Hypertensive Emergencies

Question 1

Hypertensive crisis is defined as SBP > _______ or DBP >________

Answer 1

180mmHg; 120 mm HG

Question 2

Pts with acute elevation in BP levels and do not demonstrate acute end-organ damage are diagnosed with __________

Answer 2

Hypertensive urgency

Question 3

Pts with acute elevation in BP levels and DO demonstrate life threatening acute end-organ failure are diagnosed with _______________ and will require ______ ________

Answer 3

Hypertensive crisis or emergency ; IV medications

Question 4

Acute end organ damage can manifest as ______,_______, ________, ______, ______,_____, ____________, _______

Answer 4

Encephalopathy; ischemic and hemorrhagic strokes; Acute aortic dissection; ACS; HF; Pulmonary edema or resp failure; ARF; HELLP (hemolysis, elevated liver enzymes, low platelets) preeclampsia or eclampsia

Question 5

Pt with labile BP should be monitored in _____ and ________ ____ ______ monitoring

Answer 5

ICU; intra-arterial BP

Question 6

Oral therapy should be used in patients with _________ ______with a goal of obtaining a gradual lowering of BP levels by ____% over ___ to ___ hours

Answer 6

Hypertensive urgency; 20; 24; 48

Question 7

If IV therapy is given to patient with ________with no evidence of end organ damage, the rapid reduction in BP may lead to ________ and _____ to organs that had become dependent on the increased blood flow.

Answer 7

hypertensive urgency; ischemia and infarction

Question 8

IV forms of medication used in hypertensive emergencies should have _____onset and _____duration

Answer 8

fast; short

Question 9

IM and SL in hypertensive emergencies should be avoided because they lack the ability to be ______ and may lead to _______ ______ ______ levels

Answer 9

titrated; unpredictable drop in BP

Question 10

Goal of BP reduction in hypertensive emergency should be _____ to _____ % in ____In the first ____ to _____ minutes; And in ______ ________ ______, the reduction should occur in less than ___ to ___ minutes , targeting a SBP of less than ______ and MAP less than ________

Answer 10

10-15; DBP; 30-60; ascending aortic dissection; 5-10; 120 <80

Question 11

Rapid reduction in BP slow __________

Answer 11

progression of end organ damage.

Question 12

Drugs meeting ideal characteristics for the management of Hypertensive crisis or emergency are _____ ____ ____ _____

Answer 12

labetalol, esmolol, nicardipine and fenoldopam

Question 13

Esmolol is a _________ (cardioselective or non-cardioselective, ____adrenergic blocker without peripheral _____blocking activity and therefore no ______effects

Answer 13

cardioselective; Beta; Alpha; vasodilatory

Question 14

For acute aortic dissection the recommended agent to decrease BP is _______. A combination of ______ and a ________ is recommended.

Answer 14

labetalol.; beta blocker; vasodilator.

Question 15

For acute ischemic stroke or intracerebral bleed, the recommended agent to decrease BP is _________

Answer 15

Nicardipine

Question 16

For Acute MI, the recommended agent to decrease BP is _________

Answer 16

Labetalol plus nitroglycerin

Question 17

Acute pulm edema/ DIASTOLIC Dysfunction, the recommended agents to decrease BP is ______ plus _______ + _______

Answer 17

Esmolol Plus nitroglycerin + Loop diuretic

Question 18

Acute pulm edema/ SYSTOLIC Dysfunction agents to decrease BP is ______ plus _______ + _______

Answer 18

Nicardipine Plus nitroglycerin + Loop diuretic

Question 19

Contraindicated in pregnancy are ______ and ______

Answer 19

Nitroprusside and ACEI

Question 20

Enalaprilat electrolyte imbalance _________(possible)

Answer 20

hyperkalemia

Question 21

For ______monitor serum potassium every 6 h during infusion

Answer 21

Fenoldopam

Question 22

Adverse effects of Esmolol

Answer 22

Thromophlebitis extravasation

Question 23

Is hydralazine safe in pregnancy? Adverse effect:_________other medications with that adverse effect are __________ and ______

Answer 23

Yes ; Reflex tachycardia; nicardipine; nitroglycerin

Question 24

Is labetalol safe in pregnancy? Adverse effect

Answer 24

yes; Bronchospasm

Question 25

How is esmolol administered? What is recommended for monitoring?

Answer 25

bolus followed by infusion; Intra-arterial BP monitoring.

Question 26

The preferred medications for aortic aneurysm or dissection is _________

Answer 26

Esmolol.

Question 27

Labetalol is a combined ______and (selective or nonselective) ______adrenergic receptor blocker than reduces ______ while maintaining ______ and does not reduce ____, _____, or ____blood flow

Answer 27

Alpha; Beta; afterload, cardiac output; cerebral, coronary and renal

Question 28

What is the preferred therapy in the treatment of renal hypertensive patients is _______ and that is because _____ ____ levels are reduced by the administration of__________

Answer 28

Labetalol; elevated renin; labetalol.

Question 29

The use of _______ in the treatment of hypertensive emergencies and urgencies both are safe in pregnancy

Answer 29

Labetalol

Question 30

Patients that may have an increase responsiveness of labetalol are patients with _______Impairment

Answer 30

Hepatic

Question 31

Abrupt withdrawal of labetalol may cause ________, _______ and ________ Therefore It should gradually ______especially in patients with ________

Answer 31

Tachycardia, rebound hypertension, ischemia; Tapered; CAD

Question 32

Fenoldopam is a (class)___________

Answer 32

Peripheral vasodilator

Question 33

Action of fenoldopam is that it is mediated by peripheral ____________-1 receptors with high selectivity for _______ and ______tubules of the kidney causing renal artery ________, inhibition of ______reabsorpition , ________ and ________

Answer 33

dopamine; distal and proximal; vasodilation; sodium; natriuresis; diuresis.

Question 34

Fenoldopam is contraindicated in _______ and has not yet been studied with patients with increased

Answer 34

Glaucoma; ICP

Question 35

Fenoldopam is a preferred agent in patients with _____impairment

Answer 35

Renal

Question 36

An arterial and venous vasodilators is

Answer 36

Sodium nitroprusside.

Question 37

Sodium Nitroprusside is contraindicated in _______ and _____ and use cautiously with patients with MI because of the potential for ________ ____ _____

Answer 37

aortic stenosis; coarctation ; coronary steal syndrome.

Question 38

Prolonged administration of nitroprusside , especially with patient with renal impairment can lead to an increased risk of developing fatal _______ or _____toxicity

Answer 38

cyanide; thiocyanate

Question 39

Monitoring for sodium nitroprusside include monitoring for _________ and _______Because it can lead to local _____ _______

Answer 39

``` Metabolic acidosis (cyanide toxicity) and venous oxygen concentration and signs of extravasation ; tissue necrosis. ```

Question 40

Nitroglycerin causes pronounced ________ _____ and results in decreased _____, _____, and oxygen demands while increasing ______ ______ and suppressing coronary _________

Answer 40

venous dilation; preload, cardiac output; coronary blood flow; vasospasms

Question 41

Tolerance with a patient getting nitroglycerin will occur within _________

Answer 41

24-48 hours

Question 42

Hydralazine is a direct _______ ______that reduces ______

Answer 42

arterial vasodilator; afterload

Question 43

Hydralazine is preferred for use in the treatment of _____ or ________

Answer 43

preeclampsia or eclampsia.

Question 44

The newest antihypertensive agent available in the US is _____________

Answer 44

Clevidipine

Question 45

The action of clevidipine is that it is a 3rd generation dihydropiridine________ that causes _________vaso_______, decreases (afterload or preload) increases ______ _______ and ______ without affecting cardiac _____ _____ or ____

Answer 45

CCB; arteriole; dilation; afterload; cardiac output and stroke volume ;filling pressure or HR

Question 46

Nicardipine is a second generation __________ _______ that is selective for arterial _________ _____ muscle with strong _______ and ______vasodilatory activity

Answer 46

diphydropiridine CCB ; smooth; cerebral and coronary

Question 47

Recommended for patients with SBP more than 230 mmHg and DBP of .121mmHG is __________

Answer 47

Nicardipine

Question 48

In general, in hypertensive emergencies , ________ are preferred over ___________-

Answer 48

continuous infusion; boluses

Question 49

Those medications can cause further volume contraction and usually worsen hypertension that is caused by increased renin production and should be avoided unless specifically indicated for fluid overload.

Answer 49

Loop diuretics

Question 50

After obtaining the initial goal reduction in BP levels, pt should be transitioned to ___________

Answer 50

oral therapy