special considerations of htn2 Flashcards Preview

Therapeutics Test 2 > special considerations of htn2 > Flashcards

Flashcards in special considerations of htn2 Deck (28):
1

what are the 4 short term treatment goals with HTN crisis

1. restore end organ perfusion
2. prevent end organ damage
3. decrease BP
4. restore volume

2

what are 3 long term treatment goals with HTN crisis?

1. reduce risk of CB morbitiy/mortality
2. reduce renal dysfunction
3. delay or stop progression of end organ damage

3

what type of HTN urgency treatment should be given?
outpatient or inpatient

outpatient with follow up
inpatient observation if high risk or med non-compliance

4

reduction of BP to goal in urgency treatment should be done in what time period?

24-48 hours

5

what can rapid BP reductions cause

eschemia and/or infarction

6

when should HTN urgency patients be re-evaluated

1-2 days, no more than a week

7

what are 1st line treatments for HTN urgency?
what must be done with them?

clonidine or ACEI's
must observe for several hours

8

what are considered oral short acting hypertensives

clonidine and ACEI's (particularly captopril)

9

other than short acting antihypertensives what else should be done for HTN urgency agents?

adjust current maintenance therapy:
1 restart medication
2. maximize current regimen
3. add new medication

10

arrange these by onset of action, shortest to longest: clonidine, captopril, labetalol

captopril< clonidine < labetalol

11

what is labetalols onset of action time? duration?

onset = 2 hours
duration = 4 hours

12

what dosing forms of nifedipine are not safe nor efficacious with HTN urgency?
why?

sublingual and oral
-lowers BP abruptly
-reports of MI's and strokes

13

what type of treatment is needed for HTN emergency?

ICU treatment

14

what must be assessed prior to IV therapy with HTN emergencies

assess volume status
then restore volume with saline

15

what is the two immediate goals of BP reduction in HTN emergency cases?

1. decrease MAP by 25% within an hour
2. once stable decrease BP to less than 160/110 within 2-6 hours

16

what are 2 exceptions to BP goals in HTN emergency

1. aortic dissection - must drop aggressively to 120/80
2. stroke - decrease MAP by 15-20%

17

once BP is controlled with IV agent in emergency HTN, what treatment can be use

oral antihypertensive and slow decreasing titration of IV agent

18

sodium nitroprusside can lead to what?

cyanide toxicity

19

what does nicardipine do?
who should not

increases stroke volume and coronary blood flow.
active for acute heart failure

20

what is fenoldopam useful for?

kidneyinsufficiency

21

what drug is not considered firstline for HTN emergency and absorbs to polyvinyl chloride containers

nitroglycerin

22

what are 3 drugs that are usually avoided in HTN emergency?

1 enalaprit - active metabolite of enalapril
2. hydralazine- unpredictable effects
3. clevidipine; use only intraoperatively and in critical care settings

23

clveidipine should be used with caution with what?

heart failure and concomitant beta-blocker use

24

what is the major effects on receptors of labetalol

beta blocker and alpha1 blocker

25

what effect doeslabetalol have on CO, SVR, and blood flow

maintains CO2, decreases SVR, conserves cerebral, renal and coronary blood flow

26

what receptors are effected by esmolol

beta-1 selective

27

when is esmolol most useful?

aortic dissection and perioperative HTN

28

what is generally used for catecholamine excess?

phentolamine