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26 Cards in this Set
- Front
- Back
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define severe HTN
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diastolic BP > 115mmhg
or higher end organ damage? renal, CNS, CV |
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M&M of untreated HTN crisis
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life expectancy <2yrs
1yr<25% 5yrs <1% |
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most frequent signs of HTN urgency
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headache
epistaxis faintness/agitation |
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most frequent signs of HTN EMERgerncy
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neuro deficit
dyspnea angina |
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average ages for HTN urgency/emergency
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urgency 67 +/- 16
emergency 60 +/-14 |
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average diastolic pressures for HTN urgency vs. emergency
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urgency 130 +/- 15
emergency 126 +/- 10 |
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major causes of HTN crisis
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drug use
amphetamine use - diet suppressive meds steroid use - Na retention MOA inhibitors withdrawal from HTN drugs - clonidine eclampsia withdrawal from CNS depressants severe curns |
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how to diagnose HTN urgency/emergency
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BP in both arms, repeat
CXR - pulmonary edema!!!! |
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labs for HTN
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urine and renal function
urine drugs cbc electrolytes serum |
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what special tests for HTn emergency/urgency
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ECG
fundoscopic exam |
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goals of tx for HTN emergency/urgency
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lower MAP by 20-25%
or lower 100-110 mmhg over 24-48 hrs need a map of 60 to perfuse Treat to stop end organ damage by reducing BP |
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Drugs to treat HTN emergency in neuro stuff
HTN encephalopathy CNS event - hemorrhage? |
labetalol
nitroprusside fenoldapam |
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Drugs to treat HTN crisis for MI
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nitroglycerine IV - veins decrease
labetolol fenoldapam morphine sulfate |
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drugs to treat HTN crisis with CHF
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same as HTN with MI
nitrogly IV labetalol fenoldopam morphine sulfate |
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Drugs to treat HTN crisis with renal failure
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nitroprusside
labetalol fenoldopam |
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drugs to treat HTN emergency with pheochromocytoma
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phentolamine
labetolol |
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drugs to treat HTN emergency with aortic dissection
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BBs (propanolol) with nitroprusside
trimethaphan and BB or esmolol |
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drugs to treat HTN emergency with antiHTN withdrawal
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labetolol
phentolamine |
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drugs to treat HTN emergency with eclampsia or preeclampsia
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hydralazine
mag sulfate |
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Drugs to treat HTN urgency
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clonidine
labetalol nitroprusside hydralazine - ONLY ONE FOR PREGNANCY URGENCY propanolol eslmolol phentolaminemag sulfate furosemide fenoldapam clevidipine |
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notes on nitroprusside
what is also used with this? and for what reason? |
reduce preload, and afterload a bit
help decrease MI size methemoglobinemia used in conjunction with furosemide in px's with HTN pulmonary edema!!! loop |
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notes on labetolol.
when contraindicated? at what specific time can this drug be used? |
contra in px's with left ventricle dysfunction
may be used in labor and delivery at dr.'s judgement |
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what is the only drug recommended during pregnancy for HTN CRISIS tx?
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hydralazine
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what drug cannot be used with any other meds except X and Y
for treating HTN crisis |
phentolamine
only used with lanoxin and insulin |
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what drug used in eclampsia and preeclampsia.
what can too much of this drug cause |
magnesium sulfate ( also hydralazine 1st choice)
overdose = paralysis this is a muscle relaxer |
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what is furosemide also used with in HTN crisis and in what specific case
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used with nitroglycerin for hypertensive pulmonary edema
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