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Block 2.3
Day 5: Dr. Clark Hypertensive Crisis
| Question | Answer |
|---|---|
| What is Hypertensive urgency? | >180 and/or >120 mmHg |
| What is Hypertensive emergency? | >180 and/or >120 mmHg PLUS target organ damage |
| What are examples of target organ damage? | cardiovascular: acute pulmonary edema, acute coronary ischemia (known as ACS, e.g. MI, unstable angina), aortic dissection Renal: acute renal failure (NO CKD) Neurologic: hypertensive encephalopathy, stroke Ocular: retinal hemorrhage/exudate Eclampsia |
| What is the equation for flow? | Δ Pressure / Resistance |
| T/F Autoregulation system fails in hypertensive crisis | T |
| What are the steps of the management of hypertensive crisis? | 1.) >180 mmHg and/or >120 mmHg 2.) Target organ damage? 3.) If yes, hypertensive emergency, if no, hypertensive urgency 4.) If yes, presence of conditions* with exceptions to gen tx goal. 5.) If no, reinstitute/intensity oral antihypertensive meds |
| What is the goal of a general hypertensive emergency? | Reduce BP max of 25% in 1st hour, then to <160/100-110 mmHg over next 2-6 hrs, then normal over 24-48hrs unless pt has any of the following conditions: aortic dissection, severe preeclampsia/eclampsia, pheochromocytoma crisis, or acute ischemic/hem stroke |
| For aortic dissection pts, what is the goal? | HR <60 beats/min and BP <120 mmHg within 20 mins. Initiate beta-blocker prior to initiating a vasodilator (if needed for BP control) to prevent reflex tachycardia. |
| What is preeclampsia? | New-onset pregnancy-associated HTN with proteinuria or target organ damage after 20 weeks gestation. |
| What is ecmapsia? | When preeclampsia manifests, and seizures occur |
| T/F Magnesium may be used to treat seizures in pts experiencing seizures | T |
| What is pheochromocytoma? Goal? | a tumor found on adrenal gland that secretes catecholamines, thus leading to HTN among other symptoms. Goal is <140 mmHg within first hour |
| What is CPP associated with acute ischemic stroke? | Cerebral perfusion pressure. CPP = MAP - ICP (intracranial pressure) If ICP does down, CPP will go up. To compensate, MAP will go up. |
| T/F Lower BP if patient qualifies for IV fibrinolytic and >185/110 mmHg. After decreasing, give Alteplase within 4hrs. | T |
| T/F If pt does NOT qualify for IV fibrinolytic therapy, you can let BP increase to >220/110 before lowering. | T |
| T/F In a hypertensive crisis, always give IV! | T |
| T/F Clevidipine is CIVI, onset and duration are short (within mins), is a lipid emulsion and C/I if soy or egg allergy. | T |
| T/F DHPs CIVI can cause reflex tachycardia. | T |
| T/F Nicardipine is CIVI, has longer duration (hrs) compared to clevidipine. | T |
| T/F Esmolol is a Beta1-selective CIVI, onsets and duration is short (within mins) | T |
| T/F Labetalol is a non-selective BB with alpha 1 properties, longer duration that esmolol, can be IVB or CIVI. | T |
| What are some C/I of Esmolol? | ADHF, severe bradycardia, 2nd or 3rd heart block |
| What are some C/I of Labetalol? | ADHF, severe bradycardia, 2nd or 3rd degree heart block, bronchial asthma or obstructive airway disease. |
| T/F Nitroglycerin and Sodium nitroprusside are CIVI Nitric-oxide vasodilators and short onset and duration (mins). | T |
| Which Nitric Oxide dependent vasodilators has more potent venous than arterial vasodilator? | Nitroglycerin |
| Which Nitric Oxide dependent vasodilators has more potent arterial than venous vasodilator? | Sodium nitroprusside |
| T/F Nitric-oxide dependent vasodilators are C/I with pts on PDE-5 inhibitors (e.g. tadalafil, sildenafil). | T |
| T/F Tachyphylaxis and HA is a common consideration of nitric-oxide dependent vasodilators. | T |
| T/F Sodium nitroprusside can cause cyanide toxicity with prolonged infusions or high doses. | T |
| What is a direct arterial vasodilator? | Hydralazine, duration is long and unpredictable. Not a desirable first line agent for most patients, can cause reflex tachycardia, HA, and lupus-like syndrome |
| What is an ACE inhibitor? | Enalaprilat, IVB, duration is long. Not a desirable first line agent. C/I in preg pts, hyperkalemia, |
| What is Phentolamine? | Non-selective alpha antagonist |
| What are the preferred drugs for pts who have*******acute aortic dissection*******? "BLOCK before drop" | Esmolol, labetalol |
| What are the preferred drugs for pts who have *****acute pulmonary edema******? | Nitroglycerin, nitroprusside, clevidipine |
| What are the preferred drugs for pts who have acute coronary syndrome? | Nitroglycerin, esmolol, labetalol, and nicardipine |
| What are the preferred drugs for pts who have eclampsia or preeclampsia? | labetalol, nicardipine, hydralazine |
| What are the preferred drugs for pts who have catecholamine excess? | Phentolamine, nicardipine, and clevidipine |
| What are the preferred drugs for pts who have acute ischemic stroke? | Clevidipine, nicardipine, and labetalol |
| T/F Hypertensive urgencies should prefer PO meds | T |
| What is clonidine? | Alpha 2-agonist, short onset, can cause bradycardia, sedation, rebound hypertension PO |
| What is captopril? | ACE inhibitor, C/I in preg pts and if they have hyperkalemia PO |
| What is labetalol? | Non-selective BB with alpha 1 blocking effects, short acting PO |
| What is Hydralazine? | Vasodilation, short acting PO |
Created by:
SPangKee
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