special considerations of htn2 Flashcards
what are the 4 short term treatment goals with HTN crisis
- restore end organ perfusion
- prevent end organ damage
- decrease BP
- restore volume
what are 3 long term treatment goals with HTN crisis?
- reduce risk of CB morbitiy/mortality
- reduce renal dysfunction
- delay or stop progression of end organ damage
what type of HTN urgency treatment should be given?
outpatient or inpatient
outpatient with follow up
inpatient observation if high risk or med non-compliance
reduction of BP to goal in urgency treatment should be done in what time period?
24-48 hours
what can rapid BP reductions cause
eschemia and/or infarction
when should HTN urgency patients be re-evaluated
1-2 days, no more than a week
what are 1st line treatments for HTN urgency?
what must be done with them?
clonidine or ACEI’s
must observe for several hours
what are considered oral short acting hypertensives
clonidine and ACEI’s (particularly captopril)
other than short acting antihypertensives what else should be done for HTN urgency agents?
adjust current maintenance therapy:
1 restart medication
2. maximize current regimen
3. add new medication
arrange these by onset of action, shortest to longest: clonidine, captopril, labetalol
captopril< clonidine < labetalol
what is labetalols onset of action time? duration?
onset = 2 hours duration = 4 hours
what dosing forms of nifedipine are not safe nor efficacious with HTN urgency?
why?
sublingual and oral
- lowers BP abruptly
- reports of MI’s and strokes
what type of treatment is needed for HTN emergency?
ICU treatment
what must be assessed prior to IV therapy with HTN emergencies
assess volume status
then restore volume with saline
what is the two immediate goals of BP reduction in HTN emergency cases?
- decrease MAP by 25% within an hour
2. once stable decrease BP to less than 160/110 within 2-6 hours
what are 2 exceptions to BP goals in HTN emergency
- aortic dissection - must drop aggressively to 120/80
2. stroke - decrease MAP by 15-20%
once BP is controlled with IV agent in emergency HTN, what treatment can be use
oral antihypertensive and slow decreasing titration of IV agent
sodium nitroprusside can lead to what?
cyanide toxicity
what does nicardipine do?
who should not
increases stroke volume and coronary blood flow.
active for acute heart failure
what is fenoldopam useful for?
kidneyinsufficiency
what drug is not considered firstline for HTN emergency and absorbs to polyvinyl chloride containers
nitroglycerin
what are 3 drugs that are usually avoided in HTN emergency?
1 enalaprit - active metabolite of enalapril
- hydralazine- unpredictable effects
- clevidipine; use only intraoperatively and in critical care settings
clveidipine should be used with caution with what?
heart failure and concomitant beta-blocker use
what is the major effects on receptors of labetalol
beta blocker and alpha1 blocker
what effect doeslabetalol have on CO, SVR, and blood flow
maintains CO2, decreases SVR, conserves cerebral, renal and coronary blood flow
what receptors are effected by esmolol
beta-1 selective
when is esmolol most useful?
aortic dissection and perioperative HTN
what is generally used for catecholamine excess?
phentolamine
