Hypertensive emergencies Flashcards
Sodium nitroprusside effects
DOC for hypertension emergency
Prompt vasodilation and venodilation
Reflex tachycardia (also given beta blocker)
Sodium nitroprusside PK
IV only ->can be poisonous
1-2 min half life so need continuous infusion
Sodium nitroprusside adverse
Hypotension overdose
Abdominal cramping, nausea, vomiting
Cyanide toxicity* (metabolite) can be treated with SODIUM THIOSULFATE
Labetalol description
combined alpha and beta blocker
Fenoldopam
Arteriolar dilation
Maintains renal perfusion as it lowers BP (protects the kidney)*
Promotes natriuresis
Labetalol effects
No reflex tachycardia
First line agent coronary artery disease, HF, and post MI
Labetalol contraindication
Asthma, COPD
2nd or 3rd degree AV block
Bradycardia
Fenoldopam description
Peripheral D1 agonist
Safe in patients with renal insufficiency
Fenoldopam contraindication
Glaucoma
Nicardipine description
Calcium channel blocker
Dihydropyridine
Nicardipine effects
Vascular smooth muscle relaxation
Nicardipine Adverse
Reflex tachycardia
Nitroglyceran description
DOC for patients with cardiac ischemia, angina, or s/p cardiac bypass
Nitroglyceran effects
arterial and venous vasodilation
Diazoxide effects
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
Diazoxide adverse
Hypotension
Reflex tachycardia
Sodium and Water retention
Phentolamine description
DOC for patients with catecholamine release emergencies (pheochromocytoma)
Esmolol description
used for aortic dissection or post op hypertension
Beta 1 agonist
Hydralazine description
DOC for pregnancy induced hypertensive emergencies related to eclampsia
Hypertensive crisis
Severe, acute elevation in BP DBP >120 mmHg that can lead to vascular injury and organ damage
Hypertensive Emergency
Severe HTN with signs of damage to target organs (brain, CVS, kidneys); immediate BP reduction is required with IV drugs
Hypertensive Urgency
Very high BP without target organ damage; immediate reduction is not required (start on oral combination and follow up on outpatient basis)
Treatment
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
Causes of hypertension emergency
Essential HTN, renal parenchymal or renovascular disease, eclampsia, endocrine (pheochromocytoma, etc) or drugs (ex cocaine)
