Hypertensive Emergency & Urgency Flashcards
What is the definition of hypertensive emergency
Acute elevation of BP (>180/120) WITH acute or ongoing target end organ damage
What are examples of target end organ damage
Hypertensive encephalopathy Intracranial hemorrhage Unstable angina Acute MI Acute LV failure with pulmonary edema dissecting aortic aneurysm eclampsia
What neurologic clinical findings indicate end organ damage
sommolence, confusion, seizures, coma, visual deficits or blindness
Cardiac damage should be considered if upon testing any of the following are found
S4 gallop
ischemic changes on ECG
chest x-ray indicates pulmonary edema
chest pain symptoms
clinical indicators of renal damage include
oliguria
progressive azotemia
hematuria
proteinuria
A funduscopic exam, indicates target organ damage if
patient has: papiledema, hemorrhage, or exudates
True or False, blood pressure must be reduced IMMEDIATELY in both hypertensive emergency & urgency. Why
False.
BP should only be reduced immediately in HTN emergency as there is end organ damage.
MAP should be decreased by a)______ within b)__ to ___?
25% within minutes to hours
Within ______ the target BP is 160/100?
2-6 hours
HOw oftern douse the BP need to be checked during HTN emergency & when can you stop checking
Must check BP every 5-10minutes
Stop checking when the MAP is reached & life-thretening target organ damage resolves
How long must the BP be maintained at goal
1-2 days
How long may it take before normal BP is reached?
weeks
What is the definition of hypertensive Urgency
accelerated, malignant, or perioperative elevations in BP WITHOUT new or progressive target organ damage.
What vasodilators are commonly used in Hypertensive emergencies
*3Ns & HE* Nitroprusside (Nipride) Nicardipine Nitroglycerin (Tridil) Hydralazine (Apresoline) Enalaprlate (Vasotec IV)
These adrenergic inhibitors are commonly used for hypertensive emergencies
*CLEPh* Clevidipine (Cleviprex) Labatalol Esmolol (Brevibloc) Phentolamine (Regitine)
in which emergencies would labetalol be recommended?
encephalopathy & postoperative hypertension
A patient presents to the emergency with encephalopathy & BP of 190/130 what agents should be avoided when lowering BP?
methyldopa & reserpine (sedation)
diazoxide (lowers cerebral blood flow)
hydralazine (increases intracranial pressure)
When treating a patient with HTN emergency with encephalopathy what are the agents of choice?
Labatelol
Nicardipine
Nitroprusside
Thiocynate & cyanide intoxication as well as muscle twitching, sweating & N/V are all side effects of
Nitroprusside
When sing nitroprusside, caution has to be taken if the patient is experiencing ______ or ____.
high intracranial pressure
azotemia
what steps must be taken for the safe BP lowering during any hemorrhage or stroke
BP lowering should be done if the systolic >220 or diastolic > 120mmHg
What is the agent of choice in lowering BP during a hemorrhage or stroke
nitroprusside
Nitrogylcerin is used in what type of HTN emergencies?
MI, unstable angina, CHF
Nitroprusside is recommended for use in all HTN emergencies except
MI or unstable angina
Nicardipine is an agent of choice in which HTN emergencies
encphalopathy or postoperative HTN
When using nicardipine, caution should be used in management of a)______ emergency & should NOT be used in b)_____ emergency
a) coronary ischemia emergency
b) heart failure emergency
What are the side effects of nicardipine
tachycardia
HA
flushing
phlebitis
What are the side effects of nitroglycerin
Tolerance with prolonged us
HA, vomiting
methemoglobinemia
the recommended agents for HTN emergency in a pt with an MI or unstable angina
nitroglycerin or esmolol
Esmolol is an agent of choice in which HTN emergency conditions
MI, unstable angina
Aortic dissection
PERIoperative HTN
The only ACEI that is used in HTN emergency is ____.
Enalaprilat
Enalaprilat is best used in a)_______ emergency and avoided in b)_______
a) Acute LVF ( CHF)
b) acute MI
diazoxide & hydralazine should be avoided in ________ because they increase shearing forces
dissecting aortic aneurysms
Recommended drugs for pheochromocytoma & cocaine overdose
Phentolamine & lobetalol (caution)
Side effects of phentolamine are
tachycardia, flushing, HA
catecholamine(norepi, epi, dopamine) excess is treated with
phenotlamine
In the management of an emergency in a pt with renal insufficency, what agents are recommended?
Nitroprusside, labetolol, CCB
Why are diazoxide & hydralazine avoided in CHF emergencies
these agents increase oxygen demand
Why are dihydropyridines avoided in CHF emergencies
they may worsen angina
Why is nitroprusside avoided in CHF emergencies
nitroprusside can cause coronary steal
Why are labetalol, esmolol & other BB avoided in CHF emergencies
BB reduce CO
what are the side effects of labetalol?
heart block orthostatic hypotention scalp tingling throat burning dizziness N/V
a)__________therapy is preferred in the management of HTN urgency, while b)____ therapy is used in HTn emergency?
a) oral therapy is preferred for urgency
b) IV is best in emergency
Any medication used in treating HTN urgency should have an onset of a)__________ and peak within b)_________
A) onset of 15-30 minutes
B) peak within 2-3 hours
Using which formulation of nifedipine is inappropriate for lowering BP in pts with HTN urgency
immediate-release nifedipine
To monitore for a response to therapy, BP should be checked every ____ to ______ minutes during HTn urgency
15 to 40 minutes
What are the agents used in HTN uregency?
Captopril 25mg
Clonidine 0.1-0.2mg, with max of 0.6mg
Labetalol 100-400mg
All agents used in HTN urgency can be reapeated within 1-2 hours PRN except ______; which is done __________
Labetalol, done every 2-3 hours PRn
