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62 Cards in this Set
- Front
- Back
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HTN urgency vs emergency
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1. urgency - severely elevated BP W/O end organ damage; SBP>180 DBP>120mmHg
2. emergency - end organ damage regardless of BP; see altered mental status, renal failure, & MI |
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what is the std TX for HTN emergency?
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1. ICU admission
2. cont BP monitoring 3. parenteral anti-HTN meds |
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T/F arterial line allows for cont BP monitoring
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T
arterial line allows for cont BP monitoring |
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what are the TX goals for HTN emergency?
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1. dec MAP by 20-25% w/in 60 min
2. CPP 70-90mm Hg |
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if you dec MAP too quickly which of the following are possible effects?
a. renal failure b. acute blindness c. ischemic cardiac & cerebral events d. inability to autoregulate cerebral blood flow to brain e. all the above |
e. all the above
if you dec MAP too quickly which of the following are possible effects? a. renal failure b. acute blindness c. ischemic cardiac & cerebral events d. inability to autoregulate cerebral blood flow to brain |
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1. at what MAP do you lose the ability to auto regulate cerebral blood flow to the brain?
2. at CPP < ___ you see ischemic brain injury a. 70 b. 90 c. 120 d. 150 |
1. c 120 MAP
you lose the ability to auto regulate cerebral blood flow to the brain 2. a 70 at CPP < 70 you see ischemic brain injury |
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T/F CPP limits are fairly wide, and we monitor BP continuously to err on the side of caution.
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F
CPP limits are NARROW, and we monitor BP continuously to make sure we're w/in those narrow limits. |
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How do you calc CPP (cerebral perfusion pressure)
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CPP = MAP + ICP
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What are the normal values for
1. CPP 2. MAP 3. ICP |
norm values:
1. CPP 70-90mm Hg 2. MAP 60-120mm Hg 3. ICP 10mm Hg |
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MAP eqn?
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(SBP + 2DBP) / 3
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If PT's MAP is stable after dec by 20-25% w/in 60 min, further dec SBP to __/__ over __-__ hrs. A gradual dec to PT's baseline is targeted over __-__ hrs.
Monitor for SSx of end organ deterioration 1. 170/110-120; 2-6; 12-24 2. 170/100-110; 3-5; 24-48 3. 160/100-110; 2-6; 48-72 4. 160/100 - 110; 2-6; 24-48 |
4. 160/100 - 110; 2-6; 24-48
If PT's MAP is stable after dec by 20-25% w/in 60 min, further dec SBP to 160/100-110 over 2-6 hrs. A gradual dec to PT's baseline is targeted over 24-48 hrs. Monitor for SSx of end organ deterioration |
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which of the following is a SSx of HTN emergency?
a. angina b. HA c. oliguria d. all the above |
d. all the above
SSx of HTN emergency include: angina, acute MI, pulmonary edema, dyspnea/orthopnea, cough, fatigue, HA, mental status changes, CNS dysfx, visual disturbances, oliguria, hematuria |
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what is the most common drug related cause of HTN crisis?
a. inappropriate combo b. cocaine c. cyclosporine d. nonadherence e. licorice |
a. nonadherence is the #1 cause of HTN crisis
other causes: inadequate doses, inappropriate combos, OTC meds (ephedra, ma haung, bitter orange), cocaine, amphetamines, sympathomimetics, oral contraception, adrenal steroids, cyclosporine, tacrolimus, erythropoietin, licorice |
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matching:
a. B blocker b. ACE-I c. NO vasodilator d. CCB e. other 1. enalaprilat 2. NTG 3. labetalol 4. fenoldopam 5. clevidipine |
b 1. enalaprilat - ACE-I
c 2. NTG - NO vasodilator a 3. labetalol - B blocker e 4. fenoldopam - other d 5. clevidipine - CCB B blockers: esmolol, labetalol, metoprolol ACE-I: enalaprilat NO vasodilators: NTG, nitroprusside CCB: verapamil, diltiazem, clevidipine, nicardipine Others: fenoldopam, hydralazine, nesiritide, phentolamine (alpha blocker) |
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Dosing for emergency:
1. Esmolol 2. Labetalol 3. Enalaprilat 4. NTG 5. Nitroprusside 6. Clevidipine 7. Nicardipine 8. Fenoldopam 9. Hydralazine 10. Nesiritide 11. Phentolamine |
Dosing for emergency:
1. Esmolol: bolus 500mcg/kg over 1 min; inf 50-300mcg/kg/min 2. Labetalol: bolus 20-80mg @ 10min intervals till desired BP reached; inf 1-2mg/min 3. Enalaprilat: 0.625-5mg IV q6 4. NTG: inf 5-200mcg/min 5. Nitroprusside: inf 0.25-10mcg/kg/min 6. Clevidipine: inf 1-2mg/hr 7. Nicardipine: inf 5-15mg/hr 8. Fenoldopam: inf 0.1mcg/kg/min; dose rng 0.03-0.3mcg/kg/min 9. Hydralazine: 10-20mg IV q4-6 10. Nesiritide: bolus in CHF 2mcg/kg; inf 0.01mcg/kg/min 11. Phentolamine: bolus 5-10mg |
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Dosing for other PO agents urgency:
1. captopril 2. clonidine 3. labetalol |
Dosing for other PO agents urgency
1. captopril 25mg x1 2. clonidine 0.1-0.2mg q1 max 0.6mg 3. labetalol 200-400mg q2-3 |
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which B blocker is B nonselective?
a. esmolol b. labetalol |
nonselective B blocker
labetalol: alpha1 & nonselective B blocker (1:7) esmolol B1 antag, cardioselective |
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esmolol is (+ / -) inotropic & chronotropic
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esmolol is (-) inotropic & chronotropic
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ADR of esmolol?
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1. asthma
2. heart block 3. hypotension 4. heart failure 5. nausea |
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what is the goal of aortic dissection?
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dec BP ASAP <120/80
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ADR labetalol?
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1. asthma
2. dizzy 3. heart block 4. hypotension 5. N/V |
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If you're having a HTN emergency, you should use which first?
a. B blocker b. NO vasodilator c. ACE-I d. all the above e. a & b |
e. a & b
If you're having a HTN emergency, you should use which first? a. B blocker b. NO vasodilator NOT c. ACE-I use AFTER 24 hrs |
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ADR enalaprilat?
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1. hyperkalemia
2. hypotension 3. precipitous fall in high renin states 4. renal dysfx |
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NTG is a venous vasodilator so it reduces pre/after load. At higher doses it acts as an arterial vasodilator
Nitroprusside is a arterial/venous vasodilator. It acts on pre/after load. |
NTG is a venous vasodilator so it reduces PREload. At higher doses it acts as an arterial vasodilator
Nitroprusside is a arterial & venous vasodilator. It acts on after & pre load. |
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ADR NTG?
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1. HA
2. hypotension 3. methemoglobinemia 4. tolerance w/ use (>24 hrs --> inc dose) 5. vomiting 5. |
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ADR nitroprusside?
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1. hypotension
2. muscle twitching & sweating 3. N/V 4. toxic metabolites w/ inf > 72 hrs |
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what toxic metabolites accumulate from nitroprusside causing irreversible neurologic changes & cardiac arrest?
a. cyanide b. thiocyanate c. selenium d. a & b e. all the above |
d. a & b
what toxic metabolites accumulate from nitroprusside causing irreversible neurologic changes & cardiac arrest? a. cyanide b. thiocyanate not c. selenium |
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clevidipine is a L/T type CCB. It dilates the arterioles --> dec afterload.
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clevidipine is a L type CCB. It dilates the arterioles --> dec afterload
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which of the following is a lipid formulation?
a. metopropol b. clevidipine c. fenoldopam d. NTG |
b. clevidipine
is a lipid formulation |
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ADR clevidipine?
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1. HA
2. hypotension 3. inc TG 4. N 5. tachycardia (reflex) |
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1. which of the following has benefits for cerebrovascular disease?
a. clevidipine b. nicardipine c. enalaprilat d. NTG 2. what are those benefits? |
1. b nicardipine
has benefits for cerebrovascular disease 2. crosses BBB; vasorelax cerebrovascular smooth muscle; dilates small resistant arterioles (no ICP changes) |
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which would be the best to TX hemmorrhagic stroke or CNS ischemia?
a. nicardipine b. fenoldopam c. NTG d. nesiritide |
a. nicardipine
TX hemmorrhagic stroke or CNS ischemia |
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ADR nicardipine?
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1. flushing
2. HA 3. hypotension 4. local phlebitis 5. tachycardia |
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1. which is good for TXing renal issues?
2. which is a Dpa-1 Rc agonist a. NTG b. esmolol c. nicardipine d. fenoldopam |
1 d. fenoldopam
TX renal issues 2 d. fenoldopam Dpa-1 Rc agonist |
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ADR fenoldopam?
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1. flushing
2. HA 3. hypotension 4. N 5. tachycardia |
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hydralazine is a peripheral vasodilator that dec pre/after load
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hydralazine is a peripheral vasodilator that dec AFTERload
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hydralazine is preferred for:
a. renal failure b. glaucoma c. eclampsia d. HTN encephalopathy e. a & b f. c & d |
f. c & d
c. eclampsia d. HTN encephalopathy hydralazine is preferred for |
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nesiritide is a recombinant B type natiuretic peptide. It is a venous, arterial, & coronary vasodilator, which dec pre/after load. It inc/dec cardiac output w/o direct inotropic effects
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nesiritide is a recombinant B type natiuretic peptide. It is a venous, arterial, & coronary vasodilator, which dec pre & after load. It inc cardiac output w/o direct inotropic effects
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which do you not need to titrate?
a. hydralazine b. nesiritide c. clevidipine |
b. nesiritide
don't need to titrate c. clevidipine --> titrate up @ 90 sec intervals to max 16mg/hr |
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if hydralazine is a choice DON'T choose it
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DON'T CHOOSE HYDRALAZINE
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ADR nesiritide?
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1. HA
2. hypotension 3. N 4. renal failure |
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which should you use in catecholamine excess (cocaine toxicity, pheochromocytoma, MAO-I interaxns)
a. esmolol b. nesiritide c. hydralazine d. phentolamine |
d. phentolamine
should use in catecholamine excess (cocaine toxicity, pheochromocytoma, MAO-I interaxns) |
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ADR phentolamine?
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1. chest pain
2. D 3. hypotension |
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1. PO agents are acceptable TX for
2. outpatient procedure is sufficient (follow up in 3-5 days) a. urgency b. emergency c. all the above |
1. a urgency
PO agents are acceptable TX for 2. a urgency outpatient procedure is sufficient (follow up in 3-5 days) |
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with urgency you should avoid PO & SL
a. nicardipine b. nifedipine c. verapamil d. diltiazem |
b. nifedipine
with urgency you should avoid PO & SL. it dec BP too fast & can lead to acute MI or stroke |
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matching preferred agent:
acute left ventricular HF a. clevidipine b. hydralazine c. enalaprilat d. nitroprusside |
c. enalaprilat
acute left ventricular HF |
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matching preferred agent:
acute aortic dissection a. esmolol b. hydralazine c. enalaprilat d. nitroprusside |
a. esmolol
acute aortic dissection but it can be combined w/ CCB or nitroprusside, but B blocker has to be 1st |
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matching preferred agent:
acute congestive heart failure a. labetalol b. NTG c. nesiritide d. nicardipine e. all the above except 1 f. all but 2 |
f. all but 2
acute congestive heart failure b. NTG c. nesiritide AVOID esmolol, clevidipine, nicardipine |
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matching preferred agent:
acute intracerebral hemorrhage a. clevidipine b. labetalol c. nicardipine d. phentolamine e. a & d f. b & c |
f. b & c
acute intracerebral hemorrhage b. labetalol c. nicardipine |
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matching preferred agent:
acute ischemic stroke a. NTG b. nicardipine c. labetalol d. nesiritide e. b & c |
e. b & c
acute ischemic stroke b. nicardipine c. labetalol |
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matching preferred agent:
acute MI a. esmolol b. NTG c. enalaprilat d. nicardipine e. all the above f. all but 2 e. a, b, d |
e. a, b, d
acute MI a. esmolol b. NTG d. nicardipine NTG & B blocker 1st then CCB AVOID enalaprilat |
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matching preferred agent:
acute pulmonary edema a. nesiritide b. NTG c. nitroprusside d. nicardipine e. all but d |
e. all but d
acute pulmonary edema a. nesiritide b. NTG c. nitroprusside |
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matching preferred agent:
acute renal failure a. clevidipine b. nesiritide c. fenoldopam d. nicardipine e. all the above except 1 |
e. all the above except 1
acute renal failure a. clevidipine c. fenoldopam d. nicardipine |
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matching preferred agent:
eclampsia a. labetalol b. hydralazine c. nicardipine d. all the above |
d. all the above
eclampsia a. labetalol b. hydralazine c. nicardipine |
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matching preferred agent:
perioperative HTN a. esmolol b. clevidipine c. fenoldopam d. all the above e. 2 of the above |
e. 2 of the above
perioperative HTN a. esmolol b. clevidipine NTG & B blocker 1st then CCB esmolol, NTG, nitroprusside, nicardipine, clevidipine |
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matching preferred agent:
sympathetic crisis or catecholamine toxicity a. labetalol b. clevidipine c. nicardipine d. phentolamine e. all the above f. all the above except 1 |
f. all the above except 1
sympathetic crisis or catecholamine toxicity b. clevidipine c. nicardipine d. phentolamine NO B blockers |
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matching preferred agent:
coronary ischemia a. esmolol b. NTG c. clevidipine d. nicardipine e. c & d |
b. NTG
coronary ischemia AVOID clevidipine & nicardipine |
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which should you avoid if a PT has glaucoma?
a. esmolol b. fenoldopam c. enalaprilat d. clevidipine |
b. fenoldopam
avoid if a PT has glaucoma |
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Avoid ___ if PT has dec levels of renin. ____ (race) commonly have low renin lvls.
a. clevidipine, african am b. enalaprilat, hispanic c. clevidipine, hispanic d. enalaprilat, african am |
d. enalaprilat, african am
Avoid ___ if PT has dec levels of renin. ____ (race) commonly have low renin lvls. |
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Avoid ___ if PT has soy bean allergy.
a. fenoldopam b. esmolol c. clevidipine d. nicardipine |
c. clevidipine
Avoid ___ if PT has soy bean allergy. |
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Avoid ___ if PT has high TG or lipid disorder.
a. labetalol b. clevidipine c. hydralazine d. phentolamine |
b. clevidipine
Avoid ___ if PT has high TG or lipid disorder. |
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Avoid ___ if PT has CAD
a. enalaprilat b. NTG c. phentolamine d. fenoldopam |
c. phentolamine
Avoid ___ if PT has CAD |
