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Therapeutics I > HTN Crisis > Flashcards

HTN Crisis Flashcards

(42 cards)

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1
Q

What is a HTN crisis?

A

> 180/120

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2
Q

What are the risk factors of HTN crisis?

A
  1. Female sex
  2. Age
  3. Black
  4. Low income
  5. Medication non-adherence
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3
Q

What is the patho of HTN crisis?

A
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4
Q

What is the most common pharmacological causes that could lead to HTN crisis?

A

Withdrawn of AHTN therapy (b-blockers, clonidine)

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5
Q

Discuss the signs and symptoms of HTN emergency?

A
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6
Q

What are the steps for HTN emergency treatment?

A

First hour: Decrease in DBP by 10-15% or MAP by 25% with goal DBP ≥100 mmHg
2-6 hr: SBP 160 and/or DBP 100-110
24-48 hr: Outpatient BP goals

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7
Q

What are the exceptions of HTN emergency treatments?

A
  1. Acute aortic dissection
  2. Stroke
  3. Pregnancy (severe preeclampsia or eclampsia)
  4. Pheochromocytoma crisis
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8
Q

What is the dosage form of HTN emergency treatments? Onset? Duration?

A

IV
Fast
Low DOA → increased titration

Most are titrations and weight based

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9
Q

What is the fastest drug for emergency?

A

Nitroprusside

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10
Q

What is nitroprusside? MOA? ADRs? CIs? Indications?

A

MOA: Potent arterial and venous VD that leads to smooth muscle relaxation
Coronary steal and increased ICP
ADR: Acute MI and ICP elevation
CI: Cyanide toxicity with long duration of high doses (72 hr)
Renal and liver failure
Indication: All

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11
Q

Nitroglycerin? MOA? ADR? CI? Indication?

A

MOA: venous vasodilator with no coronary steal
ADR: Tachyphylaxis (24-48hr) with lacking nitrate-free intervals, flushing, HA, erythema
CI: PDE3is
Indication: MI/ACS and ADF w/ pulmonary edema

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12
Q

Hydralazine? MOA? ADR? CI? Indication?

A

MOA: Peripheral arterial VD
ADR: Rebound tachycardia, HA, lupuslike syndrome
CI:
Indication: Pregnancy

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13
Q

Nicardipine? MOA? Pros and cons? Indications?

A

Crosses the BBB → cerebral vasodilation
Metabolized by CYP
Cheaper than clevidipine
Requires large volume adminsitration

Most indications especially strokes

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14
Q

Clividipine? MOA? Pros and cons? Indications?

A

Inhibits calcium influx in vascular smooth muscle

Lipid emulsion → expire in 12 hr → monitor TAG → caution in soy or egg allergies

Better BP variability profile, less volume administered

Faster BP attainment

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15
Q

What are b1 antagonists used? Indications? MOA?

A
  1. Esmolol (rapid onset, short duration, titratable):
  2. Metoprolol (IV push, slower onset, longer DOA): overaggressive correction:

Aortic dissection

Negative inotropic and chronotropic activity (not VD)

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16
Q

Labetalol? Indication? CI?

A

1:7 alpha to beta blockade
Infusion or push
Pregnancy, stroke, aortic dissection
Respiratory disease

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17
Q

What is the overall warning of beta blocker?

Study These Flashcards
A

Avoid with ADHF, heart block, bradycardia

18
Q

Enalaprilat? Indication? CI?

Study These Flashcards
A

IV ACEIs not easily titratable
Limited use due to slow onset and DOA

Pregnancy and renal dysfunction

19
Q

Phentolamine? MOA? Indications? ADRs?

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A

Peripheral alpha 1 and 2 blockier → direct vasodialtion

Pheochromocytoma, catecholamine excess, cocaine, amphetamine induced HTN emergency

Rebound tachycardia

20
Q

Felodopam? MOA? Indications? ADRs?

Study These Flashcards
A

Peripheral dopamine 1 agonist → arterial VD
CI: Anaphylaxis with sulfite allergies
ADR: Hypokalemia, flushing, increase IOP

21
Q

What is the difference between Type A and B aortic dissection?

Study These Flashcards
A

A: ascending (surgical emergency)
B: aortic arch or descending aorta

22
Q

What is the treatment goal for aortic dissection?

Study These Flashcards
A

Control BP and HR

HR <60 ASAP
SBP <120 and/or as low as clinically tolerated

Beta blockers used first, followed by VD if needed

23
Q

What are the 4 categories of pregnancy HTN?

Study These Flashcards
A
  1. Chronic
  2. Gestational
  3. Preeclampsia
  4. Superimposed preeclampsia
24
Q

What is gestational HTN?

Study These Flashcards
A

New-onset HTN >20 weeks gestation without proteinuria or other systemic findings

25
Whaat is preeclampsia
≥140/90 on 2 separate occasions at least 4 hrs apart with proteinuria > 20 weeks gestation or presence of severe features
26
What is superimposed preeclampsia?
Patient with HTN prior to pregnancy who now has preeclampsia
27
What severe features are you looking for in pregnancy HTN?
1. Thrombocytopenia 2. Impaired LFTs 3. New renal insufficiency 4. Pulmonary edema 5. New-onset cerebral or visual disturbances
28
What is eclampsia?
Seizure onset in a woman with preeclampsia
29
What is considered severe HTN in pregnancy?
>160/110
30
What is pregnancy treatment for HTN?
Delivery is only managed by eclampsia → Magnesium IV added to reduce seizure risk → IV AHTN for BP >160/110, preeclampsia/eclampsia or HTN emergency (Labetalol, hydralazine, CCB) → Goal
31
What is goal of HTN pregnancy ?
Decrease MAP by 20-25% over minutes to hrs then to ultimate goal SBP<140
32
When do you treat ischemic HTN?
Only treat BP if: using thrombolytics, other target organ damage present, >220/120
33
What drugs do you use for Ischemic HTN uemergency?
Labetalol, nicardipine, clevidipine, hydralazin and enalaprilat
34
What is hemorrhagic HTN emergency? Goal? Drugs?
Elevated BP → hematoma expansion → neurologic worsening SBP 140-160 Nicardipine or clevidipine
35
What is pheochromocytoma? Drugs?
Excess release of E and NE due to adrenal tumor Pure alpha antagonist Alternatives: phenoxybenzamine or doxzosin
36
Drugs for cocaine induced HTN emergency?
1. Benzos (central effect) 2. Phentolamine (2nd line) 3. CCB and VD (3rd line) 4. Combo of a/b blockers if tachycardia arises
37
What is the treatment for urgency?
Lower BP slowly using PO med → maintenance med → optimal use of quick onset med
38
What are the quick onset med? Dose?
1. Captopril: 25-50 mg, onset 15-30 min 2. Clonidince: 0.2 mg, for HTN rebound with withdrawn 3. Labetalol: 200-400 mg 4. Hydralazine: 10 mg
39
Why do we need to correct BP slowly?
1. Cerebral ischemia 2. Neurological decline 3. End organ adjustment to chronic HTN
40
How should you monitor and follow up with hypertensive emergency?
1. ER → ICU 2. Follow treatment goals and timelines 3. Monitor improvements in end organ damage and side effects of medications 4. IV → PO transition
41
What are we looking for in HTN emergency monitoring?
1. Target organ damage 2. GIT is functional 3. BP is near recommended goal for 2 consecutive readings
42
How should you monitor and follow up with hypertensive urgency?

Therapeutics I (32 decks)

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