Hypertensive emergencies

Question 1

Sodium nitroprusside effects

Answer 1

DOC for hypertension emergency
Prompt vasodilation and venodilation
Reflex tachycardia (also given beta blocker)

Question 2

Sodium nitroprusside PK

Answer 2

IV only ->can be poisonous

1-2 min half life so need continuous infusion

Question 3

Sodium nitroprusside adverse

Answer 3

Hypotension overdose
Abdominal cramping, nausea, vomiting

Cyanide toxicity* (metabolite) can be treated with SODIUM THIOSULFATE

Question 4

Labetalol description

Answer 4

combined alpha and beta blocker

Question 5

Fenoldopam

Answer 5

Arteriolar dilation
Maintains renal perfusion as it lowers BP (protects the kidney)*

Promotes natriuresis

Question 6

Labetalol effects

Answer 6

No reflex tachycardia

First line agent coronary artery disease, HF, and post MI

Question 7

Labetalol contraindication

Answer 7

Asthma, COPD
2nd or 3rd degree AV block
Bradycardia

Question 8

Fenoldopam description

Answer 8

Peripheral D1 agonist

Safe in patients with renal insufficiency

Question 9

Fenoldopam contraindication

Answer 9

Glaucoma

Question 10

Nicardipine description

Answer 10

Calcium channel blocker

Dihydropyridine

Question 11

Nicardipine effects

Answer 11

Vascular smooth muscle relaxation

Question 12

Nicardipine Adverse

Answer 12

Reflex tachycardia

Question 13

Nitroglyceran description

Answer 13

DOC for patients with cardiac ischemia, angina, or s/p cardiac bypass

Question 14

Nitroglyceran effects

Answer 14

arterial and venous vasodilation

Question 15

Diazoxide effects

Answer 15

Arteriolar dilation-prevents vascular smooth muscle contraction by opening potassium channels and stabilizing the membrane potential

Can also be used to treat hypoglycemia secondary to an insulinoma by inhibiting insulin release

Question 16

Diazoxide adverse

Answer 16

Hypotension
Reflex tachycardia
Sodium and Water retention

Question 17

Phentolamine description

Answer 17

DOC for patients with catecholamine release emergencies (pheochromocytoma)

Question 18

Esmolol description

Answer 18

used for aortic dissection or post op hypertension

Beta 1 agonist

Question 19

Hydralazine description

Answer 19

DOC for pregnancy induced hypertensive emergencies related to eclampsia

Question 20

Hypertensive crisis

Answer 20

Severe, acute elevation in BP DBP >120 mmHg that can lead to vascular injury and organ damage

Question 21

Hypertensive Emergency

Answer 21

Severe HTN with signs of damage to target organs (brain, CVS, kidneys); immediate BP reduction is required with IV drugs

Question 22

Hypertensive Urgency

Answer 22

Very high BP without target organ damage; immediate reduction is not required (start on oral combination and follow up on outpatient basis)

Question 23

Treatment

Answer 23

BP should be progressively reduced (25% in the first hour) using short acting titratable IV drug -> abrupt decreases can lead to MI, stroke, or visual changes

Question 24

Causes of hypertension emergency

Answer 24

Essential HTN, renal parenchymal or renovascular disease, eclampsia, endocrine (pheochromocytoma, etc) or drugs (ex cocaine)