Hypertension Flashcards
(292 cards)
1
Q
Diuril
A
Chlorthiazide
2
Q
Thalitone
A
Chlorthalidone
3
Q
Microzide (capsule), Oretic, Esidrix
A
Hydrochlorothiazide
4
Q
Lozol
A
Indapamide
5
Q
Zaroxolyn
A
Metolazone
6
Q
Bumex
A
Bumetanide
7
Q
Demadex
A
Torsemide
8
Q
Edecrin
A
Etharcrynic Acid
9
Q
Midamor
A
Amiloride (potassium sparing diuretic)
10
Q
Dyrenium
A
Triamterene
11
Q
Maxzide, Dyazide
A
Triamterine + HCTZ
12
Q
Aldactone
A
Spironolactone
13
Q
Inspra
A
Eplerenone
14
Q
Avapro
A
Irbesartan
15
Q
Benicar
A
Olmesartan
16
Q
Micardis
A
Telmisartan
17
Q
Tevetan
A
Eprosartan (ARB)
18
Q
Edarbi
A
Azilsartan
19
Q
Univasc
A
Moexipril
20
Q
Aceon
A
Perindopril
21
Q
Mavic
A
Trandalopril
22
Q
Sectral
A
Acebutolol
23
Q
Tenormin
A
Atenolol
24
Q
Zebeta
A
Bisoprolol
25
Bystolic
Nebivolol
26
Cartrol
Carteolol
27
Corgard
Nadolol
28
Visken
Pindolol
29
Blocadren
Timolol
30
Trandate, Normodyne
Labetolol
31
Sular
Nisoldipine
32
DynaCirc CR
Isradipine CR
33
Cardene SR
Nicardipine ER
34
Cleviprex
Clevidipine
35
Duraclon Inj
Clonidine
36
Wytensin
Guanabenz (Centrally acting alpha agonist)
37
Tenex
Guafancine
38
Aldomet
Methyldopa
39
Minipress
Prazosin (Alpha blocker)
40
Hytrin
Terazosin
41
Cardura
Doxazosin
42
Lotrel
Amlodipine + Benazapril
43
Lexxel
Enalapril + Felodipine
44
Tarka
Trandalopril + Verapamil
45
Twynsta
Amlodipine + Telmisartan
46
Exforge
Amlodipine + Valsartan
47
Azor
Amlodipine + Olmesartan
48
Tekamlo
Aliskiren + Amlodipine
49
Tekturna HCT
Aliskiren + HCTZ
50
Amturnide
Aliskiren + Amlodipine + HCTZ
51
Valtruna
Aliskiren + Valsartan
52
Lotensin HCT
Benazepril + HCTZ
53
Capozide
Captopril + HCTZ
54
Vaseretic
Enalopril +HCTZ
55
Prinzide, Zestoretic
Lisinopril + HCTZ
56
Uniretic
Moexpril + HCTZ
57
Accuretic
Quinapril + HCTZ
58
Monopril HCT
Fosinopril + HCTZ
59
Atacand HCT
Candesartan + HCTZ
60
Tevetan HCT
Eprosartan + HCTZ
61
Avalide
Irbesartan + HCTZ
62
Hyzaar
Losartan + HCTZ
63
Micardis HCT
Telmisartan + HCTZ
64
Diovan HCT
Valsartan + HCTZ
65
Benicar HCT
Olmesartan + HCTZ
66
Tenoretic
Atenolol + Chlorthalidone
67
Ziac
Bisoprolol + HCTZ
68
Inderide
Propranolol + HCTZ
69
Lopressor HCT
Metoprolol + HCTZ
70
Corzide
Nadolol + Bendroflumethiazide
71
Timolide
Timolol + HCTZ
72
Aldoril
Methyldopa + HCTZ
73
Diupres
Reserpine + Chlorthiazide
74
Hydropres
resperine + HCTZ
75
Aplresazide
Hydralazine + HCTZ
76
Exforge HCT
Amlodipine, Valsartan and HCTZ
77
Tribenzor
Amlodipine, olmesartan and HCTZ
78
what are sysmptoms of very high blood pressure?
head ahce ,throbbing, fatcige and SOB
79
What are the 5 classes of standard antihypertensive drugs?
1. diuretics, 2. \_-adrenoceptor antagonists (\_-blockers) 3. Ca-channel blockers 4. inhibitors of angiotensin (ACE-inhibitors/AT1-blockers) 5. \_-adrenergic blockers
80
what are the centrally acting antihypertensive drugs?
1. clonidine, 2. methyldopa 3. reserpine
81
what are the vasodilators?
1. nitrates, 2. nitroprusside 3. dihydralazine
82
what is a normal SBP?
\<120 mmHg
83
what is a prehypertension SBP?
120-139 mmHg
84
what is a stage 1 hypertension SBP?
140-159 mmHg
85
what is a stage 2 hypertension SBP?
\>160 mmHg
86
what is a normal DBP?
\<80mmHg
87
what is a prehypertension DBP?
80-89
88
what is a stage 1 hypertension DBP?
90-99
89
what is a stage 2 hypertension DBP?
\>100
90
what drugs are indicated for prehypertension without compelling indication?
no antihypertensive drug indicated
91
what is the initial drug therapy for stage 1 hypertension without compelling indication?
Thiazide diuretics for most.May consider ACEI, ARB, BB, CCB, or combination.
92
what is the initial drug therapy for stage 2 hypertension without compelling indication?
2 drug combination for most: usually thiazide diuretic and ACEI or ARB or BB or CCB
93
what is the initial drug therapy for prehypertensive and stage 1 hypertensive patients with compelling indications?
drugs for the compelling indications
94
What is the initial drug therapy for stage 2 hypertensive patients with compelling indications?
1. drugs for the compelling indications 2. other antihypertensive drugs (diuretics, ACEI, BB, CCB) as needed.
95
What is the relative risk of stroke in hypertensive vs. normotensive patients?
7-fold
96
what is the relative risk of CAD in hyptertensive vs. normotensive patients?
2-3 fold
97
what is the relative risk of heart failure in hypertensive vs. normotensive patients?
2-3 fold
98
what is the relative risk of peripheral vascular disease in hypertensive vs. normotensive patients?
2-3 fold
99
what kind of compound is clonidine?
\_2-sympathomimetic drug, 2nd choice in treatment of hypertension, with interesting off label uses
100
what are the relevant pharmacokinetics of clonidine? How excreted, half life
p.o.; i.v.; transdermal patch:t1/2 = 8-12h mainly renal excretion
101
what are the relevant pharmacodynamics of clonidine?
1. centrally mediated hypotensive effects: a. reduction of cardiac output b. relaxation of capacitance vessels c. reduction of peripheral resistance 2. renal blood flow maintained 3. initial hypertensive episode may occur 4. various CNS effects 5. pronounced rebound effect after
102
what are the adverse effects of clonidine?
high doses/predisposition:1. symptomatic bradycardia 2. AV-block 3. functional cardiac failure 4. dry mouth 5. drowsiness 6. sedation 7. constipation 8. mental depression
103
What is the primary use of clonidine?
second line treatment of hypertension
104
what are the other (empirical) clinical uses of clonidine?
1. symptomatic treatment of withdrawal syndromes (heroin, alcohol, benzodiazepenes) 2. prevention / treatment of alcoholic delirium 3. postmenopausal syndrome 4. refractory diarrhea (short bowel syndrome) 5. adjunct in analgo-sedation (dexmedetomidine)
105
What type of compound is methyldopa?
centrally acting antihypertensive drug
106
is methyldopa safe for use in pregnancy?
yes
107
what are the relevant pharmacokinetics of methyldopa?
p.o.:t1/2= 4-6h, up to 24h including active metabolites
108
what are the adverse effects of methyldopa?
centrally mediated hypotensive effects quite comparable, but not identical to clonidine
109
what are the important prototypical \_1-blockers and their half lives?
1. prazosin (3-4h) 2. terazosin (12h) 3. doxazosin (22h)
110
what are the relevant pharmacokinetics of the \_1-blockers?
po or iv
111
what are the relevant pharmacodynamics of \_1-blockers?
1. blockade of \_1-receptors in arterioles/venules 2. NO effect on pre-synaptic \_2-receptors 3. NO effect on inhibitory feedback for NE release
112
what are the adverse effects of \_1-blockers?
1. first dose phenomenon 2. orthostatic hypotension 3. dizziness 4. palpitations 5. headache 6. tests for ANA may turn positive 7. reflex tachycardia
113
what are the first choice diuretics in the treatment of hypertension?
thiazides like HCTZ
114
what are the second choice diuretics in the treatment of hypertension?
K+ sparing diuretics:amiloride, triamterene spironolactone
115
what is the choice diuretic for treatment of hypertension in patients with GFR \< 30ml/min or refractory hypertension?
1. loop diuretic like furosemide2. thiazide type metolazone
116
what are the rules for routine use of thiazides?
1. low dose thiazide, may already work at sub-diuretic doses within 2-4 weeks; to be taken in the morning2. if hypokalemia is a problem, combine with K+ sparing diuretic but watch for hyperkalemia with this combination 3. keeping the patient "on dry weight" may be a good thing, BUT, dehydration may cause mental confusion, may aggravate COPD, or peripheral arterial occlusive disease 4. important adverse effects: hypokalemia, impaired glucose tolerance, hyperlipidemia
117
what are the relevant pharmacokinetics of metolazone?
1. oral bioavailability 65% 2. t1/2 = 8-10h 3. duration of action 12-24 h
118
what are the pharmacodynamic of metolazone similar to?
thiazide diuretics like HCTZ
119
what is the difference in the pharmacodynamics of metolazone vs. HCTZ?
also effective at GFR \<30ml/min
120
what are the uses of metolazone?
1. hypertension (low dose 1.25 - 2.5 - 5mg) also used in combination treatment 2. edema (10-20 mg) 3. can replace other thiazides in combination treatment of furosemide resistance
121
what are the \_-adrenoceptor antagonists and their respective selectivities?
1. propanolol (\_1 + \_2, non selective) 2. atenolol (\_1 \> \_2) 3. metoprolol (\_1 \> \_2) 4. pindolol (partial agonist, ISA) 5. labetalol (4 isomers, \_-blocker & _ blocker, \_2-agonist) 6. carvedilol (2 isomers, \_-blocker, \_-blocker) 7. esmolol (\_1 \> \_2, short acting, emergency med)
122
what is the specificity of propanolol?
\_1 and \_2, non-selective
123
what is the specificity of atenolol?
\_1 \> \_2
124
what is the specificity of metoprolol?
\_1 \> \_2
125
what is the specificity of pindolol?
partial agonist, ISA
126
what is ISA?
intrinsic sympathomimetic activity
127
what is the specificity of labetalol?
4 isomers, \_&\_-blocker, \_2-agonist
128
what is the specificity of carvedilol?
2 isomers, \_-blocker, \_-blocker
129
what is the specificity of esmolol?
\_1 \> \_2, short acting, emergency med
130
when does one NEVER prescribe \_blockers and why?
never use beta-blockers in asthma or COPD because \_1-selectivity is relative
131
when are unselective \_blockers contraindicated?
1. pregnancy 2. Diabetes Mellitus
132
in what condition is the use of \_-blockers tricky?
CHF
133
what are some of the many conventional contraindications of \_-blockers?
1. asthma 2. COPD 3. PAD 4. SA or AV-node abnormalities
134
what effect do \_blockers have on LDL?
increase
135
what effect do \_blockers have on HDL?
decrease
136
what effect do _ blockers have on triglycerides?
strong increase
137
what effect do \_1blockers have on LDL?
decrease
138
what effect do \_1-blockers have on HDL?
strong increase
139
what effect do alpha 1 blockers have on triglycerides?
null
140
how do \_1 blockers affect insulin sensitivity?
they do not affect insulin sensitivity
141
what changes in cardiac output do \_1blockers produce?
minimal changes in cardiac output
142
do \_1 blockers cause cold extremity syndrome?
they do not
143
do \_-blockers cause orthostatic hypotension?
they do not
144
what are the prototypical calcium channel blockers?
1. verapamil 2. diltiazem 3. nifepidine (and dihydropyridines)
145
what are the relevant pharmacokinetics of calcium channel blockers?
p.o.; i.v.: highly bound by serum proteins, hepatic metabolism, renal excretion
146
how are calcium channel blockers eliminated?
1. metabolized in liver 2. excreted by kidney
147
what are the relevant pharmacodynamics of calcium channel blockers?
1. block L-type calcium channels --\>cardiodepressant effects 2. arteriolar vasodilation
148
what are the adverse effects of dihydropyridines?
due to excessive vasodilation: 1. dizziness 2. headache 3. flushing 4. digital dysaesthesia 5. nausea 6. peripheral edema 7. constipation 8. reflex tachycardia
149
what are the adverse effects of verapamil and diltiazem?
1. bradycardia 2. slow SA and AV conduction 3. increase digoxin levels in the blood
150
how do short acting calcium channel blockers affect risk of myocardial infarction?
the use of short acting Ca channel blockers nifedipine, diltiazem, and verapamil was associated with an increased risk of myocardial infarction
151
what is the onset and duration of verapamil, nifedipine, and diltiazem?
fast onset short acting
152
what are the 1st generation Ca channel blockers?
verapamil SR nifedipine GITS
153
what are the second generation calcium channel blockers?
1. amlodipine 2. felodipine 3. nisoldipine 4. isradipine
154
what are the second generation ca channel blockers which are long acting?
1. amlodipine 2. felodipine 3. nisoldipine
155
what are the slow onset second generation ca channel blockers?
1. amlodipine 2. felodipine
156
What are the 2 types of inhibitors of angiotensin?
1. ACE- inhibitors 2. AT1- Blockers
157
What are the prototypical ACE Inhibitors?
1. captopril 2. enalapril 3. enalaprilat 4. lisinopril 5. benazepril 6. fosinopril 7. moexipril 8. quinapril 9. ramipril
158
what are the ACE inhibitors used for?
all used to treat hypertension some also labelled for use in CHF
159
what are the prototypical AT1-blockers?
1. losartan2. valsartan
160
what is losartan used for?
labelled for hypertension and CHF
161
what is valsartan used for?
hypertension
162
what are the relevant pharmacokinetics of captopril?
po: renal elimination
163
what are the relevant pharmacodynamics of captopril?
Angiotensin II antagonism: - decrease vasoconstriction - decrease norepinephrine release - decrease aldosterone secretion - Vasodilation Bradykinin related: - no reflex tachycardia - no significant change in cardiac output - no water and sodium retention - some reduction of sympathetic tone
164
how is captopril eliminated?
renal elimination
165
what are the effects of captopril on the vasculature?
vasodilation, decrease vasoconstriction
166
what are the effects of captopril on the sympathetic nervous system?
decrease NE releasesome reduction of sympathetic tone
167
what is the effect of captopril on aldosterone secretion?
decrease aldosterone secretion
168
is reflex tachycardia associated with captopril?
no
169
is a significant change in cardiac output associated with captopril?
no
170
is sodium/water retention associated with captopril?
no
171
what are the adverse effects of captopril?
1. hypotension2. dry cough, bronchospasm 3. skin rashes, angioneurotic edema 4. neutropenia, leukopenia 5. taste perversion 6. hyperkalemia 7. proteinuria
172
what conditions are contraindications of captopril?
1. renal artery stenosis 2. renal failure 3. history of angioedema (asthma, COPD) 4. pregnancy (oligohydramnion)
173
what are the signs of captopril toxicity?
hypotension without marked tachycardia
174
what are the unwanted interactions associated with captopril?
1. NSAIDs reduce antihypertensive response by inhibition of the bradykinin pathway2. K+ sparing diuretics aggravate hyperkalemia 3. hypersensitivity reactions to other drugs may be aggravated 4. increased plasma levels of digoxin, lithium
175
what are the wanted interactions associated with captopril?
K+ wasting diuretics yield over-additive antihypertensive effect
176
elalapril is the prodrug of what?
enalaprilat
177
how is enalapril converted into enalaprilat?
intrahepatic conversion
178
what are the relevant pharmacokinetics of enalapril?
po:tmax=3-4h t1/2=11h renal elimination start with 2-5mg/d up to a maximum 40 mg/d
179
what are the relevant pharmacokinetics of enalaprilat?
iv: use in hypertensive emergencies
180
what is the tmax of enalapril?
3-4 h
181
what is the t1/2 of enalapril?
11h
182
how is enalapril eliminated?
renal elimination
183
how is enalapril dosed?
start with 2.5-5 mg and increase up to 40mg/d
184
when is enalaprilat used?
iv in hypertensive emergencies
185
how do the pharmacodynamics and adverse effects of enalapril compare to captopril?
enalapril is: more potent slower onset/longer duration of action compound contains no sulfhydryl group (no taste perversion)
186
what proportion of ACE inhibitors are prodrugs?
most are prodrugs
187
what makes fosinopril and moexipril different than all other ACE inhibitors?
fosinopril and moexipril are eliminated by the liver and all others are eliminated by the kidneys
188
do ACE inhibitors have variable influence on tissue specific AG subsystems?
this remains to be verified
189
what are the indications for ACE inhibitors?
1. hypertension 2. CHF 3. Myocardial Infarction 4. Progressive renal disease (DM nephropathy)
190
what type of drug is losartan?
Angiotensin II receptor subtype 1 blocker (AT1 blocker)
191
what are the relevant pharmacokinetics of losartan?
po: bioavailability=33% t1/2= 2h active metabolite t1/2= 6-9h hepatic elimination usual dose 50-100 mg/d
192
what are the relevant pharmacodynamics of losartan?
Like ACE inhibitors: - decrease vasoconstriction - decrease NE release decrease aldosterone secretion Unlike ACE inhibitors: no effect on bradykinin
193
what are the adverse effects of losartan?
Like ACE inhibitors except for bradykinin related AE: no cough - no angioedema
194
what conditions are contraindicated in the use of losartan?
1. renal artery stenosis2. renal failure 3. pregnancy
195
What is the first step in the guidelines for treatment for hypertension?
1. Single drug therapy- THIAZIDE or \_BLOCKER... or Ca channel blocker or ACEI or Alpha Blocker
196
what is the second step in the guidelines for the treatment for hypertension?
2. Combination Therapy- a. combine a thiazide with a \_blocker/CaChannel blocker/ACEI (or \_1 blocker) b. combine Ca channel blocker with a \_blocker/ACEI
197
what is the third step in the guidelines for treatment of hypertension?
3. Triple therapy between drugs listed above (thiazide/\_b/CaCB/ACEI/\_B)or add furosemide or add clonidine
198
Which antihypertensives are contraindicated in COPD, Asthma?
\_ Blockers ACE inhibitors
199
which antihypertensives are contraindicated in Bradycardia?
clonidine _ blockers Verapamil/Diltiazem
200
which antihypertensives are contraindicated in Diabetes Mellitus?
ThiazidesUNSELECTIVE _ Blockers
201
which antihypertensives are contraindicated in Gout?
thiazides
202
which antihypertensives are contraindicated in CAD?
hydralazinePrazosin Minoxidil
203
which antihypertensives are contraindicated in peripheral artery occlusive disease?
\_ blockers
204
which antihypertensives are contraindicated in CHF?
Ca++ antagonists HIGH DOSE \_Blockers
205
which antihypertensives are contraindicated in Renal Failure?
Amiloride Triamterene Spirololactone ACE Inhibitors
206
why are _ Blockers contraindicated in COPD/Asthma?
Induction of bronchospasm
207
why are ACE Inhibitors contraindicated in COPD/Asthma?
induction of cough, Use AT1 blocker
208
why are clonidine, \_Blockers, Verapamil/Diltiazem contraindicated in Bradycardia?
aggravation, risk of Adams-Stokes syndrome
209
why are thiazides contraindicated in DM?
reduce glucose tolerance
210
why are unselective _ Blockers contraindicated in DM?
blunt symptoms of hypoglycemia
211
why are thiazides contraindicated in Gout?
reduced excretion of uric acid
212
why are hydralazine, prazosin, and minoxidil contraindicated in CAD?
provocation of angina pectoris (reflectory tachycardia)
213
why are _ Blockers contraindicated in peripheral artery occlusive disease?
aggravation/manifestation
214
why are Ca++ antagonists and high dose _ Blockers contraindicated in CHF?
negative inotropic
215
why are amiloride, triamterene and spironolactone contraindicated in renal failure?
may cause hyperkalemia
216
why are ACE inhibitors contraindicated in Renal failure?
plasma concentration increases--\> side effect
217
what are the positive criteria for the selection of Diuretics for Tx of hypertension?
old age black race CHF chronic renal failure (loop diuretics)
218
what are the positive criteria for the selection of _ blockers in the Tx of hypertension?
youth white race post-MI migraine senile tremor atrial fibrillation PSVT
219
what are the positive criteria for selection of long acting Ca channel blockers in the Tx of hypertension?
old age black race migraine
220
what are the positive selection criteria for the selection of ACE inhibitors in the Tx og hypertension?
youth white Diabetes Mellitus Type I w/ nephropathy impotence from other drugs NOT IN PREGNANCY
221
what are the positive criteria for selection of AT1-blockers in the Tx of hypertension?
conditions for which ACEI are indicated, but can't be used due to hypersensitivity or cough
222
what are the positive criteria for selection of _ blockers in the Tx of hypertension?
prostatism DM dyslipidemia
223
What are the favorable combinations of antihypertensives?
1. Thiazide + ACEI 2. Dihydropyridine + _ Blocker 3. K wasting diuretic + K sparing diuretic
224
why is Thiazide + ACEI a favorable combination?
more effective and reduction of adverse effects
225
why is dihydropyridine + \_blocker a favorable combination?
more effective
226
why is a K wasting + a K sparing diuretic a favorable combination?
reduction of adverse effects
227
what factors contribute to cardiac output?
HR
228
what does the PSNS do to HR?
decreases it
229
what does the SNS do to HR?
increases it
230
what do catecholamines do to HR?
increases HR
231
what factors contribute to blood pressure?
Cardiac output and systemic vascular resistance
232
what factors contribute to SVR?
direct innervation circulating regulators local regulators
233
what is the effect of \_1Adrenergic receptors on SVR?
increases it by direct innervation
234
how do catecholamines affect systemic vascular resistance?
increase it
235
how does ATII affect SVR?
increases it
236
what is the effect of NO on SVR?
decreases it
237
what is the effect of prostacyclin on SVR?
decreases it
238
what is the effect of endothelin on SVR?
increases it
239
how does ATII affect SVR as a local regulator?
increases it
240
what is the effect of O2 on SVR?
increases it
241
what is the effect of H+ on SVR?
decreases it
242
what is the effect of adenosine on SVR?
decreases it
243
which drugs affect BP by affecting CO by affecting HR?
\_B CCB
244
which drugs affect BP by affecting CO by affecting SV by affecting contractility?
\_B CCB
245
which drugs affect BP by affecting CO by affecting SV by affecting Preload by affecting venous tone?
\_1B sodium nitroprusside ACE inhibitors AT1 Antagonist
246
which drugs affect BP by affecting CO by affecting SV by affecting Preload by affecting Intravascular volume by affecting Na+/H2O retention?
Diuretics ACE inhibitors AT1 Antagonists
247
which drugs affect BP by directly affecting SVR?
CCB Direct Arterial Vasodilators
248
which drugs affect BP by affecting SVR by affecting direct innervation?
\_1B Central \_2 agonists
249
which drugs affect BP by affecting SVR by affecting circulating regulators?
\_1 B central \_2 agonists ACE inhibitors AT1 antagonists
250
which drugs affect BP by affecting SVR by affecting local regulators?
endothelin antagonistssodium nitroprusside ACE inhibitors AT1 antagonists
251
what is a hypertensive emergency?
clinical situation that requires immediate BP- reduction to prevent or limit target organ damage
252
what is hypertensive urgency?
any situations in which BP should be lowered within a few hours
253
what is the general strategy for treating hypertensive emergency?
intensive care monitoring pareneral drugs
254
what is the general strategy for treating hypertensive urgency?
oral therapy
255
what is the goal for BP reduction in crisis?
generally no immediate reduction of BP to 'normal' levels
256
the endothelium modulates vascular resistance through what?
endocrine or paracrine release of vasoactive molecules such as NO and PGI2
257
in a hypertensive emergency, endothelial control of vascular tone may be overwhelmed, leading to what?
1. end-organ hyperperfusion 2. arteriolar fibrinoid necrosis 3. increased endothelial permeability with perivascular edema
258
loss of endothelial fibrinolytic activity coupled with activation of coagulation and platelets promotes what?
DIC
259
what are the causes of hypertensive emergencies?
1. essential hypertension2. renal parenchymal disease 3. renovascular disease 4. pregnancy 5. endocrine 6. drugs 7. drug withdrawal 8. central nervous disorders 9. autonomic hyperreactivity
260
what is the term for hypertensive emergency associated with pregnancy?
eclampsia
261
what endocrine disorders can cause hypertensive emergency?
pheochromocytomacushings renin-producing tumors
262
which drugs can cause hypertensive emergencies?
cocainecrack sympathomimetics amphetamines CsA MAO-I+Tyramine
263
withdrawal of which drugs can cause hypertensive emergency?
clonidine nifedipine
264
which central nervous disorders can cause hypertensive emergencies?
injury stroke tumor
265
what are the important History items to cover in hypertensive crisis?
1. severity/duration of pre-existing hypertension, details of therapy
266
what are the important Symptoms to cover in hypertensive crisis?
1. CP (MI, aortic dissection) 2. back pain (aortic dissection) 3. dyspnea (CHF, pulmonary edema) 4. neurology, seizures, altered consciousness (hypertensive encephalopathy)
267
what are the 5 key parts of an initial assessment of hypertensive crisis?
1. BP2. Fundoscopic exam 3. CV 4. Neuro 5. Lab
268
what should be considered about BP taken in hypertensive emergency?
take supine and standing take on both arms
269
what should be considered in fundoscopic exam during hypertensive emergency?
new hemorrhages exudates papilledema
270
what should be considered in CV assessment during hypertensive emergency?
evidence of CHF
271
what should be considered in a neuro exam during hypertensive crisis?
consciousness vision visual fields meningeal irritation focal signs
272
what labs should be checked during assessment of hypertensiv crisis?
urea electrolytes creatinine CBC (hemolysis, schistiocytes) ECG CXR UA plasma renin/aldo
273
what are the consensus recommendations for Tx of hypertensive crisis?
1. admit ICU, IV drugs 2. arterial BP measure line 3. therapy: a. lower BP =100-110 mmHg c. further reduction of BP within days
274
which hypertensive crisis drug is toxic in pts with renal impairment?
sodium nitroprusside
275
what is the onset of sodium nitroprusside?
immediate
276
what is the onset of labetalol?
5-10 min
277
what is the onset of hydralazine?
10 min
278
what is the onset of fenoldopam?
5-10 min
279
what is the onset of enalaprilat?
15 min
280
what is the onset of nicardipine?
5-10 min
281
what is the onset of phentolamine?
1-2 min
282
what is the duration of sodium nitroprusside?
1-2 min
283
what is the duration of labetalol?
2-6 h
284
what is the duration of hydralazine?
2-6 h
285
what is the duration of nicardipine?
2-4h
286
what is the duration of phentolamine?
3-5 min
287
what are the adverse effects of sodium nitroprusside?
hypotension nausea vomiting cyanate toxicity
288
what are the adverse effects of labetalol?
nausea vomiting heart block bronchospasm
289
what are the adverse effects of hydralazine?
reflex tachycardia
290
what are the adverse effects of enalaprilat?
hypotension renal failure
291
what are the adverse effects of nicardipine?
reflex tachycardia flushing
292
what are the adverse effects of phentolamine?
reflex tachycardia
