HTN crisis

Question 1

urgency characteristics

Answer 1

BP > 180/120
NO acute target organ damage
not life threatening

Question 1

emergency characteristics

Answer 1

BP > 180/120
acute target organ damage
life threatening

Question 2

goal of urgency

Answer 2

decrease BP over days
reinstitute/intensification of antihypertensive drug therapy

Question 3

what is a patient specific condition that can affect urgency?

Answer 3

anxiety
treat if applicable

Question 4

goal of emergency

Answer 4

decrease BP now

Question 5

in hour 1, what is the goal BP?

Answer 5

reduce by max of 25%

Question 6

in hours 2-6, what is the goal BP?

Answer 6

reduce to under 160/ 100-110

Question 7

in hours 6-48, what is the goal BP?

Answer 7

reduce to previous goal

Question 8

what are patient specific conditions that affect emergencies?

Answer 8

stroke
aortic dissection
severe eclampsia/preeclampsia
pheochromoctyoma crisis

Question 9

what type of medications are used in urgencies?

Answer 9

oral

Question 10

what drug classes are sued in urgencies?

Answer 10

ACEi
ARBs
B-blockers
CCB

Question 11

what ACEis are used to treat urgencies?

Answer 11

Lisinopril
Benazepril
Enalapril
Captopril

Question 12

what ARBs are used to treat urgencies?

Answer 12

losartan (onset of either 1 week or 6 hours)
Irbesartan
Valsartan
Telmisartan

Question 13

what beta blockers are used in urgencies?

Answer 13

metoprolol tartrate
nebivolol
carvedilol
labetalol

Question 14

what CCBs are used in urgencies?

Answer 14

diltiazem
verapamil
amlodipine (onset of either 24 hrs or 24-48 hrs)
nifedipine

Question 15

what type of drugs are used in emergencies?

Answer 15

IV

Question 16

what drug classes are used in emergencies

Answer 16

DHP CCBs
Vasodilators
B-blockers
ACEi
Alpha 2 agonists

Question 17

what DHP CCBs are used in emergencies?

Answer 17

nicardipine
clevidipine

Question 18

what vasodilators are used in emergencies?

Answer 18

Nitroglycerin
sodium nitroprusside
Hydralazine

Question 19

what beta blockers are used in emergencies?

Answer 19

labetalol
esmolol

Question 20

what ACEi are used in emergenices?

Answer 20

enalaprilat

Question 21

what alpha-2 agonists are used in emergencies?

Answer 21

clonidine

Question 22

what is phentolamine?

Answer 22

alpha 1 blocker

Question 23

what is fenoldopam?

Answer 23

dopamine agonist

Question 24

what drugs should be used in acute aortic dissection?

Answer 24

initiate BB then vasodilator to lower BP quickly and prevent reflex tachycardia

Question 25

what drugs should be used in acute HF with pulmonary edema?

Answer 25

nitroprusside, nitroglycerin in combo with diuretics alternative - nicardipine and clevidipine

Question 26

what drugs should be avoided in acute HF?

Answer 26

Bblockers non-DHP CCBs

Question 27

what drugs should be used in intracerebral hemorrhage or acute ischemic stroke?

Answer 27

labetalol nicardipine clevidipine

Question 28

what drugs should be used in acute coronary syndrome?

Answer 28

esmolol, labetalol, nitroglycerin, nicardipine, or sodium nitroprusside

Question 29

what drugs should be avoided in acute coronary syndrome?

Answer 29

caution with non-DHP CCBs avoid BB in the setting of reduced EF, HR under 60 bpm, SBP under 100 mmHg, 2nd or 2rd degree heart block, or reactive airway disease

Question 30

what drugs should be used in AKI?

Answer 30

IV anithypertensive acceptable

Question 31

what drugs should be avoided in AKI?

Answer 31

caution with sodium nitroprusside avoid ACEi/ARBs

Question 32

what drugs should be used in eclampsia/preeclampsia?

Answer 32

labetalol, nicardipine, hydralazine

Question 33

what drugs are CI in eclampsia/preeclampsia?

Answer 33

any ACEi/ARB nitroprusside

Question 34

what drugs should be used in a hypertensive encephalopathy?

Answer 34

most IV acceptable

Question 35

what drugs are used in a pheochromocytoma crisis?

Answer 35

B-blockers plus or minus nicardipine or clevidipine historically phentolamine