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Hypertensive Emergency & Urgency Flashcards

(48 cards)

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1
Q

What is the definition of hypertensive emergency

A

Acute elevation of BP (>180/120) WITH acute or ongoing target end organ damage

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2
Q

What are examples of target end organ damage

A 
Hypertensive encephalopathy
Intracranial hemorrhage
Unstable angina
Acute MI
Acute LV failure with pulmonary edema
dissecting aortic aneurysm
eclampsia
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3
Q

What neurologic clinical findings indicate end organ damage

A

sommolence, confusion, seizures, coma, visual deficits or blindness

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4
Q

Cardiac damage should be considered if upon testing any of the following are found

A

S4 gallop
ischemic changes on ECG
chest x-ray indicates pulmonary edema
chest pain symptoms

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5
Q

clinical indicators of renal damage include

A

oliguria
progressive azotemia
hematuria
proteinuria

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6
Q

A funduscopic exam, indicates target organ damage if

A

patient has: papiledema, hemorrhage, or exudates

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7
Q

True or False, blood pressure must be reduced IMMEDIATELY in both hypertensive emergency & urgency. Why

A

False.

BP should only be reduced immediately in HTN emergency as there is end organ damage.

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8
Q

MAP should be decreased by a)______ within b)__ to ___?

A

25% within minutes to hours

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9
Q

Within ______ the target BP is 160/100?

A

2-6 hours

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10
Q

HOw oftern douse the BP need to be checked during HTN emergency & when can you stop checking

A

Must check BP every 5-10minutes

Stop checking when the MAP is reached & life-thretening target organ damage resolves

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11
Q

How long must the BP be maintained at goal

A

1-2 days

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12
Q

How long may it take before normal BP is reached?

A

weeks

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13
Q

What is the definition of hypertensive Urgency

A

accelerated, malignant, or perioperative elevations in BP WITHOUT new or progressive target organ damage.

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14
Q

What vasodilators are commonly used in Hypertensive emergencies

A 
*3Ns & HE*
Nitroprusside (Nipride)
Nicardipine
Nitroglycerin (Tridil)
Hydralazine (Apresoline)
Enalaprlate (Vasotec IV)
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15
Q

These adrenergic inhibitors are commonly used for hypertensive emergencies

A 
*CLEPh*
Clevidipine (Cleviprex)
Labatalol 
Esmolol (Brevibloc)
Phentolamine (Regitine)
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16
Q

in which emergencies would labetalol be recommended?

A

encephalopathy & postoperative hypertension

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17
Q

A patient presents to the emergency with encephalopathy & BP of 190/130 what agents should be avoided when lowering BP?

A

methyldopa & reserpine (sedation)
diazoxide (lowers cerebral blood flow)
hydralazine (increases intracranial pressure)

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18
Q

When treating a patient with HTN emergency with encephalopathy what are the agents of choice?

A

Labatelol
Nicardipine
Nitroprusside

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19
Q

Thiocynate & cyanide intoxication as well as muscle twitching, sweating & N/V are all side effects of

A

Nitroprusside

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20
Q

When sing nitroprusside, caution has to be taken if the patient is experiencing ______ or ____.

Study These Flashcards
A

high intracranial pressure

azotemia

21
Q

what steps must be taken for the safe BP lowering during any hemorrhage or stroke

Study These Flashcards
A

BP lowering should be done if the systolic >220 or diastolic > 120mmHg

22
Q

What is the agent of choice in lowering BP during a hemorrhage or stroke

Study These Flashcards
A

nitroprusside

23
Q

Nitrogylcerin is used in what type of HTN emergencies?

Study These Flashcards
A

MI, unstable angina, CHF

24
Q

Nitroprusside is recommended for use in all HTN emergencies except

Study These Flashcards
A

MI or unstable angina

25
Nicardipine is an agent of choice in which HTN emergencies
encphalopathy or postoperative HTN
26
When using nicardipine, caution should be used in management of a)______ emergency & should NOT be used in b)_____ emergency
a) coronary ischemia emergency | b) heart failure emergency
27
What are the side effects of nicardipine
tachycardia HA flushing phlebitis
28
What are the side effects of nitroglycerin
Tolerance with prolonged us HA, vomiting methemoglobinemia
29
the recommended agents for HTN emergency in a pt with an MI or unstable angina
nitroglycerin or esmolol
30
Esmolol is an agent of choice in which HTN emergency conditions
MI, unstable angina Aortic dissection PERIoperative HTN
31
The only ACEI that is used in HTN emergency is ____.
Enalaprilat
32
Enalaprilat is best used in a)_______ emergency and avoided in b)_______
a) Acute LVF ( CHF) | b) acute MI
33
diazoxide & hydralazine should be avoided in ________ because they increase shearing forces
dissecting aortic aneurysms
34
Recommended drugs for pheochromocytoma & cocaine overdose
Phentolamine & lobetalol (caution)
35
Side effects of phentolamine are
tachycardia, flushing, HA
36
catecholamine(norepi, epi, dopamine) excess is treated with
phenotlamine
37
In the management of an emergency in a pt with renal insufficency, what agents are recommended?
Nitroprusside, labetolol, CCB
38
Why are diazoxide & hydralazine avoided in CHF emergencies
these agents increase oxygen demand
39
Why are dihydropyridines avoided in CHF emergencies
they may worsen angina
40
Why is nitroprusside avoided in CHF emergencies
nitroprusside can cause coronary steal
41
Why are labetalol, esmolol & other BB avoided in CHF emergencies
BB reduce CO
42
what are the side effects of labetalol?
``` heart block orthostatic hypotention scalp tingling throat burning dizziness N/V ```
43
a)__________therapy is preferred in the management of HTN urgency, while b)____ therapy is used in HTn emergency?
a) oral therapy is preferred for urgency | b) IV is best in emergency
44
Any medication used in treating HTN urgency should have an onset of a)__________ and peak within b)_________
A) onset of 15-30 minutes | B) peak within 2-3 hours
45
Using which formulation of nifedipine is inappropriate for lowering BP in pts with HTN urgency
immediate-release nifedipine
46
To monitore for a response to therapy, BP should be checked every ____ to ______ minutes during HTn urgency
15 to 40 minutes
47
What are the agents used in HTN uregency?
Captopril 25mg Clonidine 0.1-0.2mg, with max of 0.6mg Labetalol 100-400mg
48
All agents used in HTN urgency can be reapeated within 1-2 hours PRN except ______; which is done __________
Labetalol, done every 2-3 hours PRn

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