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Therapeutics II > Hypertensive Crisis > Flashcards

Hypertensive Crisis Flashcards

1
Q

nicardipine AE

A
  • palpitation
  • flushing
  • HA
  • dizziness
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2
Q

sodium nitroprusside special consideration

A
  • liver/renal failure: metabolite accumulation
  • cyanide toxicity with prolonged use
  • elevation in ICP
  • ***USE HAS FALLEN OUT OF FAVOR DUE TO RISKS
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3
Q

nicardipine is a

A

CCB

for acute stroke and most HTN crises

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4
Q

if a pt is having a stroke ___________

A

DO NOT LOWER BP

want to ensure adequate perfusion to the brain

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5
Q

pharmacologic tx considerations

A
  • 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)
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6
Q

esmolol is a

A

beta 1 blocker

for aortic dissection, ACS

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7
Q

nitroglycerin is a

A

direct vasodilator

ACS, acute HF, pulmonary edema

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8
Q

oral anti-hypertensives

A
  • captopril (ACEi)
  • nicardipine (CCB)
  • labetalol (alpha and beta 1 blocker)
  • clonidine (alpha 2 agonist)
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9
Q

Phentolamine indication and special consideration

A
  • catecholamine excess

- use with benzodiazepine is treating cocaine-induced HTN

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10
Q

BP pressure must be done ______ and in a __________

A

slowly ; controlled environment

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11
Q

Clonidine AE

A
  • sedation
  • dry mouth
  • orthostatic hypotension
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12
Q

For hypertensive crises: When switching from IV to Po

A
  • restart home BP medications
  • titrate IV antihypertensive down to achieve desired BP
  • add on additional oral maintenance medications as needed
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13
Q

Labs during initial work up of hypertensive crisis

A
  • complete blood count (CBC)
  • electrolytes (MAINLY K+)
  • liver function tests (ASL/ALT)
  • serum creatinine
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14
Q

vitals and labs need to be ___________________

A

continually monitored

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15
Q

nitroglycerin special considerations

A
  • tachyphylaxis

- flushing, HA, erythema often limit dose titration

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16
Q

_______ agents may need to be used to successfully lower BP

A

multiple

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17
Q

Labetalol AE

A
  • nausea

- dizziness

18
Q

Results of Patel et al. study

A
  • 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
19
Q

Presentation of hypertensive crisis

A
  • increased BP
  • numbness/weakness
  • chest pain
  • shortness of breath
  • back pain
  • HA
  • blurry vision
20
Q

What reading is considered an emergency hypertensive crisis?

A

severe elevation in BP WITH evidence of target organ dysfunction

ORGAN DAMAGE, admit to ICU, IV therapy

21
Q

Goals of therapy: If emergency

A
  • reduction of BP by 25% over first hour
  • target 160/100 over next 6 hours
  • target normal within 24 - 48 hours
  • parenteral therapy
22
Q

labetalol special considerations

A
  • avoid in acute HF

- avoid in bradycardia

23
Q

Possible affected organs during hypertensive crisis

A
  • brain (altered mental status, HA)
  • kidneys (increased Scr, reduced urine, back pain)
  • heart (chest pain, arrhythmias)
  • can also affect liver, respiratory and GI fxn
24
Q

examples of parenteral anti-hypertensives

A
  • sodium nitroprusside
  • nicardipine
  • esmolol
  • labetalol
  • nitroglycerin
25
Q

consider ____________ when selecting agents

A

patient specific factors

26
Q

if pt is asymptomatic, emergent reduction of BP does not improve outcomes

A

encourage compliance with maintenance medications or increase maintenance regimen

27
Q

sodium nitroprusside is a

A

direct venous dilator

most indications EXCEPT intracranial pressure elevations and acute coronary syndrome (ACS)

28
Q

Goals of therapy: If urgent

A
  • reduce BP < 160/100 over 24 hours***

- oral therapy preferred

29
Q

Clevidipine indication and special consideration

A
  • acute stroke
  • reflex tachycardia
  • avoid with egg or soy allergy
  • oil-in-water formulation
30
Q

captopril AE

A
  • hyperkalemia
  • angioedema
  • renal failure
31
Q

Enalaprilat indication and special consideration

A
  • acute HF
  • avoid in pregnancy
  • prolonged duration of action
32
Q

Consequences of uncontrolled BP > 180/120

A
  • stroke/heart attack
  • memory loss
  • eye damage
  • kidney injury
  • back pain
  • aortic dissection
33
Q

labetalol is a

A

alpha and beta 1 blocker

acute stroke, aortic dissection, ACS, pregnancy

34
Q

Important complicating conditions to be on look out for with hypertensive BP

A
  • aortic dissection
  • preeclampsia/eclampsia
  • stroke
  • pheochromocytoma (tumor in adrenal gland that releases hormone which increases BP)
35
Q

Hydralazine indication and special consideration

A
  • pregnancy
  • long t1/2 = potential hypotension
  • reflex tachycardia
  • HA
36
Q

What reading is considered urgent hypertensive crisis?

A

severe elevation in BP SBP >/= 180 and/or DBP >/= 120

NO ORGAN DAMAGE, optimize medications, oral therapy

37
Q

For hypertensive crises: Follow-up

A
  • at discharge, optimize home medications
  • educate pt on proper BP monitoring critique
  • pt should follow-up with PCP in 2 - 4 weeks
38
Q

Causes of hypertensive emergency

A
  • drugs
  • stroke/heart attack
  • endocrine disorders
  • renal disorders
  • pregnancy (eclampsia/preeclampsia)
39
Q

esmolol special consideration

A
  • avoid in acute HF

- contraindicated in pts using home beta blocker or bradycardia

40
Q

Fenoldopam indication and special consideration

A
  • most indications
  • increased ICP and intraocular pressure
  • reflex tachycardia
  • worsen glaucoma
  • hypokalemia
41
Q

nicardipine special consideration

A

reflex tachycardia

42
Q

titrate meds _________ and _____________

A

carefully ; appropriately

Therapeutics II (12 decks)

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