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20003 > hypertensive emergencies > Flashcards

hypertensive emergencies Flashcards

1
Q

presentation of pts with hypertensive emergency

A
  • headache
  • visual changes
  • altered level of consciousness
  • heart failure
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2
Q

what my happen if BP reduction is too rapid

A

ischemia in brain or retina leading to stroke or blindness

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3
Q

what are examples of different types of hypertension emergencies

A
  • hypertensive encephalopathy
  • hypertensive intercranial haemorrhage
  • myocardial ischemia with HTN
  • preeclampsia and eclampsia
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4
Q

how do alpha2 receptors in the CNS work

A
  • autoinhibitory receptors
  • stop sympathetic outflow from CNS presynaptically
  • controlling the release of noradrenaline
  • affecting heart, blood vessels and kidney - decrease BP
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5
Q

where do beta blockers work

A
  • B1 act on the heart
  • non-selective beta blocker
  • can act on lungs causing bronchoconstriction
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6
Q

where do alpha1 receptors act on

A
  • in the blood vessels
  • cause vasoconstriction
  • blocked causes vasodilation
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7
Q

what are 2 examples of b-blocker medication for HTN

A
  • esmolol
  • labetalol
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8
Q

how does esmolol work

A
  • B1 blocked
  • decreases heart rate
  • decreases force of contraction
  • altering cardiac output
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9
Q

how does labetalol work

A
  • alpha1-blocker
  • decreases vasoconstriction
  • reducing peripheral resistance
  • B blocker
  • decreasing heart rate and force of contraction
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10
Q

what is calcium channel blocker mechanism of action

A
  • affect calcium channels in blood vessels (smooth muscle cells)
    1. block Ca influx
    2. lack of Ca in cell = no contraction
    3. vasodilated > drops PVR > drops BP
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11
Q

what is an example of Ca channel blockers for HTN

A

nicardipine

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12
Q

what adverse effects do ca-channel blockers have

A
  • oedema
  • headaches
  • flushing
  • reflex tachycardia
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13
Q

why do ca-channel blockers cause headaches

A

vasodilation in the cranial nerves

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14
Q

why do ca-channel blockers cause reflex tachycardia

A

baroreceptor reflex on the heart

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15
Q

mechanism of action of loop diuretics in HTN

A

inhibit Na/K/Cl uptake in thick ascending limb in loop of Henley = more water in urine

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16
Q

what are the adverse effects of loop diuretics

A
  • ototoxicity
  • hyperuricemia
  • hypokalaemia
  • hypomagnesemia
17
Q

how does Na nitroprusside work

A

causes direct vasodilation of arteries and veins

18
Q

what are the adverse affects of Na nitroprusside

A
  • reflex tachycardia
  • headache
  • cyanide or thiocyanate toxicity
19
Q

what medication can be used as management for HTN with preeclampsia and eclampsia

A
  • magnesium sulfate
  • hydralazine
  • labetalol
  • Na nitroprusside
20
Q

how does magnesium sulfate work in HTN with pre-eclampsia and eclampsia

A
  • vasodilates cerebellar and releax muscles
  • blockers peripheral neuromuscular transmission
21
Q

what is the mechanism of action of hydralazine in pre-eclampsia and eclampsia

A

directly dilates the peripheral arteries

22
Q

what are the adverse effects of hydalazine

A
  • relfex tachycardia
  • headaches
  • flushing
  • hypotension
  • peripheral oedema
23
Q

what is the mechanism of action of benzodiazepines with HTN in seizures

A
  • enhances GABA effects
  • net result of inhibitory post synaptic potential
  • chloride influx = hyperpolarisation inhibiting GABA
  • brain depresses CNS, RR and consiousness
24
Q

what are the adverse effects of benzodiazepines

A
  • respiratory depression
  • drowsiness
  • headache
  • nausea
  • oversedation
25
Q

why must benzodiazepines not be taken alongside alcohol or antidepressents

A

they also depress the CNS and cause respiratory depression

26
Q

why would you not give b-blockers in cocaine induced seizures

A
  • releases adrenaline and noradrenaline
  • affects a1 = vasoconstriction increase FOC
  • block B-receptors that will vasodilate this stops all vasodilation and A1 is not affected so vasoconstriction will continue to increase

20003 (17 decks)

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