Htncx

Front 1

What is the definition of hypertensive crisis?

Back 1

SBC >160 and DBP >100

Front 2

What is the definition of hypertensive urgency?

Back 2

HTN crisis w/o acute target organ damage

Front 3

hypertensive emergency

Back 3

HTN crisis with acute target organ damage

Front 4

pathophysiology of hypertensive crisis

Back 4

1)endothelial damage
-clotting cascade
-vasoconstrictor release
2)renin-angio activation
3)catecholamine release
4)mechanical stretching of vessel
-cytokine release

Front 5

target end-organ damage in hypertensive emergency

Back 5

1)brain
-stroke, encephalopathy, mental status changes
2)retina
-papilledema, hemorrhages
3)kidney
-hematuria, proteinuria, inc.SCr
4)heart
-AMI/UA, dissecting AA
5)pulm edema, eclampsia, hemolytic anemia

Front 6

perioperative hypertension definition

Back 6

SBP >20% pre-operative reading for 15 mins or >50% increase from original value

Front 7

perioperative hypertension etiology

Back 7

1)vasoconstriction (catecholamines, baroreceptor)
2)intravascular hypovolemia

Front 8

how long does postoperative hypertension last?

Back 8

2-6 hours

Front 9

formula for cerebral perfusion pressure

Back 9

CPP = MAP - ICP

Front 10

preeclampsia criteria (mild)
BP, proteinuria, platelets, liver function, clotting studies, bilirubin

Back 10

-BP 130/80 - 140/95
-proteinuria 300mg/24 hours
-platelets, LF, clotting studies, bilirubin = normal

Front 11

preeclampsia criteria (moderate)
BP, proteinuria, platelets, liver function, clotting studies, bilirubin

Back 11

-BP = >160/110
-proteinuria = >5gm/24 hours
-platelets = <150,000
-liver function = elev AST/ALT
-clotting studies = may be prolonged
-bilirubin = may be elevated

Front 12

What criteria reflect patients with the greatest risk for mortality and morbidity?

Back 12

HELLP
-hemolysis
-elevated liver enzymes
-low platelets

Front 13

goals of therapy

Back 13

lower MAP or DBP over an acceptable time frame based on severity of crisis and individual patient tolerance w/o provoking cerebral or cardiac hypoperfusion, stroke, or MI

Front 14

hypertensive emergency goal

Back 14

decrease MAP by 20-30% over 30-60 mins or decrease DBP by 5-1- every 5-10 mins to a diastolic pressure of 100

Front 15

hypertensive urgency goal

Back 15

reduce DBP gradually over a period of 12-24 hours

Front 16

route of administration for hypertensive emergency and hypertensive urgency

Back 16

-IV
-oral or parenteral

Front 17

What variables effect SVR?

Back 17

-circulating vasoconstrictors
-circulating catecholamines

Front 18

What variables effect CO?

Back 18

-circulating catecholamines

Front 19

Treatment options for SVR

Back 19

-Calcium channel blockers
-nitrovasodilators
-dopamine agonists
-ACE inhbitors

Front 20

Treatment options for CO

Back 20

beta blockers

Front 21

Sodium nitroprusside MOA

Back 21

1)arterial and venous vasodilation which decreases both preload and afterload
-metabolized by blood vessels to NO leading to cGMP and vasodilation

Front 22

sodium nitroprusside onset of action

Back 22

30 seconds to 2 minutes

Front 23

sodium nitroprusside metabolization

Back 23

smooth muscle metabolizes nitroprusside to NO and cyanide, cyanide further metabolized by rhodanase to thiiocyanate which is elimated in urine

Front 24

sodium nitroprusside toxicity

Back 24

1)hypotension
2)infusion >4mcg/kg/min for >24 hours can lead to cyanide toxicity (cardiac arrest, encephalopathy, seizures, coma)

Front 25

Labetalol MOA

Back 25

1)selective alpha and non-selective beta adrenergic receptor blocker with alpha: beta ratio of 1:7

Front 26

labetalol onset of action

Back 26

5-15 mins and lasts up to 2-12 hours

Front 27

labetalol adverse effects

Back 27

1)heart block
2)orthostatic hypotension

Front 28

Esmolol MOA

Back 28

1)cardioselective beta adrenergic blocker, decreases sympathetic tone

Front 29

esmolol onset of action

Back 29

seconds and duration of action up to 10-20 mins (ideal in ICU)

Front 30

esmolol metabolization

Back 30

occurs in erythroctes by esterases and has a metabolite 1/500 activity eliminated in urine

Front 31

esmolol adverse effects

Back 31

1)hypotension
2)nausea

Front 32

esmolol hepatic and renal considerations

Back 32

don't need to adjust in hepatic or renal failure and useful in patients w/ AMI

Front 33

Fenoldopam MOA

Back 33

dopamine agonist (DA1 agonist) through dilation of coronary, renal (afferent/efferent) arteries

Front 34

Fenoldopam onset of action

Back 34

5-15 minutes w/ duration of action up to 30-60 mins

Front 35

Fenoldopam metabolism

Back 35

via hepatic pathway w/ involvement of P450 system

Front 36

fenoldopam adverse effects

Back 36

1)tachycardia
2)nausea
3)flushing

Front 37

fenoldopam vs. dopamine

Back 37

5-10x more potent than dopamine for renal vasodilator

Front 38

Nicardipine MOA

Back 38

2nd gen dihydropyridine CCB particularily selective for cerebral and coronary vessels

Front 39

nicardipine onset of acction

Back 39

1-5 mins and duration of action 2-6 hours

Front 40

nicardipine adverse effects

Back 40

1)tachycardia
2)headache

Front 41

nitroglycerin MOA

Back 41

-potent vasodilator that decreases blood pressure by decreasing preload and cardiac output
-compromises cerebral and renal perfusion due to decreased preload and CO

Front 42

nitroglycerin onset of actio\n

Back 42

2-5 mins and duration of action is 5 mins

Front 43

nitroglycerin adverse effects

Back 43

1)hypotension
2)tachycardia
3)headache
4)tolerance

Front 44

hydralazine MOA

Back 44

vasodilator that reduces peripheral resistance by direct action on vascular smooth muscle

Front 45

hydralazine onset of action

Back 45

5-15mins then preciptous fall in BP lasting 12 hours

Front 46

hydralazine adverse effects

Back 46

1)angina aggravation
2)tachycardia
3)headaches
4)unpredictable effects on BP and difficult to titrate

Front 47

enalaprilat MOA

Back 47

-reduces serum aldosterone, reduction in total peripheral resistance and afterload
-only IV ACE inhibitor

Front 48

enalaprilat onset of action

Back 48

15-30 mins and duration of action up to 6 hours

Front 49

enalaprilat adverse effects

Back 49

preciptous fall in BP in high-renin states, variable response

Front 50

1st line treatment for hypertensive emergency

Back 50

nitroprusside

Front 51

severe renal or hepatic insufficiency and MI

Back 51

nitroglycerin

Front 52

preeclampsia or eclampsia

Back 52

hydralazine

Front 53

preoperative patients w/ aortic dissection

Back 53

esmolol

Front 54

renal insufficiency w/ risk of cyanide toxicity

Back 54

fenoldopam

Front 55

coronary, cerebral, or peripheral artery disease and surgical patients

Back 55

nicardipine

Front 56

patients with HF and at risk for cerebral hypotension

Back 56

enalapril

Front 57

syndromes of coronary insufficiency (avoid in CHF, COPD, decreased HR)

Back 57

labetolol