special considerations of htn2

Question 1

what are the 4 short term treatment goals with HTN crisis

Answer 1

1. restore end organ perfusion
2. prevent end organ damage
3. decrease BP
4. restore volume

Question 2

what are 3 long term treatment goals with HTN crisis?

Answer 2

1. reduce risk of CB morbitiy/mortality
2. reduce renal dysfunction
3. delay or stop progression of end organ damage

Question 3

what type of HTN urgency treatment should be given?

outpatient or inpatient

Answer 3

outpatient with follow up

inpatient observation if high risk or med non-compliance

Question 4

reduction of BP to goal in urgency treatment should be done in what time period?

Answer 4

24-48 hours

Question 5

what can rapid BP reductions cause

Answer 5

eschemia and/or infarction

Question 6

when should HTN urgency patients be re-evaluated

Answer 6

1-2 days, no more than a week

Question 7

what are 1st line treatments for HTN urgency?

what must be done with them?

Answer 7

clonidine or ACEI’s

must observe for several hours

Question 8

what are considered oral short acting hypertensives

Answer 8

clonidine and ACEI’s (particularly captopril)

Question 9

other than short acting antihypertensives what else should be done for HTN urgency agents?

Answer 9

adjust current maintenance therapy:
1 restart medication
2. maximize current regimen
3. add new medication

Question 10

arrange these by onset of action, shortest to longest: clonidine, captopril, labetalol

Answer 10

captopril< clonidine < labetalol

Question 11

what is labetalols onset of action time? duration?

Answer 11

onset = 2 hours
duration = 4 hours

Question 12

what dosing forms of nifedipine are not safe nor efficacious with HTN urgency?
why?

Answer 12

sublingual and oral

• lowers BP abruptly
• reports of MI’s and strokes

Question 13

what type of treatment is needed for HTN emergency?

Answer 13

ICU treatment

Question 14

what must be assessed prior to IV therapy with HTN emergencies

Answer 14

assess volume status

then restore volume with saline

Question 15

what is the two immediate goals of BP reduction in HTN emergency cases?

Answer 15

1. decrease MAP by 25% within an hour

2. once stable decrease BP to less than 160/110 within 2-6 hours

Question 16

what are 2 exceptions to BP goals in HTN emergency

Answer 16

1. aortic dissection - must drop aggressively to 120/80

2. stroke - decrease MAP by 15-20%

Question 17

once BP is controlled with IV agent in emergency HTN, what treatment can be use

Answer 17

oral antihypertensive and slow decreasing titration of IV agent

Question 18

sodium nitroprusside can lead to what?

Answer 18

cyanide toxicity

Question 19

what does nicardipine do?

who should not

Answer 19

increases stroke volume and coronary blood flow.

active for acute heart failure

Question 20

what is fenoldopam useful for?

Answer 20

kidneyinsufficiency

Question 21

what drug is not considered firstline for HTN emergency and absorbs to polyvinyl chloride containers

Answer 21

nitroglycerin

Question 22

what are 3 drugs that are usually avoided in HTN emergency?

Answer 22

1 enalaprit - active metabolite of enalapril

2. hydralazine- unpredictable effects
3. clevidipine; use only intraoperatively and in critical care settings

Question 23

clveidipine should be used with caution with what?

Answer 23

heart failure and concomitant beta-blocker use

Question 24

what is the major effects on receptors of labetalol

Answer 24

beta blocker and alpha1 blocker

Question 25

what effect doeslabetalol have on CO, SVR, and blood flow

Answer 25

maintains CO2, decreases SVR, conserves cerebral, renal and coronary blood flow

Question 26

what receptors are effected by esmolol

Answer 26

beta-1 selective

Question 27

when is esmolol most useful?

Answer 27

aortic dissection and perioperative HTN

Question 28

what is generally used for catecholamine excess?

Answer 28

phentolamine