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4 Cards in this Set
- Front
- Back
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Define hypertensive emergency and urgency
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Urgency: Diastolic greater than 120/130 and systolic greater than 180
Emergency: evidence of target organ damage to brain, hearts, kidneys |
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What are the goals in hypertensive crisis
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Urgency: Lower MAP to goal or near goal in 24 hrs
Emergency: Lower MAP by 25% or diastolic to 100-110 within 30 to 60mins |
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What are the common drugs used in hypertensive emergency
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Sodium Nitroprusside - cyanide/thiocyanate toxicity, do not use in renal/hepatic failure
Esmolol: bronchospasm, bradycardia, heart block Labetalol: same as esmolol Nicardipine: reflex tachycardia, nausea, do not use in acute HF Nitroglycerin - increased ICP Hydralazine: reflex tachycardia, HA, angina/MI Enalaprilat: renal insuffiency, hyperkalemia, renal artery stenosis Fenoldopam: HA, flushing, tachycardia Clevidipine: renal failure, hepatic failure, soy/egg product allergy |
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What agents are preferred in hypertensive crisis for specific comorbidities
Acute aortic dissection: Acute heart failure: Stroke: AMI: Pulmonary edema: Acute renal failure: Eclampsia, preeclampsia: Hypertensive encephalopathy: Sympathetic crisis: |
Acute aortic dissection: esmolol or in combo with nicardipine or nitroprusside
Acute heart failure: Nitroprusside, nitroglycerin, nesiritide, ACEI (avoid beta blockers) Stroke: nicardipine, labetalol AMI: Beta blocker in combo with nitroglycerin Pulmonary edema: nesiritide, nitroglycerin, nitroprusside Acute renal failure: Fenoldopam, nicardipine, clevidipine Eclampsia, preeclampsia: hydralazine, labetalol, nicardipine Hypertensive encephalopathy: nitroprusside, labetalol, fenoldopam, nicardipine Sympathetic crisis: nicardipine, fenoldopam, phentolamine |
