Scribd Logo
Upload

Welcome to Scribd!

  • 17 views

    Hypertension Emergencies & Urgencies: Dr. Suresh Menon MD (Int. Med.)

    Uploaded by

    sansac28
    This document discusses the definitions and treatment of hypertensive emergencies and urgencies. It defines emergencies as having symptomatic end-organ damage with diastolic BP over 130 mmHg, while urgencies are asymptomatic with diastolic BP over 110 mmHg. For emergencies, treatment aims to lower BP over hours with short-acting IV drugs like nitroprusside, nitroglycerin, fenoldopam, and hydralazine. Hypertensive urgencies can be treated orally with short-acting drugs like clonidine and beta-blockers. The document provides details on several IV antihypertensive medications and their dosages, onset times, durations, and adverse effects.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Hypertension Emergencies & Urgencies: Dr. Suresh Menon MD (Int. Med.)

    Uploaded by

    sansac28
    17 views20 pages
    This document discusses the definitions and treatment of hypertensive emergencies and urgencies. It defines emergencies as having symptomatic end-organ damage with diastolic BP over 130 mmHg, while urgencies are asymptomatic with diastolic BP over 110 mmHg. For emergencies, treatment aims to lower BP over hours with short-acting IV drugs like nitroprusside, nitroglycerin, fenoldopam, and hydralazine. Hypertensive urgencies can be treated orally with short-acting drugs like clonidine and beta-blockers. The document provides details on several IV antihypertensive medications and their dosages, onset times, durations, and adverse effects.

    Original Description:

    emergency management of hypertensin

    Original Title

    Ht n Emergency

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses the definitions and treatment of hypertensive emergencies and urgencies. It defines emergencies as having symptomatic end-organ damage with diastolic BP over 130 mmHg, while urgencies are asymptomatic with diastolic BP over 110 mmHg. For emergencies, treatment aims to lower BP over hours with short-acting IV drugs like nitroprusside, nitroglycerin, fenoldopam, and hydralazine. Hypertensive urgencies can be treated orally with short-acting drugs like clonidine and beta-blockers. The document provides details on several IV antihypertensive medications and their dosages, onset times, durations, and adverse effects.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    17 views20 pages

    Hypertension Emergencies & Urgencies: Dr. Suresh Menon MD (Int. Med.)

    Uploaded by

    sansac28
    This document discusses the definitions and treatment of hypertensive emergencies and urgencies. It defines emergencies as having symptomatic end-organ damage with diastolic BP over 130 mmHg, while urgencies are asymptomatic with diastolic BP over 110 mmHg. For emergencies, treatment aims to lower BP over hours with short-acting IV drugs like nitroprusside, nitroglycerin, fenoldopam, and hydralazine. Hypertensive urgencies can be treated orally with short-acting drugs like clonidine and beta-blockers. The document provides details on several IV antihypertensive medications and their dosages, onset times, durations, and adverse effects.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 20

    HYPERTENSION Emergencies & Urgencies

    Dr. Suresh Menon MD ( Int. Med.)

    Definitions
    Emergencies
    Symptomatic Acute End-Organ Damage Diastolic B.P. usually >130 mmHg

    Urgencies
    Asymptomatic NO Acute End-Organ Damage Diastolic B.P. usually >110 mmHg; Systolic B.P. usually >180 mmHg

    This is a Hypertensive Emergency


    Begin to look for other causes of symptoms

    Begin Treatment!

    Principles of Therapy
    Lower B.P. over hours
    Initial goal B.P. 160s/90s

    Too rapid lowering may cause dire consequences (CVA, MI) May take several days to get to reasonable levels Avoid medications that cannot be controlled (sublingual nifedipine)

    Hypertensive Emergencies: Treatment


    For most patients the greatest risk of treating a hypertensive emergency is the risk of accompanying hypotension.

    Treat with short acting, easily titratable, I.V. drug.

    Parenteral Drugs for Treatment of Hypertensive Emergencies


    Drug Dosage Onset Duration Adverse Indic.(I) Effects Contrain.(C)
    1-2 min. N/V,mus. twitch., cyanide, thiocyan. tox. intracran. pressure I: CHF, aortic dissect., catechol. C: hepatic, renal insuff. HA, I: coronary dizziness, dis., CHF vomit., C: CVA methemglo. intracran. tolerance pressure

    Vasodilators
    Nitroprus- 0.3-10 1-2 min. side mcg/kg/min IV infusion

    Nitroglycerin (IV)

    5-100 2-5 min. mcg/kg/min

    3-5 min.

    Parenteral Drugs for Treatment of Hypertensive Emergencies


    Diazoxide

    (Hyperstat
    IV)

    1-3 mg/kg (up to 150 mg) IV bolus, q515 min; repeat q424 hr as needed

    2-4 min

    3-12 hr

    Nausea, hypotension, flushing, tachycardia, hyperglycemia, aggravation of angina, fluid retention

    C: Syndromes of coronary insufficiency, (unless used with betablocking agent), cerebrovascul ar accident, hypersensitivity to sulfonamides

    Parenteral Drugs for Treatment of Hypertensive Emergencies


    Fenoldopam 0.1-1.7 mesylate micrograms/kg/min (Corlopam) IV infusion 5-15 1-4 hr Headache, dizziness, min flushing,
    I: Severe hypertension with increased renal insuffiintraocular ciency pressure, hypokalemia, C: Glaucoma dose-related tachycardia

    Hydralazine 10-20 mg IV or IM 10-20 3-8 hr Tachycardia, I: CHF flushing, C: Coronary HCl bolus, repeat q4-6 hr min headache, insufficiency, (Apresoline) as needed (maximum
    dose, 40 mg) vomiting, aggravation of angina

    aortic dissection, cerebrovascular accident (may increase intracranial pressure)

    Parenteral Drugs for Treatment of Hypertensive Emergencies


    Enalaprilat 1.25-5 mg q6 15
    (Vasotec I.V.) hr IV min 6 hr Precipitous drop in blood pressure in high-renin states, variable response I: CHF C: Use with caution in patients with severe renal insufficiency
    (not receiving dialysis)

    Nicardipine 5-15 mg/hr 5-20 IV infusion min HCl


    (Cardene)

    1-2 Tachycardia, hr headache, flushing, local phlebitis

    C: Greater than firstdegree heart block, CHF

    Parenteral Drugs for Treatment of Hypertensive Emergencies


    Adrenergic Inhibitors
    Phentolamine (Regitine) -blocker 5-20 mg IV, repeat as necessary 1-2 min 10-30 Tachycardia, I: min nausea, Catecholamine flushing, excess abdominal C: Syndromes pain, of coronary aggravation insufficiency of angina 10-20 Hypotension, I: Syndromes of min nausea, coronary bradycardia insufficiency or heart C: Greater than block, first-degree dizziness heart block, CHF

    Esmolol 200-500 1-2 HCl micrograms/kg/ min (Brevibloc) min over 1-4 min, then 50-300 micrograms/kg/ min IV infusion

    Parenteral Drugs for Treatment of Hypertensive Emergencies


    Labetalol HCl (Normodyne, Trandate) - blocker 20-80 mg IV bolus, repeat as needed (maximu m dose, 300 mg); or 2 mg/min IV infusion 2-10 min 2-4 hr Hypotension, nausea, itching, scalp tingling, dizziness I: Syndromes of coronary insufficiency, catecholamine excess C: > firstdegree heart block, CHF, bronchial asthma

    Fenoldopam: Indications
    In-hospital, short-term (up to 48 hours) management of severe hypertension when rapid, but quickly reversible, emergency reduction of blood pressure is clinically indicated, including malignant hypertension with deteriorating end organ function. Transition to oral therapy with another agent can begin at any time after blood pressure is stable during fenoldopam infusion.

    Physiologic Effects Fenoldopam


    Does not cross BBB Systemic Vasodilation

    Metabolized by conjugation No P450 interaction

    Coronary Vasodilation without steal (in animals) Reflex tachycardia


    RBF Na excretion H2O excretion Maintains GFR during BP lowering

    Mesenteric vasodilation Mucosal PO2 (in animals)

    Fenoldopam: Adverse Events


    Headache Flushing Nausea EKG Abnormalities Tachycardia Vomiting Dizziness Extrasystoles Dyspnea

    Hypotension
    Hypokalemia

    Nicardipine: Characteristics
    Dihydropyridine Reflex tachycardia Useful when -Blockers contraindicated Water soluble and light stable
    (allows for IV infusion)

    Slow onset and offset Arterial catheter not mandatory May accumulate Variable duration of hypertensive effect Good in patients with renal disease

    Nitroprusside
    Onset 1-4 min., half-life Toxicity related to 1-2 min. total dose Metabolized by RBC S&S: met. acidosis, to cyanide then by confusion, air hunger, liver to thiocyanate, hyper-reflexia, cleared by kidneys confusion, and Caution with hepatic seizures. &/or renal disease Reversible by hydroxycobalamine, sodium nitrate, (?) methylene blue

    Therapy Hypertensive Urgencies


    Oral meds. Preferred
    Close monitoring Fast follow-up Start with short acting forms
    (not Ca+2 channel blockers)

    Drugs for Urgencies


    Clonidine -Blockers, - Blockers Captopril, Enalapril Minoxidil (if already on -blocker & diuretic) Hydralazine

    Drug Related Malignant Hypertension


    MAO Inhibitors Cold Preparations Withdrawal Antihypertensive Meds
    Clonidine, -Blockers

    Street Drugs
    Cocaine, PCP

    You might also like