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PT II: Cardio I > HTN crises > Flashcards

HTN crises Flashcards

(70 cards)

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1
Q

HTN emergency

A

acute end organ damage

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2
Q

HTN urgency

A

NO evidence of acute end organ damage

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3
Q

acute end organ damage examples

A
  • HTN encephalopathy
  • intracranial hemorrhage
  • ischemic stroke
  • visual changes
  • acute left ventricular failure (with pulm edema)
  • dissecting aortic aneurysm
  • acute MI
  • preeclampsia
  • acute renal failure
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4
Q

BP of HTN crises

A

> 180/120

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5
Q

history assessment for HTN crises

A
  • previous HTN
  • preexisting end organ damage
  • med history
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6
Q

BP assessment in HTN crises

A
  • both arms
  • supine and standing
  • MAP
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7
Q

normal MAP

A

70-100 mmHg

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8
Q

symptoms of HTN encephalopathy

A 
HA
N/V
visual disturbances
confusion
seizures
drowsiness
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9
Q

fundoscopic exam HTN crises

A
  • advanced retinopathy
  • hemorrhages
  • exudates
  • papilledema
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10
Q

Symptoms of cardiac exam of HTN crises

A
  • chest pain (MI)
  • dyspnea (HF)
  • severe back pain or pain between shoulder blades (aortic dissection)
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11
Q

signs of left ventricular dysfunction

A
  • rales
  • S3
  • JVD
  • peripheral edema
  • ascites
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12
Q

signs of aortic dissection

A
  • significant difference in BP between right and left arms

- widened mediastinum on CXR

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13
Q

tests to run for HTN crises

A

electrocardiogram
CXR
echocardiogram

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14
Q

renal exam for HTN crises

A
  • pedal edea
  • oliguria
  • proteinuria
  • hematuria
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15
Q

tests for renal exam HTN crises

A

BUN/ACr

urinalysis

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16
Q

Overal goals of HTN crises

A
  • reduce BP to reasonable level

- maintain organ perfusion

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17
Q

Reducing BP in HTN crises

A
  • should NOT reduce to normal immediately
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18
Q

excessive BP reduction can lead to what?

A

cerebral
cardiac
renal hypoperfusion

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19
Q

HTN emergency BP goal

A
  • lowered immediately but gradually
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20
Q

How to reduce BP in HTN emergency

A
  • do not want to immediately normalize
  • reduce MAP by no more than 25% in 1 hour
  • achieve BP goal of 160/100-110 within 2-6 hours
  • further reductions can be made over next 24 hours
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21
Q

How to reduce BP in HTN emergency with acute ischemic stroke

A
  • do not reduce DBP <120mmHg during first 6 hours
  • reduce MAP by no more than 15% in 24 hours
  • no further reduction of first 48-72 hours, then slowly reduce
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22
Q

How to reduce BP in HTN emergency with aortic dissection, preeclampsia or pheochromocytoma

A
  • reduce SBP <140 1st hour

- reduce SBP <120 within 1st hour for aortic dissection

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23
Q

Are you more or less conservative in HTN emergency with acute ischemic stroke?

A

less

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24
Q

Are you more or less conservative in HTN emergency with preeclampsia?

A

more

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25
HTN urgency BP goal
- lowered less rapidly over 24-48 hours | - lower BP toward 140-159/90-99
26
Ideal characteristic of parenteral agents
- rapid onset | - short t1/2
27
Nitroprusside CI in who?
- history of coronary atherosclerotic disease (MI) - hepatic/renal dysfunction - encephalopathy, head trauma
28
which drug is associated with coronary steal?
nitroprusside
29
how does coronary steal work?
nitroprusside dilates healthy, but not atherosclerotic coronary arteries - dilated arteries will steal blood from diseased atherosclerotic vessels
30
s/s of cyanide toxicity
metabolic acidosis - tachycardia - coma - almond smelling breath
31
S/s of thiocyanate toxicity
- HA - hyperreflexia - weakness - mental status changes - seizures
32
Downside of nitroglycerin
- tolerance within 24-48 hours | - headache
33
nitroprusside and nitroglycerin MOA
arterial and venous vasodilators
34
labetalol MOA
a1 and nonselective BB | lower TPR and CO
35
Labetalol and esmolol CI
- bronchospastic disease - heart problems (bradycardia, heart block, HF) - liver disease
36
Patient post-MI and going through HTN emergency. What drug should you use and whY?
esmolol: ultra short acting cardioselective BB
37
nicardipine MOA
- DHP CCB | - arterial vasodilator
38
Should use nicardipine in which patients? Why?
- MI or HF exacerbation | - pure vasodilation = reflex tachycardia to maintain perfusion
39
Clevidipine MOA
- DHP-CCB arterial vasodilator
40
difference between nicardipine and clevidipine
clevidipine not water soluble | mixed with soybean oil (milky white IV)
41
What is the IV ACEI for HTN emergency? Why is it not popular for this indication?
enalaprilat Long DOA 6-12 hours overshoot = lowered BP for extended time
42
enalaprilat CI
acute MI
43
Fenoldopam MOA
postsynaptic DA1 receptor agonist
44
Want to use nitroprusside to treat patient's HTN emergency, but he has bad kidneys and liver. Next go to drug?
fenoldapam
45
use with caution in glaucoma patients (HTN crises drug)
fenoldapam
46
hydrazine MOA
arterial vasodilator
47
hydrazine CI
MI and aortic dissection (reflex tachycardia)
48
never dispense these poke and squeeze PO meds. Why?
IR nifedipine (SL) lowers BP dramatically and unpredictably
49
Med options for HTN urgency
- PO clonidine, captopril, labetalol
50
Pregnant patient with HTN urgency. What are her options?
clonidine labetalol no captopril ACEI)
51
ADE nitroprusside
- hypotension - N/V - CN toxicity - need to protect infusion from light
52
ADE nitroglycerin
- hypotension - tachycardia - HA - tolerance
53
ADE labetalol
- hypotension - dizziness - bradycardia - heart block - bronchospasm
54
ADE esmolol
- hypotension - dizziness - bradycardia - heart block - bronchospasm
55
ADE nicardipine
- hypotension - HA - flushing - tachycardia
56
ADE clevidipine
- hypotension - HA - flushing - tachycardia - lipid emulsion
57
ADE enalaprilat
- hypotension - renal insufficiency - hyperkalemia - angioedema
58
ADE fenoldopam
- hypotension - flushing - dizzy - HA - hypokalemia
59
ADE hydralazine
- hypotension - tachycardia - HA - flushing
60
MI what do you use for HTN emergency?
nitroglycerin labetalol esmolol metoprolol
61
acute HF what do you use for HTN emergency?
nitroprusside (in absence of acute renal failure) nitroglycerin enalaprilat
62
aortic dissection what do you use for HTN emergency?
labetalol or esmolol + nitroprusside
63
HTN encephalopathy what do you use for HTN emergency?
labetalol nicardipine/clevidipine fenoldopam
64
What do you avoid with HTN encephalopathy?
nitroprusside
65
preeclampsia what do you use for HTN emergency?
hydrazine labetalol nicardipine
66
what do you avoid in preeclampsia for HTN emergency?
nitroprusside | ACEI
67
acute renal failure what do you use for HTN emergency?
fenoldopam nicardipine hydralazine
68
cocaine induced what do you use for HTN emergency?
labetalol
69
what do you avoid in cocaine induced HTN emergency?
pure BB
70
HTN due to excess catecholamines what do you use for HTN emergency?
labetalol esmolol nitroprusside nicardipine

PT II: Cardio I (4 decks)

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