Pm_Renal_Intmed_Htn_Emergent

Front 1

Health Risk for Prehypertensives, ie BP 120-129 / 80-89

Back 1

2x risk for developing HTN as those with normal values

Front 2

What are the 2 types of Arterial HTN?

Back 2

Systolic HTN w/ wide PP (thus DBP is not high/as high)

Systolic and Diastolic HTN
--inc. PVR: renal, endo, neurogenic, misc


with Sys HTN and wide PP, think Decreased Aortic Compliance/Athero or Inc. Stroke Volume)

Front 3

What percentage of HTN is Essential?

Name some 2nd Causes of HTN

Back 3

aka Unknown or Idiopathic = 90-95%

2nd: Renal A. Stenosis, Renal Parenchymal Dz, Coarct of Aorta, Pheochromocytoma, HyperAldo, Misc

Front 4

This cause of HTN may present with:
Sudden onset HTN
Refractory to usual Tx
Abdominal Bruits
Milde HypoKalemia?

Back 4

REnal A. Stenosis: in older pts/men, think Athero, in young women, think Fibromuscular Dysplasia

Note: the Mild HypoK is 2nd to Activation of RAAS, aldo boots out K

Front 5

This 2ndary cause of HTN may present with:
Inc Serum Creatinine
+/- Abnormal U/A: protein, cells, casts?

Back 5

Renal Parenchymal Dz

Front 6

slide This 2ndary cause of HTN may present with:
Constriction of point on CXR
Late Systolic Murmur loudest in mid back
Children or young adults?

Back 6

Coarctation of Aorta
-constriction common at Left Subclavian A.
+ Delayed Femoral Pulse
+ CXR Notching
---3 Sign with Aorta

Front 7

This 2ndary cause of HTN may present with:
HTN and decreased K w/o Diuretics?

Back 7

Hyperadosteronism:
Adrenal Adenoma or
Bilateral Adrenal Hyperplasia

Front 8

This 2ndary cause of HTN may present with:
In Young to Middle Age
Paroxysmal or Sustained Sx and signs of:
Chronic Weight Loss
Palpitations
Orthostatic HTN
Impaired Glucose Intolerance
Profuse Diaphoresis

Back 8

Pheochromocytoma
-Dx with 24hr Urine--for catecholamine metabs
CT or angio to localize--can be very tricky to find!

Front 9

Name some Misc 2ndary cause of HTN
-____parathyroidism

Back 9

Cushings and Adrenogenital Syndromes
OCPs
HYPERparathyroidism
Acromegaly

Front 10

Renal A. Stenosis is young Fems more commonly du to What?

Back 10

Fibromuscular dysplasia

Front 11

Common Sx with Renal A. Stenosis?

Back 11

Bruit in Abdomen
Heart murmur in back

Front 12

Cause of HTN in Childs or Young Adults often due to ?

Back 12

Coarctation of Aorta
--const at L. Subclavian

Front 13

Sx/Signs of Coarct Aorta?
Xray?

Back 13

---dec or delayed femoral pulse
--Late systolic mumur loudest at mid back
--CXR notching
------3 Sign with Aorta

Front 14

Name 4 criteria for Hypertensive Urgencies?

Back 14

Severely HTN w/O Severe Sx or Progressive Target-Organ Damage (TOD)
-Newly Diagnosed, poor control/compliance
-Extensive Body Burns---greater fl loss from surface when bp is high in burn pts
-Severe Epistaxis--inc. blood loss when bp is high

Front 15

Name criteria for HTN Urgencies in Surgery

Back 15

Severe HTN in pts requiring immediate surg
Post-op HTN
Severe HTN after Renal Transplant

Also Rebound HTN is Urgent

Front 16

Name criteria for HTN Urgencies in Drug induced sits?

Back 16

OD of Sympathomimetics
Metoclopramide (GI motility drug)
Alpha Adrenergic agonist and Non selective BB Interaction

-+ asscw/ Chronic Spinal Injury --autonomic hyperreflexia syndrome

Front 17

Goals of Tx in HTN Urgencies?

Back 17

Lower BP w/in hours to 24 hrs

--aggresive dec BP harmful, esp w/ CV risks

Front 18

Tx options in URgency?
1 Alpha Drug
1 BB (selective)
1 ACE

Back 18

Clonidine: 0.2mg oral, 0.1mg every hour until control
---dec 25% / hour

Labetalol 200-400mg oral
Captopril

go see primary care physician soon after urgent tx

Front 19

What is the health risk for Malignant HTN

ie, Diastolic >120

Back 19

Risk or evidence of End-organ Damage no matter what the measured number

--seen in both essential and secondary HTN
--avg age 40
-men>women

Front 20

What is papilledema?

Back 20

Edema of the optic disk, region where the optic nerve forms, often due to increased intracranial pressure

Front 21

Name 3 HTN Emergencies?
have evidence of end organ damage as opp to Urgency

Back 21

Eclampsia or severe HTN during Preggers
Cerebrovascular

Front 22

Regarding Cerebrovascular HTN emergencies, what are ICH, SAH and ACIs?

Back 22

ICH: Intracranial Hemorrhage
SAH: Sub-arachnoid Hemorrhage
ACI: Acute Cerebral Infarcion

Front 23

What are a few other Cerebrovascular HTN

Back 23

Papilledema, Retinal Hemorrhages & Exudates
HTN Encephalopathy

Front 24

Name some common cardiac Target Organ Damage from HTN

Back 24

CHF
Acute Aortic Dissection
Acute LV failure w/ pulmonary edema
Acute MI
Unstable Angina

Front 25

Name some common Target Organ Damage in kidneys?

Back 25

Rapidly Progressive Renal Failure
Oliguria
Microangiopathic hemolytic anemia---may make worse

Front 26

The following are what?
Head Trauma
Post CABG-HTN
Post Op bleeding at suture/staple lines
Catecholamine Excess

Back 26

HTN Emergencies
--Pheo Crisis: Pheochromatosis

Front 27

The following are sx for what?
Severe Headache
Vomiting
Visual Disturbances (trans blind)
Trans Paralysis
Convulsions
Stupor
Coma

Back 27

Hypertensive Encephalopathy
--must exclude/consider too:
CVA, ICH, Seizure Dzo, Mass Lesion, Vasculitis, Encephalitis, Psych Dzo

Front 28

What are initial goals for Tx of HTN Emergencies?

Back 28

Limit/Prevent Target ORgan Damage--Correct Medical Complications
-get to 160/100 or reduce by 25% over Minutes to hours
---much diff than with Urgencies

Front 29

What is Rx for Tx of HTN Emergencies?

Back 29

Nitroprusside
0.25 -.8 mcg/kg/min
-with infusion pump

Front 30

MOA of nitroprusside?

Back 30

Dilates both Arterioles and Veins
-several days with few AEs
--risk of Cyanide Tox

Front 31

THis drug is good for Emergency HTN and dilates veins > arterioles

Back 31

Nitroglycerin
5-100mcg/min
--CABG, MI,
Unstable Angina
Left Ventricular Failure

Front 32

What sort of drug is Fenoldopam, an emergency HTN drug?
WHat is it an alternative to?

Back 32

Dopamine Agonist
0.4mcg/kg/min IV
--Possible alternative to Nitroprusside
-enhanced renal perfusion and Cre Cl
--risk of inc. intraOcular P.

Front 33

What is IV Enalaprilat especially good for?

Back 33

Enalaprilat
--Left Heart Failure

Hint 33

Hydr

Front 34

What is DOC for Pre-Eclampsia?

Avoided in what scenarios

Back 34

Hydralazine
-enhances uterine blood flow too

--avoid in Myo Ischemia, Aortic dissection

Front 35

What is alternative in Eclampsia if not responding to Hydralazine

Back 35

Labetalol
--Prevents inc in HR

Contraindicated in: asthma, HF, Brady/Heart Block

Front 36

What are 2 possible adjunct Rx to give while Tx HTN?

Back 36

Furosemide--maintaine Na DU as Arterial Pr. dec.
Bumetanide too

Digoxin as well

Front 37

Note on Tx of HTN?
Switch from IV to oral agents as soon as Pt is able to tolerate it

Back 37

and thats all