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PHRD6085 Pharmacotherapy Lecture 6 - Hypertensive Crisis
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criteria for hypertensive urgency
BP
180/110 mmHg
NO end organ damage
criteria for hypertensive emergency
BP
180/110 mmHg
End organ damage
2 equations for MAP
(CO*SVR) + CVP
(2*DBP + SBP)/3
list common causes of hypertensive crises
lack of adherence to antihypertensive meds
abrupt inc in BP in pts w/ chronic HTN
sympathomimetic drugs
w/drawal from antihypertensive agents
preeclampsia
head injury
acute glomerulonephritis
vasculitis
list types of end organ damage assoc'd w/ HTN emergency
cerebral infarction
acute pulmonary edema
hypertensive encephalopathy
acute congestive HF
acute MI or unstable angina
HTN Urgency goals of tx
reduce BP to 160/100 mmHg over several hours-days
avoid reduction in MAP >25% in first 24hr
LT BP goal = <140/90 mmHg
HTN Urgency treatment
gradual reduction of BP w/ PO meds
no hospitalization
monitor w/in 7 days
*AVOID rapid release nifedipine
list drugs used in HTN urgency (5)
labetalol (200mg po, q3-4hr)
captopril
clonidine
nicardipine
minoxidil
HTN emergency goals of tx
decrease BP by 10% during first hour, then 15% over next 2-3hr
get BP to 160/100 mmHg over first 6hr
avoid reducing MAP >25% during first 2hr
LT BP goal = <140/99mmHg
goal values for aortic dissection & HTN emergency
SBP <120mmHg
MAP < 80mmHg
WITHIN 10 MINUTES
list drugs used in HTN emergency (9)
labetalol (2mg/min IV or 20-80mg q10min up to 300mg)
nicardipine (5mg/hr IV then titrate 2.5mg/hr q5min to desired BP - max 15mg/hr)
nitroglycerin
nitroprusside
hydralazine
clevidipine
enalaprilat
esmolol
fenoldopam
what may occur if there is too rapid of a MAP reduction?
cerebral hypoperfusion
treatment option for HTN emergency + aortic dissection
labetalol 2mg/min IV
treatment option for HTN emergency + angina/MI
labetalol 2mg/min IV
treatment option for acute pulmonary edema/left ventricular failure
nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
treatment option for HTN emergency + acute renal failure
nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
treatment option for HTN emergency + cocaine OD/sympathetic crisis
nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
treatment option for HTN emergency + pheochromocytoma
nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP
treatment option for HTN emergency + hypertensive encephalopathy/intracranial hemorrhage/subarachnoid hemorrhage/thrombotic stroke
nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP
treatment option for HTN emergency + pre-eclampsia/eclampsia
nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP
Author
daynuhmay
ID
282142
Card Set
PHRD6085 Pharmacotherapy Lecture 6 - Hypertensive Crisis
Description
Hypertensive Crisis
Updated
9/5/2014, 8:38:20 AM
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