Hypertension Flashcards Preview

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Flashcards in Hypertension Deck (292):
1

Diuril

Chlorthiazide

2

Thalitone

Chlorthalidone

3

Microzide (capsule), Oretic, Esidrix

Hydrochlorothiazide

4

Lozol

Indapamide

5

Zaroxolyn

Metolazone

6

Bumex

Bumetanide

7

Demadex

Torsemide

8

Edecrin

Etharcrynic Acid

9

Midamor

Amiloride (potassium sparing diuretic)

10

Dyrenium

Triamterene

11

Maxzide, Dyazide

Triamterine + HCTZ

12

Aldactone

Spironolactone

13

Inspra

Eplerenone

14

Avapro

Irbesartan

15

Benicar

Olmesartan

16

Micardis

Telmisartan

17

Tevetan

Eprosartan (ARB)

18

Edarbi

Azilsartan

19

Univasc

Moexipril

20

Aceon

Perindopril

21

Mavic

Trandalopril

22

Sectral

Acebutolol

23

Tenormin

Atenolol

24

Zebeta

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