PHRD6085 Pharmacotherapy Lecture 6 - Hypertensive Crisis

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daynuhmay
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282142
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PHRD6085 Pharmacotherapy Lecture 6 - Hypertensive Crisis
Updated:
2014-09-05 04:38:20
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Hypertensive Crisis
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Hypertensive Crisis
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  1. criteria for hypertensive urgency
    • BP 180/110 mmHg
    • NO end organ damage
  2. criteria for hypertensive emergency
    • BP 180/110 mmHg
    • End organ damage 
  3. 2 equations for MAP
    • (CO*SVR) + CVP
    • (2*DBP + SBP)/3
  4. 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
  5. 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
  6. 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
  7. HTN Urgency treatment
    • gradual reduction of BP w/ PO meds
    • no hospitalization
    • monitor w/in 7 days
    • *AVOID rapid release nifedipine
  8. list drugs used in HTN urgency (5)
    • labetalol (200mg po, q3-4hr)
    • captopril
    • clonidine
    • nicardipine
    • minoxidil
  9. 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
  10. goal values for aortic dissection & HTN emergency
    • SBP <120mmHg
    • MAP < 80mmHg 
    • WITHIN 10 MINUTES
  11. 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
  12. what may occur if there is too rapid of a MAP reduction?
    cerebral hypoperfusion
  13. treatment option for HTN emergency + aortic dissection
    labetalol 2mg/min IV
  14. treatment option for HTN emergency + angina/MI
    labetalol 2mg/min IV
  15. treatment option for acute pulmonary edema/left ventricular failure
    nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
  16. treatment option for HTN emergency + acute renal failure
    nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
  17. treatment option for HTN emergency + cocaine OD/sympathetic crisis
    nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
  18. treatment option for HTN emergency + pheochromocytoma
    nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP
  19. 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
  20. treatment option for HTN emergency + pre-eclampsia/eclampsia
    nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP

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