Hypertensive Emergencies

Question 1

what is severe asymptomatic hypertension

Answer 1

greater than 180/120 without end organ damage sometimes referred to as a hypertensive urgency

Question 2

what is a hypertensive emergency

Answer 2

gretaer than 180/120 with end organ damage though BP can be less elevated if it is acute

Question 3

what are the three type of hypertensive urgencies

Answer 3

severe, asymptomatic, hypertension

pre-eclapsia and chronic renal failure

Question 4

if acute coronary syndrome is suspected what should you order

Answer 4

cardiac enzymes

Question 5

in management of hypertensive urgencies versus emergencies

Answer 5

hypertensive urgencies can be treated with oral agents but usually hypertenisve emergencies usually require parential IV therapy

Question 6

general rules for management of hypertensive emergencies

Answer 6

MAP reduced 10-20% in first our and by 5-15% over the next 23 hours

Question 7

________is a direct acting vasodilator acting on both arteriolar and venous vessels and reduces cardiac preload and after load

Answer 7

sodium nitroprusside

Question 8

what are the limitations for sodium nitroprusside

Answer 8

can lead to cyanide or thiocyante toxicity due to metabolites
can exacerbate cardiac ischemia in pts. with ischemic heart disease

Question 9

what class is lebetalol

Answer 9

alpha beta blocker

Question 10

is the ONLY beta blocker useful for hypertensive emergencies

Answer 10

lebetalol

Question 11

what are the limitations for use of lebetalol in use for hypertensive emergencies

Answer 11

avoid high grade AV block
caution with asthma and COPD patients
avoid with acute CHF

Question 12

this drug is the MOST Useful in symptomatic ischemic heart disease or hypertensive heart failure

Answer 12

nitrates (IV nitroglycerin)

Question 13

what are the limitations to nitrates (IV nitroglycerin)

Answer 13

headache is common at higher doses necessary to significantly reduce BP

Question 14

what is the action of nitrates at low doses

Answer 14

venous dilation

Question 15

what is the action of nitrates at high doses

Answer 15

venous and arteriolar dilation

Question 16

is a direct arterial vasodilator

Answer 16

hydralzine

Question 17

hydralazine should be given with

Answer 17

concurrent beta blocker as it will cause reflex tachycardia

Question 18

what is the agent of choice for preeclapsia or eclampsia

Answer 18

hydralazine

Question 19

what are the limitations for hydralazine

Answer 19

reflex tachycardia is problematic for acute aortic diseection (increased shear force) and ischemic heart disease

Question 20

what are the symptoms of LV failure

Answer 20

dyspnea, orthopnea, and PND

Question 21

what are the signs of LV failure

Answer 21

pulmonary congestion/edema

Question 22

what is the management for hypertensive LV failure

Answer 22

IV opioids (morphine)
IV loop diuretics (furosemide)
IV sodium nitroprusside or IV nitroglycerin

Question 23

in patients with ischemic heart disease________-may exacerbate cardiac ischemia

Answer 23

sodium nitroprusside

Question 24

management of hypertension associated with UA or MI

Answer 24

sublingual and IV nitrates
beta blocker (IV or oral)
systolic BP has to be less than 180 mmHg

Question 25

what is the etiology for hypertension assoc. with aortic dissection

Answer 25

intimal tear allowing blood to pass into the aortic media creating subintimal channel contained by outer edia and adventital aortic layers. shear stress with each systolic pulse extends dissection

Question 26

what are the symptoms of aortic dissection

Answer 26

tearing chest pain radiating to the back

Question 27

what are the signs of aortic dissection

Answer 27

murmur aortic rergurgitation BP discreptancy between arms or absent pulses evidence of hemorrhage

Question 28

Management of aortic diessection

Answer 28

treat all patients regardless of LOCATION to systoolic BP less than 120 and heart tate 60-70,

Question 29

what is the first line drug for aortic dissection

Answer 29

IV lebetalol and THEN add IV nitroprusside/nitroglycerin

Question 30

what are the symptoms of hypertensive encephalopathy

Answer 30

headache, nausea, vomitting, visual distrubances, restlessness, confusion, seizures and coma

Question 31

what are the signs of hypertensive encephalopathy

Answer 31

focal neurologic signs (diagnosis of exclusion)

Question 32

what is DOC for hypertensive encephalopathy

Answer 32

sodium nitroprusside

Question 33

what is second line drug for Hypertensive encephalopathy

Answer 33

labetalol or nitrates

Question 34

what is the management for ischemic stroke hypertension

Answer 34

allow permissive hypertension unless initial BP is greater than 185/110 and candidate for thrombolysis or initial BP is greater than 220/120 if not candidiates for thrombolysis

Question 35

what is the management of subarachnoid hemorrhage

Answer 35

complicated by competing risks and benefits and the use of antihypertensive therapy in these settings depends on the severity of hypertension and whether or not there is documented or suspected increased intracranial pressure

Question 36

what are the two commonly used management therapies

Answer 36

IV hydralazine an IV lebetalol

Question 37

what is used to control seizrues for preeclampsia or eclampsia

Answer 37

magnesium sulfate