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29 Cards in this Set
- Front
- Back
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Hypertension:
General HTN: -Systolic BP > ... mmHg OR -Diastolic BP > ... mmHg Hypertensive Urgency: -Systolic BP >... mmHg OR -Diastolic BP>... mmHg |
140
90 180 110 |
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Diagnosis and management depends on the ..., not the ...
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patient profile
absolute level of BP |
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Evaluation: signs and symptoms
... - HA, N/V, focal weakness, AMS, Sz ... - decreased visual acuity ... - chest pain, SOB, coughing ... -malaise, fatigue, asymptomatic ... -severe chest, abdominal or back pain, syncope |
Brain
Eyes Heart Kidneys Vascular |
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Brain: hypertensive encephalopathy
usually MeanArterialPressure > ...-... mmHg -mean is 1/3 between systolic and diastolic (closer to ...) Immediate MAP reduction by 20-25%, but excessive BP reduction will cause hypoperfusion, so bring down ... |
150-200
diastolic gradually |
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Heart: acute coronary syndrome
Immediate BP reduction to prevent myocardial ischemia If pulmonary edema (CHF) is present, tx must focus on decreasing ... and ... |
preload and afterload
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look at slide 15 and 16 - CXR
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ok
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Vascular: aortic dissection
Begins as tear in aortic ... Blood dissects into ... -true and false lumen (May channel back to lumen distally) at risk for hemorrhaging |
intima
media |
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What does this presentation suggest?
-severe, sudden onset tearing chest/abdominal pain w/ radiation to back -BP generally elevated, but may be normal or low at presentation due to hemorrhage |
Aortic dissection
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If you see a ... on a radiograph, you should assume aortic dissection until proven otherwise
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mediastinal widening
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Kidneys: renal failure
Renal function closely related to BP Renal disease may result in ... -Unable to dump fluid and electrolytes as needed -Impaired renal blood flow will trigger elevated ... to increase renal flow HTN may lead to acute ... -Parenchymal damage due to unadjusted flow to kidneys -Elevated ... and BUN; ... in urine |
HTN
BP renal failure creatinine RBCs |
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If someone comes in with severe HTN and no end-organ damage is found, what tests should you always order and why?
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UA (look for blood and protein) and chemistry panel (elevated K+/BUN/creatinine)
because the kidneys could be failing while showing no obvious signs (it’s silent) |
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Anti-HTN Meds: Considerations
Alpha-1: ... Alpha-2: decreases ... outflow, ... Beta-1: ... inotropic effects Beta-2: ..., ... |
vasoconstriction
sympathetic vasoconstriction positive vasodilation bronchodilation |
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Treatment of HTN emergencies:
If end-organ damage found, immediate MAP reduction with IV medications MAP=(1/3 (SBP-DBP) + DBP) -Mean arterial pressure is 1/3 of way up from DBP -Closer to DBP because more time spent in diastole Gradual BP reduction w/in ... Less than ...-...% reduction within first 30-60 minutes |
24hrs
20-25 |
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Treatment of HTN emergencies:
Begin IV anti-hypertensive medication Place ... to closely monitor BP – use in all HTN emerg pts Cardiopulmonary monitoring -Rhythm strip and pulse oximetry O2 administration Admit to ... |
arterial line
ICU |
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Tx: ...
Rapid onset 1-2 min, lasts 3-4 min Relaxes smooth mm. in arteries and veins Decreases preload and afterload -Decreases myocardial O2 demand May get reflex tachycardia May increase ICP Toxic metabolite thiocyanate |
Nipride (Na-Nitroprusside)
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Nipride (Na-Nitroprusside) – use:
-All HTN emergencies except ... Problems: -Rapid ... and sensitive to ...: Use within 24 of mixing and cover with foil |
pre-eclampsia (crosses placenta)
degradation light |
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Tx: ...
5-10 min onset; 8h duration Alpha-1 block and beta-1+2 block -4:1 a vs b blocking action Relaxes smooth mm. (a blockade) No reflex tachycardia (due to b blockade) No increased ICP May worsen severe CHF or COPD -(Negative inotropism and bronchoconstriction) |
Labetalol
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Tx: ...
Ultra short acting –use as drip (gtt) -5min onset, 2 min duration -All blockade will resolve w/in 30 min of d/c gtt Beta-1 blocker > Beta 2 Use in SVT, AMI, unstable angina, thyrotoxicosis Usually used in combination with other agent Not for use in COPD or asthma Not for use if cocaine present |
Esmolol
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Cocaine is an a-agonist:
-Vaso... Using b-blocking medication to treat this will cause ... inotropism (... myocardial contractility) without effects to vasodilate at a receptors “Unopposed a” may cause ... CO Labetalol considered safe, but generally avoid ... if cocaine present |
constriction
negative decreased decreased b-blockers |
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Tx: ... – IV
Immediate onset, lasts minutes Venous dilation > arterial dilation Decreases preload and afterload Coronary vasodilation Use for AMI/ischemia, CHF Headache, tachycardia, N/V, may decrease CO |
Nitroglycerin
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What drug should you use in pregnancy induced HTN?
-Can develop lupus-like syndrome with chronic oral use |
Hydralazine
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Tx: Hydralazine
Direct arterial dilator: -relaxes vascular smooth mm. Onset within 10min; duration 4-6 hr Use in pregnancy induced HTN Reflex tachycardia -Avoid with ... or ... Side FX: HA, nausea, lethargy, postural hypotension Can develop ... syndrome with chronic oral use |
aortic dissection or CAD
lupus-like |
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Hypertensive “urgency” management:
No end organ damage found Be sure to check ... function -Silent; asymptomatic -If patient newly diagnosed, you may not have baseline Check ... if chest pain ... if SOB ... head if focal neuro deficit (or HA) |
renal
EKG CXR CT |
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Hypertensive “urgency” Tx:
Sublingual ... -Used for: *Unstable angina *Acute MI *Acute LV failure with pulmonary edema (CHF) -Can also be used to rapidly reduce BP in HTN urgency -Quickly absorbed through oral mucosa *0.3-0.6mg tab or spray under tongue *Onset 5 min *Duration several hours |
Nitroglycerin (NTG)
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Sublingual Nitroglycerin (NTG) cont:
Not ... Rapidly and dramatic reduction in BP -May not be appropriate for HTN ... Side FX: HA, tachycardia, n/v, hypoxia, hypotension |
titratable
encephalopathy |
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Tx: ...
Alpha-2 agonist: decreases sympathetic activity (lowers plasma catecholamines) -Lowers BP and HR -Vasomotor reflexes unchanged so will not develop postural hypotension; no reflex tachycardia Onset in 30-60 min (but can be up to 6-8 h for adequate response), duration 6-8 hours Withdrawal when abruptly stopped: -Severe rebound hypertension, tachycardia, flushing, abd sx |
Clonidine
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Tx: ...
Angiotensin I converting enzyme inhibitor (ACE-Inhibitor) Acute CHF Rapid oral absorption; onset 15-30 min; duration 4-6hrs No change in CO, HR or cerebral flow May decrease renal blood flow -Avoid in chronic renal failure or renal a. stenosis May cause ... |
Captopril
angioedema |
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Tx: ...
Ca+2-channel antagonist Coronary and peripheral arterial dilation -May develop some tachycardia Rapid oral absorption: 1-5min SL; 3-5hr duration No change in renal flow Risk of serious adverse reactions -Acute coronary event; ischemic CVA |
Nifedipine
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Hypertensive “urgency” discharge example:
Restart their usual meds if previously prescribed Start ... -Begin at lower dose (12.5 or 25 mg) and f/u at one week to check response |
HCTZ
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