Hypertensive Crisis

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Author:
giddyupp
ID:
53085
Filename:
Hypertensive Crisis
Updated:
2011-01-13 12:22:33
Tags:
Hypertensive Crisis PHPR522
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Description:
Hypertensive Crisis
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  1. What is a hypertensive urgency?
    hypertensive crisis with no acute target organ damage
  2. What is a hypertensive emergency?
    hypertensive crisis with acute target organ damage
  3. What are the risk factors for hypertensive crisis?
    • male
    • elderly
    • african american
    • post-op
    • usually have previous HTN dx
    • cocaine use
    • hx of stroke
    • hx of CHF
  4. What are the clinical sx of HTN emergency?
    • hypertensive encephalopathy
    • acute MI/ACS
    • pulmonary edema (acute CHF)
    • aortic dissection
    • acute kidney injury
    • pre-eclampsia/eclampsia
  5. What are the clinical sx of HTN urgency?
    • HA
    • epistaxis
    • faintness
    • agitation
  6. How do you do an initial evaluation for HTN crisis?
    • new sx
    • med hx
    • physical exam
    • quickly assess and implement plan
  7. How do you treat HTN urgency?
    • slow BP reduction (24-48h)
    • add new anti-HTN and/or
    • increasing dose of current med or
    • acute short-acting oral anti-HTN
    • 1-3d follow-up in office
  8. What drugs are used for HTN urgency?
    • clonidine
    • captopril (or other ACEI)
    • labetalol
  9. How do you treat HTN emergency?
    • immediate BP reduction:
    • 10-15% DBP reduction or to about 110 mmHg (in 30-60 min)
    • if stable, bring to 160/100-110 (2-6h)
    • if tolerated, further reduce BP (24-48h)
  10. What drugs are used for HTN emergency?
    • labetalol
    • esmolol
    • nicardipine
    • fenoldopam
  11. What drugs should be avoided in HTN emergency?
    • hydralazine
    • nifedipine
    • ACEI
    • clonidine
  12. What is the DOC for HTN crisis with acute MI/ACS?
    labetalol or esmolol w/ nitro
  13. What is the DOC for HTN crisis with pre-eclampsia/eclampsia?
    labetalol or nicardipine
  14. What is the DOC for HTN crisis with ARF/microangiopathic anemia?
    nicardipine or fenoldopam
  15. What is the DOC for HTN crisis with sympathetic crisis/cocaine overdose?
    • diazepam or lorazepam
    • phentolamine and nitro (second line)
  16. What is the DOC for HTN crisis with acute postoperative HTN?
    esmolol, nicardipine, or labetalol
  17. What drug is CI in glaucoma?
    fenoldopam
  18. What drug is CI in acute CHF, asthma or low HR?
    BBL
  19. What drug is CI in acute CHF or coronary ischemia?
    nicardipine
  20. What drug is CI in renal failure +dehydration or hyperkalemia?
    enalaprilat

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