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Hypertensive emergency Flashcards

1
Q

Which are the preferred antihypertensives for a dissecting aneurysm? Which should be avoided?

A

-nitroprusside + beta-blocker
-nicardipine +/- beta-blocker
-labetolol

Avoid
-direct vasodilators alone (nitroprusside hydralazine)

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2
Q

Which are the preferred antihypertensives for a pulmonary edema? Which should be avoided?

A

-nitroprusside
-nitrates
-nicardipine
-fenoldopam
-diuretics

Avoid
-beta-blockers (unless from diastolic dysfunction)
-labetalol

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3
Q

Which are the preferred antihypertensives for angina/MI? Which should be avoided?

A

-beta-blockers
-nitrates
-nicardipine
-Ca channel blockers
-labetalol

Avoid
-direct vasodilators alone (nitroprusside diazoxide hydralazine)
-phentolamine

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4
Q

Which are the preferred antihypertensives for a cerebral hemorrhage? Which should be avoided?

A

-no treatment versus nicardipine or nitroprusside

Avoid - clonidine

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5
Q

Which are the preferred antihypertensives for hypertensive encephalopathy? Which should be avoided?

A

-nitroprusside
-nicardipine
-labetalol
-fenoldopam

Avoid
-clonidine
-reserpine
-beta-blockers

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6
Q

Which are the preferred antihypertensives for catecholamine excess? Which should be avoided?

A

-phentolamine
-nicardipine
-nitroprusside + beta-blocker
-benzodiazepine as adjunct

Avoid
-beta blocker alone
-labetalol

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7
Q

Which are the preferred antihypertensives for postop HTN? Which should be avoided?

A

-esmolol
-nicardipine
-nitroprusside

Avoid
-long acting agents

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8
Q

Which are the preferred antihypertensives for preeclampsia? Which should be avoided?

A

-labetalol
-nicardipine

Avoid
-ACE inhibitors

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9
Q

What is the dosing and duration of PO clonidine for moderate HTN?

A

-initial 0.1 - 0.2mg
-subsequent 0.1mg q1hr to maximum 0.7mg
-8 - 12hr

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10
Q

What is the dosing and duration of PO nifedipine for moderate HTN?

A

-initial 10mg
-subsequent 10 - 20 q15min
-3 - 6hr

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11
Q

What is the pathophysiology behind organ damage in HTN?

A

Small vessel damage that results in:
-platelet and fibrin deposition
-loss of vascular autoregulation
-elevation of SVR

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12
Q

What is the basic MOA for the most efficacious HTN meds?

A

Reduction in afterload
-unless pt has renal failure ongoing HTN causes natriuresis and intramuscular volume contraction

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13
Q

What are the common causes of HTN crises?

A

-antiHTN drug withdrawal
-autonomic hyperactivity
-collagen vascular disease
-recreational drugs
-acute glomerulonephtitis
-head trauma
-preeclampsia
-renovascular HTN

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14
Q

During which part of the perioperative period is a HTN crisis most likely?

A

Early postop due to increased sympathetic tone

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15
Q

What are the common causes of periop HTN crises?

A

-cardiac surgery
-major vascular reconstruction
-NSGY
-H&N surgery
-renal txp
-major trauma

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16
Q

How do you calculate SVR?

A

= 79.9(MAP - CVP)/CO

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17
Q

What does a discrepancy between UE and LE BP’s indicate?

A

Aortic coarctation or distal dissection

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18
Q

What does a discrepancy between UE BP’s indicate?

A

Proximal aortic dissection

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19
Q

What physical exam finding is a sensitive indicator of HTN induced organ injury?

A

Retinopathy

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20
Q

What is the typical dosing of esmolol for severe HTN?

A

500mcg/kg load and 25 - 50mcg/kg/min infusion
-increase infusion 25mcg/kg/min q10m to max of 300mcg/kg/min

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21
Q

What is the typical dosing of enalaprilat for severe HTN?

A

1.25mg q6h
-increase by 1.25mg to max of 5mg q6hr

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22
Q

What is the typical dosing of fenoldopam for severe HTN?

A

0.1mcg/kg/min
-increase 0.1 - 1mcg/kg/min q15min to max 1.6mcg/kg/min

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23
Q

What is the typical dosing of hydralazine for severe HTN?

A

10 - 20mg bolus q30min

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24
Q

What is the typical dosing of labetolol for severe HTN?

A

20mg bolus q15min

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25
What is the typical dosing of nicardipine for severe HTN?
5mg/h -increase 2.5mg/h q10-15min to max 15mg/hr
26
What is the typical dosing of nitroglycerin for severe HTN?
5mcg/min -increase 5-10mcg/min q5-10min to max 200mcg/min
27
What is the typical dosing of nitroprusside for severe HTN?
0.25mcg/kg/min -increase 1-2mcg/kg/min q5-10min to max 10mcg/kg/min
28
What is the MOA of esmolol for severe HTN?
Beta-blocker
29
What is the MOA of enalaprilat for severe HTN?
ACE inhibitor
30
What is the MOA of fenoldopam for severe HTN?
Dopamine 1 agonist
31
What is the MOA of hydralazine for severe HTN?
Direct vascular dilator arterial > venous
32
What is the MOA of labetalol for severe HTN?
Alpha and beta-blocker
33
What is the MOA of nicardipine for severe HTN?
Ca channel blocker and arterial dilator
34
What is the MOA of nitroglycerin for severe HTN?
Direct vascular dilator venous > arterial
35
What is the MOA of nitroprusside for severe HTN?
Direct vascular dilator
36
What are the advantages of using esmolol for severe HTN?
-rapid on rapid off -plasms metabolized
37
What are the advantages of using enalaprilat for severe HTN?
-rapid on rapid off -antiarrhythmic
38
What are the advantages of using fenoldopam for severe HTN?
Increased renal blood flow
39
What are the advantages of using hydralazine for severe HTN?
No CNS effects
40
What are the advantages of using labetolol for severe HTN?
-no overshoot hypotension -preserved cardiac output
41
What are the advantages of using nicardipine for severe HTN?
-rapid on -easily titrated -coronary dilator
42
What are the advantages of using nitroglycerin for severe HTN?
-rapid on -coronary dilator
43
What are the advantages of using nitroprusside for severe HTN?
-rapid on rapid off -easily titrated -nonsedating
44
What are the SE of using esmolol for severe HTN?
-exacerbates CHF and asthma -cardiac conduction blockade -nausea
45
What are the SE of using enalaprilat for severe HTN?
-hypotension in volume deplete patients -can exacerbate renal failure -headache -not in pregnancy
46
What are the SE of using hydralazine for severe HTN?
-reflex tachycardia -overshoot hypertension -headache -vomiting
47
What are the SE of using labetolol for severe HTN?
-exacerbates CHF and asthma -cardiac conduction blockade -tolerance with prolonged use
48
What are the SE of using nicardipine for severe HTN?
-reflex tachycardia -headache
49
What are the SE of using nitroglycerin for severe HTN?
-weak arterial dilator -headache -ethanol vehicle -absorbed by some IV tubing
50
What are the SE of using nitroprusside for severe HTN?
-thiocyanate or cyanide toxicity -reflex tachycardia -vomiting -light sensitivity
51
What is severe HTN?
SBP > 160 or DBP > 100
52
At what blood pressure in non pregnant patients is overt organ injury seen? In pregnant patients?
-220/130 -DBP >100
53
Why are nitroprusside and nicardipine good to treat HTN encephalopathy?
Rapid onset and the encephalopathy starts to clear within hours of BP control
54
Which stroke syndromes are potentially related to HTN?
-bland cerebral infarction -subarchnoid hemorrhage -intracerebral hemorrhage
55
Which antihypertensive is efficacious in subsrachnoid hemorrhages and what is its MOA?
-nimodipine -Ca channel blocker -efficacious even in absence of BP reduction
56
Why is clonidine not the antihypertensive of choice in cerebral ischemia/hemorrhage?
Has a sedating effects that can compromise ability to do neurostatus exams
57
What physical exam findings are suspicious for aortic dissection?
HTN in patient with chest or back pain especially if concomitant BP discrepancies between UE and LE or asymmetry in b/l UE
58
What is the immediate goal in aortic dissection?
Decrease in both mean BP and ejection velocity (the rate of increase in systolic pressure)
59
Which antihypertensives are indicated for aortic dissection and why?
-beta blockers are effective for decreasing ejection velocity but don't control BP quickly enough -nitroprusside or nicardipine are rapid onset vasodilators to be used with beta blockers -combined alpha and beta blockers (labetolol) can be used alone
60
What is the goal when treating HTN induced pulmonary edema?
Decrease SVR as pulm edema is usually due to excessive LV afterload or acutely worsened diastolic dysfunction
61
Which antihypertensive is good for pulmonary edema and myocardial ischemia?
Nitroglycerin
62
Why is HTN control important in myocardial ischemia?
-preserve endangered myocardium -reducing afterload -increases myocardial perfusion
63
Why are arterial vasodilators avoided in MI?
They cause tachycardia which increases myocardial oxygen consumption
64
At what rate should HTN emergency be corrected?
decreased by no more than 20-25% in the first hour then to 160/110 during next 2-6hrs
65
What is the definition of a HTN crisis? HTN emergency?
-crisis is SBP > 180 or DBP >110 -emergency is HTN mediated organ damage
66
At what rate should HTN emergency be corrected in a pt w/ a concomitant aortic dissection?
lower SBP to 100 - 120mmHg w/in 20 min to reduce aortic shearing forces
67
What is the risk of using ACE inhibitors for BP control in pregnancy?
risk of fetal renal damage
68
Which beta blockers are safe to use in pregnancy, which one is not?
-labetalol and metoprolol -atenolol is not

Cardiovascular (6 decks)

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