Hypertensive Emergencies Flashcards
Hypertensive crisis is defined as SBP > _______ or DBP >________
180mmHg; 120 mm HG
Pts with acute elevation in BP levels and do not demonstrate acute end-organ damage are diagnosed with __________
Hypertensive urgency
Pts with acute elevation in BP levels and DO demonstrate life threatening acute end-organ failure are diagnosed with _______________ and will require ______ ________
Hypertensive crisis or emergency ; IV medications
Acute end organ damage can manifest as ______,_______, ________, ______, ______,_____, ____________, _______
Encephalopathy; ischemic and hemorrhagic strokes; Acute aortic dissection; ACS; HF; Pulmonary edema or resp failure; ARF; HELLP (hemolysis, elevated liver enzymes, low platelets) preeclampsia or eclampsia
Pt with labile BP should be monitored in _____ and ________ ____ ______ monitoring
ICU; intra-arterial BP
Oral therapy should be used in patients with _________ ______with a goal of obtaining a gradual lowering of BP levels by ____% over ___ to ___ hours
Hypertensive urgency; 20; 24; 48
If IV therapy is given to patient with ________with no evidence of end organ damage, the rapid reduction in BP may lead to ________ and _____ to organs that had become dependent on the increased blood flow.
hypertensive urgency; ischemia and infarction
IV forms of medication used in hypertensive emergencies should have _____onset and _____duration
fast; short
IM and SL in hypertensive emergencies should be avoided because they lack the ability to be ______ and may lead to _______ ______ ______ levels
titrated; unpredictable drop in BP
Goal of BP reduction in hypertensive emergency should be _____ to _____ % in ____In the first ____ to _____ minutes; And in ______ ________ ______, the reduction should occur in less than ___ to ___ minutes , targeting a SBP of less than ______ and MAP less than ________
10-15; DBP; 30-60; ascending aortic dissection; 5-10; 120 <80
Rapid reduction in BP slow __________
progression of end organ damage.
Drugs meeting ideal characteristics for the management of Hypertensive crisis or emergency are _____ ____ ____ _____
labetalol, esmolol, nicardipine and fenoldopam
Esmolol is a _________ (cardioselective or non-cardioselective, ____adrenergic blocker without peripheral _____blocking activity and therefore no ______effects
cardioselective; Beta; Alpha; vasodilatory
For acute aortic dissection the recommended agent to decrease BP is _______. A combination of ______ and a ________ is recommended.
labetalol.; beta blocker; vasodilator.
For acute ischemic stroke or intracerebral bleed, the recommended agent to decrease BP is _________
Nicardipine
For Acute MI, the recommended agent to decrease BP is _________
Labetalol plus nitroglycerin
Acute pulm edema/ DIASTOLIC Dysfunction, the recommended agents to decrease BP is ______ plus _______ + _______
Esmolol Plus nitroglycerin + Loop diuretic
Acute pulm edema/ SYSTOLIC Dysfunction agents to decrease BP is ______ plus _______ + _______
Nicardipine Plus nitroglycerin + Loop diuretic
Contraindicated in pregnancy are ______ and ______
Nitroprusside and ACEI
Enalaprilat electrolyte imbalance _________(possible)
hyperkalemia
For ______monitor serum potassium every 6 h during infusion
Fenoldopam
Adverse effects of Esmolol
Thromophlebitis extravasation
Is hydralazine safe in pregnancy? Adverse effect:_________other medications with that adverse effect are __________ and ______
Yes ; Reflex tachycardia; nicardipine; nitroglycerin
Is labetalol safe in pregnancy? Adverse effect
yes; Bronchospasm
How is esmolol administered? What is recommended for monitoring?
bolus followed by infusion; Intra-arterial BP monitoring.
The preferred medications for aortic aneurysm or dissection is _________
Esmolol.
Labetalol is a combined ______and (selective or nonselective) ______adrenergic receptor blocker than reduces ______ while maintaining ______ and does not reduce ____, _____, or ____blood flow
Alpha; Beta; afterload, cardiac output; cerebral, coronary and renal
What is the preferred therapy in the treatment of renal hypertensive patients is _______ and that is because _____ ____ levels are reduced by the administration of__________
Labetalol; elevated renin; labetalol.
The use of _______ in the treatment of hypertensive emergencies and urgencies both are safe in pregnancy
Labetalol
Patients that may have an increase responsiveness of labetalol are patients with _______Impairment
Hepatic
Abrupt withdrawal of labetalol may cause ________, _______ and ________ Therefore It should gradually ______especially in patients with ________
Tachycardia, rebound hypertension, ischemia; Tapered; CAD
Fenoldopam is a (class)___________
Peripheral vasodilator
Action of fenoldopam is that it is mediated by peripheral ____________-1 receptors with high selectivity for _______ and ______tubules of the kidney causing renal artery ________, inhibition of ______reabsorpition , ________ and ________
dopamine; distal and proximal; vasodilation; sodium; natriuresis; diuresis.
Fenoldopam is contraindicated in _______ and has not yet been studied with patients with increased
Glaucoma; ICP
Fenoldopam is a preferred agent in patients with _____impairment
Renal
An arterial and venous vasodilators is
Sodium nitroprusside.
Sodium Nitroprusside is contraindicated in _______ and _____ and use cautiously with patients with MI because of the potential for ________ ____ _____
aortic stenosis; coarctation ; coronary steal syndrome.
Prolonged administration of nitroprusside , especially with patient with renal impairment can lead to an increased risk of developing fatal _______ or _____toxicity
cyanide; thiocyanate
Monitoring for sodium nitroprusside include monitoring for _________ and _______Because it can lead to local _____ _______
Metabolic acidosis (cyanide toxicity) and venous oxygen concentration and signs of extravasation ; tissue necrosis.
Nitroglycerin causes pronounced ________ _____ and results in decreased _____, _____, and oxygen demands while increasing ______ ______ and suppressing coronary _________
venous dilation; preload, cardiac output; coronary blood flow; vasospasms
Tolerance with a patient getting nitroglycerin will occur within _________
24-48 hours
Hydralazine is a direct _______ ______that reduces ______
arterial vasodilator; afterload
Hydralazine is preferred for use in the treatment of _____ or ________
preeclampsia or eclampsia.
The newest antihypertensive agent available in the US is _____________
Clevidipine
The action of clevidipine is that it is a 3rd generation dihydropiridine________ that causes _________vaso_______, decreases (afterload or preload) increases ______ _______ and ______ without affecting cardiac _____ _____ or ____
CCB; arteriole; dilation; afterload; cardiac output and stroke volume ;filling pressure or HR
Nicardipine is a second generation __________ _______ that is selective for arterial _________ _____ muscle with strong _______ and ______vasodilatory activity
diphydropiridine CCB ; smooth; cerebral and coronary
Recommended for patients with SBP more than 230 mmHg and DBP of .121mmHG is __________
Nicardipine
In general, in hypertensive emergencies , ________ are preferred over ___________-
continuous infusion; boluses
Those medications can cause further volume contraction and usually worsen hypertension that is caused by increased renin production and should be avoided unless specifically indicated for fluid overload.
Loop diuretics
After obtaining the initial goal reduction in BP levels, pt should be transitioned to ___________
oral therapy
