HyperTN ER & Urgency

Question 1

Drugs use during pregnancy

Answer 1

1. Labetalol:
   - 1st line either IV or PO
   - Both alpha 1 and beta- blocker
2. Nefidipine ER - Procardia XL
3. Methydopa:
   - Is still used sometime
   - Weak & cause more ADEs
4. Hydralazine
   - Falling out of favor. Fetal tachycardia

Question 2

What is hypertensive ER?

Answer 2

• ER: Increase BP w/ sx of end organ damage (brain, heart, eyes, kidneys)
• In ER ASAP & use IV BP
• Don’t overshoot: decrease BP by 15-25% QD (hypoTN => ischemic stroke or ARF)

Question 3

What is hypertension Urgency?

Answer 3

• BP > 180/110
• No end organ damage. No need IV meds
• Decrease BP in 24-48H w/ PO Meds

Question 4

What are the drugs treatment for HTN Urgency

Answer 4

CCAL

1. Captopril
   - 25mg PO. Repeat prn
   - Precaution: renal failure, bilateral renal artery stenosis
2. Clonidine:
   - 0.1-0.2 mg PO. Repeat prn to total dosage of 0.6mg
   - Precaution: rebound HTN
3. Labetalol
   - 200-400 mg PO. Repeat Q2-3H
   - P: bronchocontriction, HB, bradycardia
4. Amlodipine
   - 2.5-5 mg

Question 5

Nipride

• OSA:
• Dilute with
• Storage
• Dispose:
• ADEs:

Answer 5

Sodium Nitroprusside

• OSA: 5 min. Use D5W
• Protect from light w/ Aluminum foil
• Discard after 24H or if sol’n turns dark brown/blue or blue (breakdown into cyanide). Light yellow = good
• ADEs: N/V/HA, sweating, muscle twitching, restlessness, thiocyanate/cyanide toxicity

Question 6

Cyanide Antidote Kits

Answer 6

• Na nitrate 3% sol’n over 2-4 min THEN
• Na thiosulfate 150-200 mg/kg or 50mL of 25% sol’n.
  May repeat at 1/2 the original dose after 2H

Question 7

Nitroglycerin IV

• MOA
• Dose:
• ADEs

Answer 7

• MOA: Decrease preload & myocardial O2 demand. Increase myocardial O2 supply…. Primary work as venodilator but at high dose = arterial dialator
• D: 5 mcg/min. Increase 5 mcg/min Q3-5 min to 20mcg/min then increase by 10 mcg/min to 100 mcg/min
• ADEs: HypoTN, HA, flushing, N, tachycardia

Question 8

Cardense IV

• Dose:
• OSA:
• ADEs

Answer 8

Nicardipine

• MOA: CCB
• Dose: IV LD 5-15 mg/H => MD rate 3 mg/h
• OSA: 2-10 min. D = 40-60 min after stopping infusion.
• ADEs: HA/N, flushing, dizziness, and local thrombophlebitis (infusion > 14H)

Question 9

Corlopam

• MOA:
• Dosage:
• ADEs

Answer 9

Fenoldopam Mesylate

• MOA: selective peripheral dopamine DA-1 receptor agonist/antagonist. Decrease TPR, decr BP, inc renal blood flow, diuresis. Potent vasodilator of peripheral and renal arteries
• D: 0.1-0.3 mcg/kg/min. OSA =

Question 10

Apresoline

• MOA:
• Dosage:
• ADEs

Answer 10

Hydralazine

• MOA: direct relaxation of arterioles, decr TPR, dec BP.
• Dosage: 10-20 mg IV or 10-50 mg IM. OSA = 10-30 min of IV & 20-40 for IM. D = 2-6H
• ADEs: HA, palpitations, tachycardia, precipitation of angina, Na and water retention & flushing.

Question 11

Vasotec IV

Dosage:

Answer 11

Enalapril

• 1.25 mg doses, IV Q6H
• A dose of 0.625 mg: for pt taking diuretic, CrCl 2.5mg QD
• If take 1.25mg Q6H => 5 mg QD

Question 12

Normodyne
Transdate

• Brand:
• Dosage:

Answer 12

Labetalol IV

• Dosage: 20 mg (0.25 mg/kg for 80 kg pt) over 2min, then 20-80 mg Q10Min until desired BP
  OSA: 2-5 min; D = 2-4H
  ADEs: wheezing, HB, postural hypotension, flushing.

Question 13

Brevebloc

• Brand:
• Dosage:
• OSA:
• ADEs

Answer 13

Esmolol

• Ultra short acting beta-1 selective blocker
• Useful in MI and aortic dissection
• D: 250-500 mcg/kg/min for 1 min then 50-100 mcg/kg/min for 4 min
• OSA:

Question 14

Regitine

• MOA
• Indication
• Dose
• SE
• CI

Answer 14

Phentolamine

• MOA: Alpha blocker
• I: HTN ER 2nd to stimulant (cocaine, amphetamine) toxicity, pheochromocytoma, clonidine w/d, and MAOI drug interaction
• D: 5-15 mg IV
• ADEs: hypoTN w/ reflex tachy
• CI: MI or CAD

Question 15

Overdose phentolamine

Answer 15

Treat with NE