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PHRM 844 > Hypertensive crisis > Flashcards

Hypertensive crisis Flashcards

1
Q

Hypertensive Urgency

SBP > ___ and/or DBP > ___
- no evidence of target organ damage

A

180
120

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2
Q

Hypertensice Emergency

SBP > ___ and/or DBP> ___
- evidence of target organ damage

A

180
120

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3
Q

what does target organ damage look like?

A
  • headache
  • chest pain
  • shortness of breath
  • back pain
  • numbness/weakness
  • change in vision
  • difficulty speaking
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4
Q

Risk factors for development of a HTN crisis

  • obesity
  • ___ gender
  • history of CV disease
  • higher number of prescibed antihypertensive medications
  • ___ with antihypertensive medications
A

female
non-adherence

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5
Q

Causes of Hypertensive crisis

  • ___ HTN
  • non-adherence
  • medication/substance related
  • pregnancy
  • ___ disease
  • ___ disorders
A
  • chronic
  • renal
  • endocrine
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6
Q

HTN Urgency - Goals of Therapy and Patient Workup

  • reinstitute/intensify antihypertensive drug therapy
  • treatment of ___ as applicable

There is NO indication for
- referral to ___
- immediate reduction in ___ (overcorrection may cause harm and offers no benefit)
- hospitalization

A
  • anxiety
  • ED
  • BP
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7
Q

HTN Emergency - Goals of Therapy and Patient Workup

  • Hour 1: reduce BP by max for ___ %
  • Hours 2-6: reduce BP < ___ / ___
  • Hours 6-48: reduce BP to ___

There is indication for
- referral to ___
- ___ admission
- ___ antihypertensives

Conditions with specific BP goals: stroke, aortic dissection, severe eclampsia/preeclampsia, pheochromocytoma crisis

A
  • 25%
  • 160/100-110
  • goal
  • ED
  • hospital
  • IV
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8
Q

Why should BP be lowered gradually?
- if you overcorrect and lower too much, it could result in passive ___ and risk tissue ___

A

collapse, ischemia

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9
Q

Pharmacotherapy

Hypertensive emergency should be treated with ___ medications

Prefer medications with predictable action
- fast onset/offset
- predicatable PK
- minimal AE

Patient-specific factors and type of target organ damage

A

IV

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10
Q

DHP Calcium Channel Blockers

Nicardipine - ___ IV infusion
- onset: ___ - ___ min
- duration: ___ - ___ min

Pros:
- titratable
- relative lower risk for AE

Cons:
- contraindicated in severe aortic ___
- titrate coutiously with renal/hepatic impairment
- reflex ___

A
  • titratable
  • 5-10
  • 15-30
  • stenosis
  • tachycardia
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11
Q

DHP Calcium Channel Blockers

Clevidipine - ___ IV infusion
- onset: ___ - ___ min
- duration: ___ - ___ min

Pros
- lack of accumulation in organ impairment
- titratable

Cons
- contraindicated in severe aortic ___
- lipid formula (contraindicated with ___ / ___ allergy)
- elevates ___
- change ___ lines every ___ hours
- induces ___

A
  • titratable
  • 2-4
  • 5-15
  • stenosis
  • soy/egg
  • triglycerides
  • IV, 12
  • AFib
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12
Q

Vasodilators

Nitroglycerin - ___ IV infusion
- onset: ___ - ___ min
- duration ___ - __ min

Pros
- beneficial in coronary ___
- titratable

Cons:
- ___ with prolonged use (Max 24-48 hrs)
- interaction with ___
- ___ limiting
- headache and reflex ___
- caution with high ___
- excessive ___ in hypovolemia

A
  • titratable
  • 2-5
  • 5-10
  • ischemia
  • tolerance
  • PDE-5i
  • dose
  • tachycardia
  • ICP
  • hypotension

ICP = intracranial pressure

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13
Q

Vasodilators

Sodium Nitroprusside - ___ IV infusion
- onset: ___
- duration: ___ - ___ min

Pros:
- titratable

Cons:
- ___ with prolonged use (Max 24-48 hrs)
- interaction with ___
- ___ limiting
- headache and reflex ___
- caution with high ___
- excessive ___ in hypovolemia
- ___ toxicity

A

titratable
- seconds
- 2-3 min
- tolerance
- PDE-5i
- dose
- tachycardia
- ICP
- hypotension
- cyanide

ICP = intracranial pressure

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14
Q

Vasodilators

Hydralazine - IV ___
- onset: ___ - ___ min
- Duration: ___ - ____ min

Pros:
- may be used on pts with ___

Cons:
- not ___
- less ___ PK
- rebound ___

A

push
- 10-20
- 60-240
- bradycardia
- titratable
- predicatable
- tachycardia

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15
Q

Beta blockers

Labetalol - IV ___ followed by ____ IV infusion
- onset: ___ - ___ min
- duration: ___ - ___ min

Pros:
- decreases ___ and ___
- can be given as ___ infusion

Cons:
- usually, an IV ___ is more appropriate
- decreases ___
- Contraindication with severe ____, ADHF, and reactive ___ disease

A

push, titratable
- 5-10
- 180-360
- HR, BP
- titratable
- infusion
- HR
- bradycardia, airway

ADHF = acute decompensated HF

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16
Q

Beta blockers

Esmolol - ___ IV infusion
- onset: ___ - ___ min
- duration: ___ - ___ min

Pros:
- decreases ___
- ___ selective (tolerated in reactive airway disease)

Cons:
- adjunct, not ___ fot BP reduction
- avoid in severe ___ and ADHF

A

titratable
- 1-2
- 10-20
- HF
- cardioselective
- monotherapy
- bradycardia

17
Q

Others

Enalaprilat - IV ___
- onset: < ___ min
- duration: ~ ___ hrs

Pros:
- may be beneficial in emergencies related to ___ excess

Cons
- delayed ___ and peak
- contraindicated in ___ , ___kalemia, acute ___ , bilateral ___ artery stenosis, and pregnancy

A

push
- 15
- 6
- renin
- onset
- AKI, hyperkalemia, MI, renal

18
Q

Others

Clonidine; taken ___
- onset: ___ - ___ min
- duration: hours; max effect at ___ - ___ hours

Pros:
- ___ option when IV access can not be established

Cons:
- often used inappropriately in hypertensive emergency
- ___ onset
- can cause hypertensive crisis ___

A

PO
- 30-60 min
- 2-4
- PO
- delayed
- withdrawal

19
Q
A

labetalol

20
Q
A

clevidipine

21
Q
A

hydralazine

22
Q

Factors that Affect Choice of Treatment

ADHF with pulmonary edema
- avoid ___ and ___
- ___ or ___ appropriate
- ___ and ___ are acceptable alternatives

A
  • BB, non-DHP CCBs
  • nitroglycerin, nitroprusside
  • nicardipine, clevidipine
23
Q

Factors that Affect Choice of Treatment

Aortic Dissection
- inititate a ___ then ___ (example: nicardipine, clevidipin, nitroprusside)
- lower BO quickly and prevent reflex ___

(unique BP goals)

A
  • BB, vasodilator
24
Q

Factors that Affect Choice of Treatment

Acute Coronary Syndromes
- ___ , labetalol, ___ , nicardipine, or ___ can be used
- use caution with ___; avoid ___ in the setting of reduced EF, HR < ___ bpm, SBP < ___ mmHg, 2nd or 3rd degree heart block, or reactive airway disease

A
  • esmolol, nitroglycerin, nitroprusside
  • non-DHP CCBs
  • BB, 60, 100
25
Q

Factors that Affect Choice of Treatment

AKI
- most ___ antihypertensives are acceptable
- use caution with ___ ; avoid ___

A
  • IV
  • nitroprusside, enalaprilat
26
Q

Factors that Affect Choice of Treatment

eclampsia/severe preeclampsia
- ___ , ___ , or ___
- contraindicated: ___ and ___

(unique BP goals)

A
  • hydralazine, labetalol, nicardipine
  • enalaprilat, nitroprusside
27
Q

Factors that Affect Choice of Treatment

Stroke (Intracrainial Hemorrhage/Ischemic)
- ___ , ___ , or ___

(unique BP goals)

A

nicardipine, clevidipine, labetalol

28
Q
A

nicardipine 5 mg/hr IV infusion

29
Q
A

it is indicated as an adjunct and not a first line agent

PHRM 844 (52 decks)

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