Quiz 2 Roadmap-High Acuity

What are the interventions for hypertensive urgency?

1) Meds: lisinopril/captopril, metoprolol, amlodipine, losartan, clonidine

2) reducing stimuli: sitting in a quiet room, dim light, sit calmly

3) education: diet, exercise, alcohol/smoking cessation, med management

4) addressing psychosocial needs

sodium nitroprusside

releases nitric oxide and cyanide in blood. Nitric oxide relaxes smooth muscle in the blood

Does nitroprusside drop in preload afterload or both?

both

Labetalol

A1, B2, (decreases HR and contractility), and B2 blocker. Primarily causes arterial dilation and decreased HR.

Does labetalol drop in preload, afterload, or both?

afterload

Clevidipine

Arterial dilator, selective CCB in smooth muscle (does not block Ca in heart) that causes rapid reductions in blood pressure without affecting heart rate.

Does clevidipine cause a drop in preload, afterload, or both? 

afterload 

Hydralazine

potent arterial dilator relaxing smooth muscle

Does hydralazine cause a drop in preload, afterload, or both?

Afterload

Esmolol

selective B1 blocker, it decreases HR and contractility

Does esmolol cause a drop in preload, afterload, or both?

It primarily decreases afterload.

What are the key differences in urgency vs emergency hypertensive crisis?

Urgency refers to severely elevated blood pressure without acute end-organ damage, while emergency indicates significantly elevated blood pressure with acute damage requiring immediate intervention.

Which condition(s) require immediate interventions based on the SBP vs MAP 

aortic dissection: SBP should be lowered to less than 100-120 mm Hg as soon as possible, if tolerated by the patient 

acute ischemic stroke: BP needs to be lowered to allow for the use of thrombolytic agents 

what timeframe do we use to reach our MAP goal?

1-2 hours

What parameters are we targeting in hypertensive emergency?

The parameters targeted in a hypertensive emergency include a mean arterial pressure (MAP) of less than 110 mmHg, with careful monitoring to avoid rapid drops that could cause further complications.

What are the pharmacokinetics of dobutamine?

Dobutamine is a catecholamine that primarily stimulates beta-1 adrenergic receptors, increasing cardiac output by enhancing myocardial contractility. It has a short half-life, typically 2 minutes, and is administered intravenously.

If a patient’s heart is failing due to weak contractility, which medications would be best to give?

dobutamine and dopamine because they increase contractility strengthand improve cardiac output.

Sodium nitroprusside (nitropress)

dilates veins - decreases preload

dilates arteries - decreases afterload 

nitroglycerine 

dilates veins - decreases preload

morphine sulfate

dilates veins - decreases preload

dilates arteries - decreases afterload 

milrinone

dilates arteries - decreases afterload

dopamine

increases contractility strength

dobutamine

increases HR and contractility

which side of the heart more commonly fails in heart failure?

left-sided heart failure 

what physical finding is different in a patient with a vascular assist device (VAD) that may confuse a nurse on assessment?

these patient’s do not have a pulse or a BP