Acute HTN Crisis

Question 1

HTN urgency vs Emergency

Answer 1

both >180 and >120
Emergency has organ failure or complications

Question 2

What are cause of HTN crisis?

Answer 2

Non adherence
Drug withdraw
Less common
Hyperthermia
Serotonin syndrome
elevated intracranial pressure

Question 3

What dose a pt present with for HTN crisis?

Answer 3

SOB, chest pains, headache, altered mental status, focal neurological deficit

Question 4

Flow chart for HTN crisis

Answer 4

Question 5

Goals of therapy for HTN crisis

Answer 5

1. Resolve clinical
2. Prevent organ dmg
3. Bp goals
   (No conditions present) 25% for the 1st hour then 160/110 over next 2-6 then Normal over the next 24-48
   Yes present SBP <140 first hour or <120 within 20 mins for aortic dissection

Question 6

HTN Urgency treatment

Answer 6

Restart or intensify OG meds
Option add PRN meds
Like
Clonidine fast onset but bradycardia and sedation
Captopril triturable and fast onset but AKI and Hyperkalemia
Labetalol Vasodialating and decrease sympathetic nervous system but bradycardia and long H/F
Minoxidil Potent vasodilator but edema and tachycardia

Question 7

HTN emergency Treatment

Answer 7

Direct vasodilators ( enelaprilat, hydralazine, nitroglycerin, nitoprusside, phentolamine, fenoldopam)
Calcium channel blockers (clevidipine, nicardipine, verapamil, diltazem)
Beta blockers ( esmolol, labetaolol, metoprolol)

Question 8

Nitroglycerin onset and adverse effects

Answer 8

2-5mins
Given IV
AD
Headache, tachy
Used for angina, HF, pulmonary edema

Question 9

Nitroprussde onset, adverse and usage

Answer 9

HTN crisis
O: seconds
AD
Cyanide toxicity
Coronary steal
USE
HF
AORTIC DISSECTION

Question 10

Hydralazine onset, adverse and use

Answer 10

O: 5-15
Used for HTN crisis
AD
Tachycardia
Uses
Eclampsia/pre eclampsia

Question 11

Phentolamine onset, adverse and use

Answer 11

HTN crisis
O - seconds
AD
none
USE
Phenochromoctoma

Question 12

Enalaprilat onset, use, AD

Answer 12

HTN crisis
O 15 mins
AD AKI
USE
HF

Question 13

Fenoldopam onset, use, Adverse

Answer 13

HTN crisis
O 5 mins
AD
Increase intracoular pressure
USE
Renal dysfunction

Question 14

What CCB are prefaced for HTN crisis

Answer 14

NIcardipine and clevidipine bc the are DHP and non DHP have heart side effects

Question 15

Nicardipine onset, use and Ad

Answer 15

HTN crisis
O - 5-15 mins
AD
Reflex tachycardia and headache
USE
Most HTN emergencies
Stroke
Pts with CKD

Question 16

Esmolol uses, onset, AD

Answer 16

Uses HTN crisis
O 1 mins
Ad decrease HR
USE
Aortic dissection (like nitroprusside)
Perioperative HTN

Question 17

Labetalol uses, onset and AD

Answer 17

Use HTN crisis
O 2-5 mins
AD decrease HR
USE
Stroke
ILLICIT DRUG USES
Clonidine withdraw

Question 18

metoprolol uses, onset and Ad

Answer 18

Uses HTN crisis
Onset 20 mins
Ad
Decrease HR
USES
Perioperative HTN
A fib w/ RVR

Question 19

In clinical work which 2 meds are used for general HTN crisis

Answer 19

Labetalol IV push if no HF, bardycardia, or asthma or COPD
If have use NICARDIPINE instead

Question 20

Acute MI prefaced agents

Answer 20

Nitroglycerin
Maybe beta blockers
AVOID nitroprusside

Question 21

Acute decomp HF preferred agents

Answer 21

Nitroglycerin, nitroprussdie
AVOID
Beta blocker and non DHP CCB

Question 22

Aortic Dissection preferred agents

Answer 22

Goal <120 SBP in 1st hour and control heart rate

Nitroprusside/ nitroglycerin + Esmolol or Labetalol to control reflex tachycardia

AVOID hydrazayline and minoxidil

Question 23

AKI prefers agents

Answer 23

Nicardipine, clevidipine, Labetalol

Avoid
Diuretics, ACE1 and nitroprussdie

Question 24

Hyperandrenergic state( drug induced) preferred agents

Answer 24

Phentolamine, nitroprusside, beta blocker w/ alpha actives like Labetalol

Avoid
Non alpha blocker beta blockers

Question 25

Preeclampsia preferred agents

Answer 25

Magnesium + Labetalol or nicardipine or Hydralazine
Avoid
Diuretics, ACEi and nitroprussdie

Question 26

HTN with Hemorrhagic stoke guidelines

Answer 26

Avoid over aggressive changes in BP lead to ischemia or worsening edema

Question 27

What do you do with Pt with Hemorrhagic stroke with SBP ≥ 220?

Answer 27

No specific guidelines just use IV meds to lower BP

Question 28

What do you do with Pt with Hemorrhagic stroke with SBP < 220?

Answer 28

Mild to moderate - SBP goal 140 (130-150) but not lower than 130
Severe ICH (inter cranial hemorrhage ) - no guideline but target the Same as above

Question 29

HTN crisis with Ischemic stroke guidelines

Answer 29

Question 30

Ischemia with HTN crisis worried about what and if yes what is the treatment

Answer 30

Thrombolysis
Yes
Lower to 185/110 before TPA
Maintain with for 24 on TPA

Question 31

Ischemia with HTN crisis worried about what and if no what is the treatment

Answer 31

BP <220/110 initiate within 48-72
BP ≥220/110 15% drop within 24hrs target of <220

Question 32

Preferred agents for HTN crisis with Hemmorhagic and ischemic complications

Answer 32

Same as preferred
Nicardapine and labetaolol
AVOID nitroprusside!!!!