HTN Crisis

Card Set Information

Author:
DrJBlack
ID:
137085
Filename:
HTN Crisis
Updated:
2012-02-22 22:44:59
Tags:
HTN Crisis Drugs
Folders:

Description:
HTN Crisis Drugs for Cardio Exam #2
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user DrJBlack on FreezingBlue Flashcards. What would you like to do?


  1. Pathophysiology for hypertensive crisis
    abrupt increase in vasoconstriction --> endothelial injury --> activation of coagulation necrosis --> renin-angiotensin system activation --> (+) inflammation --> volume depletion
  2. Risk factors of HTN Crisis
    • increased age
    • Black
    • Male
    • diagnosed
    • pregnancy
    • lack of primary care physician
    • non-compliance
    • illicit drugs
    • drugs
    • renal parenchymal disease
  3. hypertensive urgency
    • severe elevation in BP without progressive target organ dysfunction
    • asymptomatic (may have general fatigue, malaise, etc)
    • patient unaware until normal examination
  4. Hypertensive Urgency Tx
    • adjust current therapy by increasing dose or simplifying regimen and/or
    • add short-acting ORAL therapeutic option
  5. Hypertensive Urgency Tx Goals
    • Gradual reduction in BP
    • goal = stage 1 HTN values which can be achieved over several hours/days
    • don't be too aggressive with patients that have cerebrovascular accident, MI, or ARF
  6. Hyptertensive Urgency Tx Options
    • captopril (Catpoten)
    • clonidine (Catapres)
    • labetalol (Trandate, Normodyne)
    • nifedipine (Procardia, Adalat)
  7. captopril
    • Brand Name: Capoten
    • Class: ACEI
    • AEs: rash, pruritus, proteinuria, loss of taste, hypotension
    • CI: renal aretery stenosis, hyperkalemia, dehydration, renal failure, pregnancy
    • Dosing: 6.25-50 mg PO (25 mg normal dose q hr)
    • OOA: 15 min (quick onset)
    • DOA: 4-6 hrs (predictable duration)
  8. clonidine
    • Brand Name: Catapres
    • Class: alpha-2 agonist
    • CI: altered mental status, severe cartoid artery stenosis
    • Dosing: 0.2 mg PO initially, then 0.1 mg/hr (MDD = 0.8 mg) --> available in a patch, which takes longer for absorption
    • OOA: 0.5-2 hours
    • DOA: 6-8 hours
  9. labetalol
    • Brand Name: Trandate, Normodyne
    • Class: alpha- and beta- blocker
    • CI: bronchial asthma, bradycardia, decompensated CHF
    • Dosing: 200-400 mg PO q 2-3 hrs
    • OOA: 0.5-2 hours
    • DOA: 4 hours
  10. nifedipine
    • Brand Names: Procardia, Adalat
    • Class: calcium channel blocker
    • CI: GENERALLY AVOID (rapid decrease in blood pressure)
    • Dosing: 10-20 mg PO
    • OOA: 15-30 min
    • DOA: 3-5 hrs
  11. Hypertensive Urgency - Tx Goals
    • patients should be observed (depending on severeity of in crease in BP), then followed in outpatient setting
    • follow up is essential --> schedule for re-evaluation in 1 wk (ideally 1-3 days) and be preventative for the patient
  12. hypertensive emergency
    • acute elevation in BP associatied with target organ damage
    • signs/symptoms of acute target injury; severe chest pain, HA, anxiety, confusion, SOB
  13. Hypertensive Emergency - Tx Goals
    • immediate lowering of BP to prevent organ damage
    • no blood pressure goal to begin with
    • initial target = MAP greater than or equal to 25% within min-hrs
    • if stable, reduce BP to 160/100-110 mmHg in next 2-6 hrs
    • gradual reductions towards normal BP over next 24-48 hrs
  14. Hypertensive Emergency Tx
    • require PARENTERAL drug therapy
    • Ideal drug should have the following:
    • rapid OOA
    • short DOA
    • easily titratable
    • require minimal dosage adjustments
    • minimal risk of hypotension
    • lack significant SEs
    • mild reduction in myocardial contractility
    • easy conversion to oral agents
    • low cost (including drug and monitoring costs)
  15. Hypternsive Emergency - Tx Options
    • nitroprusside (Nipride)
    • nitroglycerin
    • fenoldopam (Corlopam)
    • hydralazine (apresoline)
    • enalaprilat (Vastoec)
    • nicardipine (Cardene)
    • phentolamine (Regitine)
    • esmolol (Brevibloc)
    • labetolol (Trandate, Normodyne)
    • clevidipine butyrate (Cleviprex)
  16. Nitroprusside
    • Brand Name: Nipride
    • MOA: smooth muscle relaxer or arterial and venous vasodialtor that decreases both afterload and preload
    • Indications: CHF, aortic dissection, syndromes of catecholamine excess
    • CI: avoid prolonged use in patients with hepatic/renal impairment, acute MI
    • Miscellaneous: thiocynate toxicity --> thiocynate > 60 mg/L = toxic, which will cause hallucinations, vomiting; careful with brain bleeds
    • Dosing: lowest dose possible should be used for the shortest DOA; initial = 0.3 mcg/kg/min; 0.25-10 mcg/kg/min IV infusion; max = 10 mcg, which shouldn't be used for an extended period of time
    • OOA: within seconds
    • DOA: 2-3 min
  17. nitroglycerin
    • MOA: lowers blood pressure, reduces preload, decreases left ventricular filling pressure, and myocardial oxygen consumption
    • Indication: unstable angina, acute MI, and acute left ventricular failure
    • CI: cerebrovascular accident - head trauma/intracerebral hemorrhage
    • Miscellaneous: must be in glass - NOT polyvinylchloride (PVC); can become tolerant of medication
    • Dosing: 5-200 mcg/min IV infusion
    • OOA: 2-5 min
    • DOA: 5-10 min
  18. fenoldopam
    • Brand Name: Corolopam
    • Class: peripheral DA-1 agonist (no DA-2 activity)
    • Indication: severe hypertension with renal insufficiency
    • CI: glaucoma, sulfite allergy
    • ADRs: HA, flushing, tachycardia, dizziness, increased IOP (dose related)
    • Dosing: 0.1-1.6 mcg/kg/min IV infusion (titratable drug)
    • OOA: 4-5 min
    • DOA: 30 min
  19. hydralazine
    • Brand Name: Apresoline
    • MOA: direct vasodilation (relaxes arteriole smooth muscle and decrease afterload)
    • Use: limited to pre-eclampsia and eclampsia
    • Drawbacks: prolonged and unpredictable BP lowering; inability to effectively titrate; can cause reflex tachycardia (not optimal for use)
    • Dosing: 10-20 mg IV or IM bolus, repeat q 4-6 hrs PRN
    • OOA: 10-20 min
    • DOA: 1-4 hrs
  20. enalaprilat
    • Brand Name: Vasotec
    • MOA: ACEI
    • Indication: HF
    • CI: use with caution in patients with severe renal insufficiency, acute MI, pregnancy
    • Miscellaneous: only IV ACEI
    • Dosing: 1.25-5 mg IV q 6 hr (MDD = 20 mg/day); requires dose adjustments on diuretic and CLcr < 30 mL/min
    • OOA: within 15 min
    • DOA: longer DOA of 12-24 hrs
  21. nicardipine
    • Brand Name: Cardene
    • Class: dihydropyridine (DHP) calcium channel blocker --> increases stroke volume --> increase in blood to brain
    • Indication: hypertensive encephalopathy, acute renal failure
    • AEs: tachycardia, flushing, HA, dizziness, hypotension, N/V
    • Misc: advantageous to anything cerebral and no significant change in intracranial pressure; lots of vasoconstriction
    • Dosing: 5 mg/hr, increase infusion rate by 2.5 mg/hr q 5min to max infusion rate 30 mg/hr; dosing independent of weight
    • OOA: 5-15 min
    • DOA: 4-6 hrs
  22. phentolamine
    • Brand Name: Regitine
    • Class: alpha-AR blocker
    • Indication: catecholamine excess
    • CI: syndromes of coronary insufficiency
    • Misc: often paired with beta blocker to offset reflex tachycardia
    • Dosing: 5-20 mg IV, repeat as necssary
    • OOA: 1-2 min
    • DOA: 10-30 min
  23. esmolol
    • Brand Name: Brevibloc
    • MOA: beta-1 selective blocker --> rate control; often used in post-op HTN
    • Indication: syndromes of coronary insufficiency
    • CI: > 1st degree heart block, HF
    • Miscellaneous: metabolized by rapid hydrolysis by RBCs; pay attention to dillution to avoid toxicity
    • Dosing: 500-1000 mcg/kg over 1-4 min bolus, then 50-300 mcg/kg/min IV infusion
    • OOA: 1-2 min
    • DOA: 10-20 min
  24. labetalol
    • Brand Name: Trandate, Normodyne
    • MOA: alpha and beta blocker (more affinity for beta)
    • Indications: hyperadrenergic syndromes, cerebrovascular events
    • CI: 2nd or 3rd degree heart block, HF, bronchial asthma
    • Dosing: 20-80 mg IV bolus q 10 min until BP controlled (MDD = 300 mg/day) or 2 mg/min IV infusion
    • OOA: 2-5 min
    • DOA: 2-4 hrs
  25. clevidipine butyrate
    • Brand Name: Cleviprex
    • Class: 3rd generation DHP calcium channel blocker
    • CI: acute HF and allergy to soybeans, soy products, eggs, or egg product
    • Misc: lipid emulsion; undergoes rapid metabolism by arterial blood esterases; monitor TG; no renal/hepatic adjustments due to metabolism via arteriole esterases; no serious decrease in BP b/c it can lead to complications such as stroke, MI (especially quickly)
    • OOA: 2-4 min (rapid)
    • DOA: 5-15 min (rapid offset)
  26. Hypertensive Emergency Tx Goals
    • excessive decreases can lead to complications
    • special conditions to consider: ischemic stoke & stroke eligible for thromboylitc agents; aortic disscetion (bleeding into/along aorta)
  27. Hypertensive Emergency Tx Goals: Cerebrovascular Accidents
    • direct correlation of chronic level of BP and risk of stroke
    • many acute stroke patients that have initial HTN may resolve spontaneously within 48 hrs
    • Exception to tx for CA: TPA administration, other type of emergeny or intracerebral hemorrhage
  28. Hypertensive Emergency: Aortic Dissection
    • Signs: discrepancies b/t pulses, murmur of aortic insufficiency, and neurological defects
    • requires rapid lowering of BP in 5-30 min
    • tx of choice: beta-blocker & vasodialator
    • critically ill patient - usually admitted to ICU, surgery like

What would you like to do?

Home > Flashcards > Print Preview