BBB last lect

Hypertensive crises both have measured BPs over

>180/120

severe BP with target organ damage (acute or ongoing) is a

hypertensive emergency

elevated HTN without symptoms or new or progressive target organ damage is defined as

hypertensive urgency

Emergent therapy goals

life threatening- immediately lower BP, IV therapy

Urgency therapy goals

lower BP over a few days, PO therapy

In a hypertensive crisis, initial evaluations should include ___ status check, intensive __ __ monitoring, EKG , collect a medical _, and determine medication_ .

mental, blood pressure, history, compliances,

in evaluations, consider full , symptoms, proper Blood pressure __, and if they have

vitals, measuring technique, pain/anxiety— if yes treat first

secondary causes of HTN

amphetamines, corticos, calcineurin inhibitors, decongestants, NSAIDs, estrogen oral contraceptives, cocaine, nicotine, food (sodium, alc)

Cardiac target organ damage includes: __dissection, acute __ failure , acute _ edema, or myocardial __

aortic, heart, pulmonary, ischemia

Neuro target organ damage may include: CVA, intracereberal __, severe _/confusion, encephalopathy

hemorrhage, headache, visual loss

Renal target organ damage may include: acute_ disease, decreased , and __.

renal disease, urine output, hematuria

Tests for organ damage evaluations include: __, chest__, urinalysis, CT, cardiac__, and serum __ and __.

EKG, X-ray, enzymes, creatinine, electrolytes

In hypertensive urgency- __ meds are given to lower BP within__. Choice of agent can involve __dose, __ therapy if nonadherent, or __.

oral, several days.

adjusting (inc), re-initiating, adding a new agent

re-eval hypertensive urgency patient within __ days. (prefered __ days).

start __ and go __

7; 1-3 days

low, slow

HTN urgency is outpatient treatment. Target is to lower systolic by _% or to __/__. Rapid correction can lead to__, __, __. However too slow can see:

25, 160/100

ischemia: stroke, MI, AKI

aneurysm, MI risk

HTN urgency bad ideas: __ route. Sublingual or IR (women) __.

IV, nifedipine

HTN urgency good short term ideas

captopril, clonidine (short term)

HTN emergency goals: reduce systolic by no more than __%, in __hour.

the drug of choice is __. Usually admit to __ and close __.

25, 1.

none

ICU, follow up

Sodium Nitroprusside dilates __ via __. It must be __, and has a half life of __.

venous and arterials directly, NO. titrates slowly, 2 mins.

Signs of nitroprusside toxicity include __, __, and decreased __saturation.

tinnitus, acidosis, O2

NTG is best used for __. primarily dilates the __, has a half life of __, must be made in a __ bottle, and common side effect includes __.

cardiac ischemia, veins, 1-4 mins, glass, headaches tolerance with prolonged use

Hydralazine is __ bc it is unpredictable and _ _ effects. half life is _.

contrindications:

discouraged, prolonged antihypertensive, 3-7 hrs

CAD (reflex tachycardia)

Enalaprilat drug class is _. has a long

ACEI, duration of effect

Fenoldopam is a postsynaptic _ agonist, decreasing peripheral _ _ with increased _ blood flow and diuresis.

avoid in patients with

dopamine, vascular resistance, renal

glaucoma

Nicardipine is a_ , with a longer half life up to _,

special indication: arterial HTN in _

CCB-dihydropyridine, 45 mins, acute ischemic stroke

Celvidipine is a _% lipid_. therefore avoid in allergies with _, _, or if pt cannot receive high _.

adverse effects include

20 emulsion, egg, soybeam triglycerides

afib, insomnia

esmolol is a _ beta-blocker while labetalol is a _.

selective B1, a1 and B 2 blocker.

labetalol is a good agent in _and _ disease.

stroke, coronary artery

the most common AE in labetalol is

orthostatic HTN

phentolamine is a _ blocker. its exclusive use is to counteract _. the main risk is_ because_

a1, catecholamine excess. CV- tachycardia alpha blockade without beta

aortic stenosis requires caution when adding BP meds

diuretics reduce , betablockers reduce _, and vasodilators reduce

preload, contractility, systemic blood pressure needed for coronary artery perfusion

General rule for aortic stenosis

low dose, titrate slowly (no specific treatment regimen, ACEIs are suggested)

Renal artery stenosis patients tend to have_. _ and _are not good classes to use with low _ pressure.

HTN, ACEI, ARBs, glomerular

permissive HTN in _ stroke means acute elevated BP is needed to _ brain _. Only address HTN is SBP is _ or DBP is _. and then lower by % in 1st _hours

ischemic, maintain perfusion, >220, >110.

15% in 24 hours (exception in thrombolysis)