HTN Crisis - Resident

Question 1

Define HTN Urgency

Answer 1

BP > 180/120

Question 2

Define HTN Emergency

Answer 2

BP > 180/120
&
Evidence of target organ dysfunction

Question 3

what organs are normally affected by HTN crisis and the symptom that goes with it

Answer 3

LUNGS - SOB
BRAIN - altered mental status
HEART - ECG changes
Kidneys - ACUTESCr changes

Question 4

what kinds of SCr changes make it known that there has been some end organ damage to the kidney in HTN crisis

Answer 4

ACUTE CHANGES
if SCr normally < 3 - any 0.5 increase in SCr = acute kidney damage

if SCr normally > 3 - any 1 increase in SCr = acute kidney damage

Question 5

what is main symptom of HTN urgency

Answer 5

HA

Question 6

what are the main symptoms of HTN emergency

Answer 6

• N/V
• Chest pain
• SOB
• HA
• Back pain
• Blurry vision

Question 7

what are some cause of HTN emergencies

Answer 7

• essential HTN
• Renal disease
• Pregnancy
• Drugs
• CNS disorders
• Endocrine disorders

Question 8

Goals of therapy for HTN Urgency:

Answer 8

get BP to < 160/110

*DO NOT reduce MAP by no more than 25% within 1st 24 hrs using oral therapy

Question 9

Goals of therapy for HTN emergency:

Answer 9

MAP reduction of ~10% during 1st hour then more 15% within next 2 - 3 hours using PARENTERAL THERAPY

Question 10

HTN Urgency - use oral or parenteral?

Answer 10

ORAL

Question 11

HTN emergency - use oral or parenteral?

Answer 11

parenteral

Question 12

what agents can be used for HTN urgency

Answer 12

• Captopril
• Nicardipine
• Labetalol
• Clonidine

Question 13

Onset of action for Captopril

Answer 13

15 - 20 minutes

Question 14

Route of admin for captopril?

Answer 14

ORAL! 9can be sublingual

Question 15

Dosing for Captopril (HTN URGENCY)

Answer 15

initial 25 mg;

Repeat in 90 - 120 minutes PRN

Question 16

Onset of action of Nicardipine

Answer 16

0.5 - 2 hours

Question 17

Dosing for Nicardipine (HTN URGENCY)

Answer 17

30 mg (initial)
Q8h prn

Question 18

Onset of action for Labetalol

Answer 18

1 - 2 hrs

Question 19

Dosing for Labetalol (HTN URGENCY)

Answer 19

initial 200 mg

Repeat in 3 - 4 hrs prn

Question 20

Onset of action of Clonidine

Answer 20

15 - 30 minutes

Question 21

Dosing of Clonidine (HTN URGENCY)

Answer 21

0. 1 - 0.2 mg

* repeat 0.1 mg QH until goal BP - max of 0.7 mg/day

Question 22

what to do if HTN emergency and pt is having a stroke….

Answer 22

do not lower BP right away - dont want decrease brain perfusion

Question 23

what types of agents are used for HTN emergency

Answer 23

• Sodium Nitroprusside
• Nicardipine
• Esmolol
• labetalol
• nitroglycerin

Question 24

ADEs of Sodium nitroprusside

Answer 24

N/V

thiocyanate toxicity

Question 25

dosing for sodium nitroprusside (HTN EMERGENCY)

Answer 25

0.3 - 0.5 mcg/kg/min

MAX 2 mcg/kg/min

Question 26

dosing for nicardipine (HTN EMERGENCY)

Answer 26

5 - 15 mg/hr IV infusion

Question 27

onset of action for sodium nitroprusside (HTN EMERGENCY)

Answer 27

immediate

Question 28

onset of action for nicardipine (HTN EMERGENCY)

Answer 28

1 - 5 minutes

Question 29

dosing for Esmolol (HTN EMERGENCY)

Answer 29

500 microg/kg IV bolus
OR
50 - 100 microg/kg/min IV infusion

Question 30

dosing for Labetalol (HTN EMERGENCY)

Answer 30

20 - 80 mg IV bolus Q 10 mins
or
0.5 - 2.0 mg/min IV infusion

Question 31

Which drug is as effective as nitroprusside w/out cyanide risk; easier administration

Answer 31

Nicardipine

Question 32

which drug is best for coronary artery disease and anxiety

Answer 32

Esmolol

Question 33

which drug is best for brain syndromes and pregnancy

Answer 33

Labetalol

Question 34

which drug is good for CHF and angina; not great for HTN emergency

Answer 34

Nitroglycerin