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HTN > Hypertensive Emergency & Urgency > Flashcards

Hypertensive Emergency & Urgency Flashcards

1
Q

What is the definition of hypertensive emergency

A

Acute elevation of BP (>180/120) WITH acute or ongoing target end organ damage

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2
Q

What are examples of target end organ damage

A 
Hypertensive encephalopathy
Intracranial hemorrhage
Unstable angina
Acute MI
Acute LV failure with pulmonary edema
dissecting aortic aneurysm
eclampsia
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3
Q

What neurologic clinical findings indicate end organ damage

A

sommolence, confusion, seizures, coma, visual deficits or blindness

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4
Q

Cardiac damage should be considered if upon testing any of the following are found

A

S4 gallop
ischemic changes on ECG
chest x-ray indicates pulmonary edema
chest pain symptoms

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5
Q

clinical indicators of renal damage include

A

oliguria
progressive azotemia
hematuria
proteinuria

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6
Q

A funduscopic exam, indicates target organ damage if

A

patient has: papiledema, hemorrhage, or exudates

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7
Q

True or False, blood pressure must be reduced IMMEDIATELY in both hypertensive emergency & urgency. Why

A

False.

BP should only be reduced immediately in HTN emergency as there is end organ damage.

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8
Q

MAP should be decreased by a)______ within b)__ to ___?

A

25% within minutes to hours

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9
Q

Within ______ the target BP is 160/100?

A

2-6 hours

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10
Q

HOw oftern douse the BP need to be checked during HTN emergency & when can you stop checking

A

Must check BP every 5-10minutes

Stop checking when the MAP is reached & life-thretening target organ damage resolves

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11
Q

How long must the BP be maintained at goal

A

1-2 days

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12
Q

How long may it take before normal BP is reached?

A

weeks

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13
Q

What is the definition of hypertensive Urgency

A

accelerated, malignant, or perioperative elevations in BP WITHOUT new or progressive target organ damage.

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14
Q

What vasodilators are commonly used in Hypertensive emergencies

A 
*3Ns & HE*
Nitroprusside (Nipride)
Nicardipine
Nitroglycerin (Tridil)
Hydralazine (Apresoline)
Enalaprlate (Vasotec IV)
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15
Q

These adrenergic inhibitors are commonly used for hypertensive emergencies

A 
*CLEPh*
Clevidipine (Cleviprex)
Labatalol 
Esmolol (Brevibloc)
Phentolamine (Regitine)
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16
Q

in which emergencies would labetalol be recommended?

A

encephalopathy & postoperative hypertension

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17
Q

A patient presents to the emergency with encephalopathy & BP of 190/130 what agents should be avoided when lowering BP?

A

methyldopa & reserpine (sedation)
diazoxide (lowers cerebral blood flow)
hydralazine (increases intracranial pressure)

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18
Q

When treating a patient with HTN emergency with encephalopathy what are the agents of choice?

A

Labatelol
Nicardipine
Nitroprusside

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19
Q

Thiocynate & cyanide intoxication as well as muscle twitching, sweating & N/V are all side effects of

A

Nitroprusside

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20
Q

When sing nitroprusside, caution has to be taken if the patient is experiencing ______ or ____.

A

high intracranial pressure

azotemia

21
Q

what steps must be taken for the safe BP lowering during any hemorrhage or stroke

A

BP lowering should be done if the systolic >220 or diastolic > 120mmHg

22
Q

What is the agent of choice in lowering BP during a hemorrhage or stroke

A

nitroprusside

23
Q

Nitrogylcerin is used in what type of HTN emergencies?

A

MI, unstable angina, CHF

24
Q

Nitroprusside is recommended for use in all HTN emergencies except

A

MI or unstable angina

25
Q

Nicardipine is an agent of choice in which HTN emergencies

A

encphalopathy or postoperative HTN

26
Q

When using nicardipine, caution should be used in management of a)______ emergency & should NOT be used in b)_____ emergency

A

a) coronary ischemia emergency

b) heart failure emergency

27
Q

What are the side effects of nicardipine

A

tachycardia
HA
flushing
phlebitis

28
Q

What are the side effects of nitroglycerin

A

Tolerance with prolonged us
HA, vomiting
methemoglobinemia

29
Q

the recommended agents for HTN emergency in a pt with an MI or unstable angina

A

nitroglycerin or esmolol

30
Q

Esmolol is an agent of choice in which HTN emergency conditions

A

MI, unstable angina
Aortic dissection
PERIoperative HTN

31
Q

The only ACEI that is used in HTN emergency is ____.

A

Enalaprilat

32
Q

Enalaprilat is best used in a)_______ emergency and avoided in b)_______

A

a) Acute LVF ( CHF)

b) acute MI

33
Q

diazoxide & hydralazine should be avoided in ________ because they increase shearing forces

A

dissecting aortic aneurysms

34
Q

Recommended drugs for pheochromocytoma & cocaine overdose

A

Phentolamine & lobetalol (caution)

35
Q

Side effects of phentolamine are

A

tachycardia, flushing, HA

36
Q

catecholamine(norepi, epi, dopamine) excess is treated with

A

phenotlamine

37
Q

In the management of an emergency in a pt with renal insufficency, what agents are recommended?

A

Nitroprusside, labetolol, CCB

38
Q

Why are diazoxide & hydralazine avoided in CHF emergencies

A

these agents increase oxygen demand

39
Q

Why are dihydropyridines avoided in CHF emergencies

A

they may worsen angina

40
Q

Why is nitroprusside avoided in CHF emergencies

A

nitroprusside can cause coronary steal

41
Q

Why are labetalol, esmolol & other BB avoided in CHF emergencies

A

BB reduce CO

42
Q

what are the side effects of labetalol?

A 
heart block
orthostatic hypotention
scalp tingling
throat burning
dizziness
N/V
43
Q

a)__________therapy is preferred in the management of HTN urgency, while b)____ therapy is used in HTn emergency?

A

a) oral therapy is preferred for urgency

b) IV is best in emergency

44
Q

Any medication used in treating HTN urgency should have an onset of a)__________ and peak within b)_________

A

A) onset of 15-30 minutes

B) peak within 2-3 hours

45
Q

Using which formulation of nifedipine is inappropriate for lowering BP in pts with HTN urgency

A

immediate-release nifedipine

46
Q

To monitore for a response to therapy, BP should be checked every ____ to ______ minutes during HTn urgency

A

15 to 40 minutes

47
Q

What are the agents used in HTN uregency?

A

Captopril 25mg
Clonidine 0.1-0.2mg, with max of 0.6mg
Labetalol 100-400mg

48
Q

All agents used in HTN urgency can be reapeated within 1-2 hours PRN except ______; which is done __________

A

Labetalol, done every 2-3 hours PRn

HTN (5 decks)

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