IV to Po
- restart home BP medications
- titrate IV antihypertensive down to achieve desired BP
- add on additional oral maintenance medications as needed
Labs during initial work up of hypertensive crisis
- complete blood count (CBC)
- electrolytes (MAINLY K+)
- liver function tests (ASL/ALT)
- serum creatinine
vitals and labs need to be ___________________
continually monitored
nitroglycerin special considerations
- tachyphylaxis
- flushing, HA, erythema often limit dose titration
_______ agents may need to be used to successfully lower BP
multiple
Labetalol AE
- nausea
- dizziness
Results of Patel et al. study
- determine if referral to hospital is associated with better outcomes than outpt management of hypertensive urgency
- visits to ED associated with more hospitalizations but not improved outcomes
- most patients still had uncontrolled HTN 6 months later
Presentation of hypertensive crisis
- increased BP
- numbness/weakness
- chest pain
- shortness of breath
- back pain
- HA
- blurry vision
What reading is considered an emergency hypertensive crisis?
severe elevation in BP WITH evidence of target organ dysfunction
ORGAN DAMAGE, admit to ICU, IV therapy
Goals of therapy: If emergency
- reduction of BP by 25% over first hour
- target 160/100 over next 6 hours
- target normal within 24 - 48 hours
- parenteral therapy
labetalol special considerations
- avoid in acute HF
- avoid in bradycardia
Possible affected organs during hypertensive crisis
- brain (altered mental status, HA)
- kidneys (increased Scr, reduced urine, back pain)
- heart (chest pain, arrhythmias)
- can also affect liver, respiratory and GI fxn
examples of parenteral anti-hypertensives
- sodium nitroprusside
- nicardipine
- esmolol
- labetalol
- nitroglycerin
consider ____________ when selecting agents
patient specific factors
if pt is asymptomatic, emergent reduction of BP does not improve outcomes
encourage compliance with maintenance medications or increase maintenance regimen
sodium nitroprusside is a
direct venous dilator
most indications EXCEPT intracranial pressure elevations and acute coronary syndrome (ACS)
Goals of therapy: If urgent
- reduce BP < 160/100 over 24 hours***
- oral therapy preferred
Clevidipine indication and special consideration
- acute stroke
- reflex tachycardia
- avoid with egg or soy allergy
- oil-in-water formulation
captopril AE
- hyperkalemia
- angioedema
- renal failure
Enalaprilat indication and special consideration
- acute HF
- avoid in pregnancy
- prolonged duration of action
Consequences of uncontrolled BP > 180/120
- stroke/heart attack
- memory loss
- eye damage
- kidney injury
- back pain
- aortic dissection
labetalol is a
alpha and beta 1 blocker
acute stroke, aortic dissection, ACS, pregnancy
Important complicating conditions to be on look out for with hypertensive BP
- aortic dissection
- preeclampsia/eclampsia
- stroke
- pheochromocytoma (tumor in adrenal gland that releases hormone which increases BP)
Hydralazine indication and special consideration
- pregnancy
- long t1/2 = potential hypotension
- reflex tachycardia
- HA
What reading is considered urgent hypertensive crisis?
severe elevation in BP SBP >/= 180 and/or DBP >/= 120
NO ORGAN DAMAGE, optimize medications, oral therapy
For hypertensive crises: Follow-up
- at discharge, optimize home medications
- educate pt on proper BP monitoring critique
- pt should follow-up with PCP in 2 - 4 weeks
Causes of hypertensive emergency
- drugs
- stroke/heart attack
- endocrine disorders
- renal disorders
- pregnancy (eclampsia/preeclampsia)
esmolol special consideration
- avoid in acute HF
- contraindicated in pts using home beta blocker or bradycardia
Fenoldopam indication and special consideration
- most indications
- increased ICP and intraocular pressure
- reflex tachycardia
- worsen glaucoma
- hypokalemia
nicardipine special consideration
reflex tachycardia
titrate meds _________ and _____________
carefully ; appropriately
