Term
ANTIHYPERTENSIVES
HYPERTENSIVE CRISIS |
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Definition
Causes
-Chronic hypertension
-renal disease
-Preecalmpsia
-Pheochromocytoma
-Head Injury |
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Term
| Causes of Hypertensive Crisis |
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Definition
Medications
-Cocaine, amphetamines, diet pills
-MONOAMINE OXIDASE (MAO) INHIBITORS
--Tyramine containing foods
--sympathomimetic agents
-rebound from antihypertensive therapy |
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Term
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Definition
| -the ability to maintain cerebral blood flow for a range of blood pressure through vasodilation and vasoconstriction |
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Term
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Definition
-chronic hypertension raises upper and lower limits
-Trauma increases lower limit |
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Term
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Definition
| DEFINITION-Diastolic BP Greater than 120mmHg without the presence of end organ damage |
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Term
Hypertensive Urgency
Goal of therapy |
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Definition
to decreas blood pressure over 24-48hrs
Treatment options
-Captopril (Capoten)
-Nifedipine (procardia)
-Clonidine (catapres) |
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Term
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Definition
-Decrease both preload and afterload
-most don't work very fast
--Exceptions: captopril, IV enalapril, lisinopril
-Recommended for
--hypertension, heart failure, postmyocardial infarction
-ADVERSE EFFCTS: hypotension, cough, increased K+, angioedema |
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Term
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Definition
-Pharmokinetics
ONSET: 15min
DURATION: 4-6 hrs
--Variable, potentially excessive response
DOSE: 6.25-50mg |
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Term
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Definition
3 major classifications
-PHENYLALKYAMINES (verapamil)
-BENZOTHIAZEPINES (diltiazem)
-DIHYDOPYRIDINES (nifedipine)
-Each class bind during a different state
-Verapamil and diltiazem when channel open
-Nifedipine during resting stage |
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Term
| Calcium Channel Blocker Effects |
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Definition
-Vaodilation with decreased SVR
-Decreased contraction of myocardium and oxygen consumption
-Decreased heart rate and conduction
Adverse Effects: flushing, dizziness, HA, constipation (V), peripheral edema (N), hypotension (V) |
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Term
NIFEDIPINE (PROCARDIA)
CONTROVERSY |
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Definition
SL Administration not FDA approved-"bite and swallow" no longer performed
-lack of controlled trials
-case reports
Widely prescribed for BP control
-no longer used in most EMS |
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Term
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Definition
-inhibits CNS and decreases sympathetic outflow
--reduces heart rate, vascular tone, and BP
--One of the few agents with real data about use in the ED |
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Term
Clonidine (Catapres)
Pharmokinetics |
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Definition
-Alpha-2 agonist, centrall acting antihypertensive
-ONSET: 0.5-1hr
-DURATION: 6-8hrs
DOSE
-0,2mg initially, the 0.1mg/hr up to 0.8mg
SIDE EFFECTS: sedation, dry mouth |
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Term
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Definition
Diuretics
-not practical in lowering BP immediately
-useful whn starting patients on anti-HTN therapy
CLASSES
-Thiazides- Na/Cl resorption in distal tubule
-LOOP: inhibit Na/K/Cl transport in loop of Henle
-K+ sparing:Inhibit aldosterone or sodium levels |
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Term
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Definition
Direct arteriolar dilator
-No venous effects
-works on renal, splanchnic, and coronary arteries
-May cause reflex tachycardia
-2hr 1/2 life
-contraindicated in patients with CAD |
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Term
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Definition
-Activates K+ ATP-ase channel
-Longer 1/2 life and effect duration than hydralyzine
-used only for resistant form of hypertension
-ADVERSE EFFECTS
--Excessive vasodilation
--hair growth |
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Term
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Definition
PHARMOKINETICS-Artiolar vasodilator ONSET: 1-5min DURATION: 6-12hrs
DOSE: IV Bolus: 50-100mg q 5min up to 600mg
SIDE EFFECTS: Tachycardia, N/V, fluid retention, hyperglycemia
*old drug, not really used much today |
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Term
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Definition
-Direct effect on arterioles and veins
-very new, many MDs, do not know about it
-Works as fast as nitroprusside
--short 1/2 life
-no toxic metabolite
-PROBLEMS: high cost, raise intraoccular pressure |
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Term
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Definition
Pharmokinetics
-Direct arteriolar and venodilator
-ONSET: seconds
-Duration: 3-5 minutes
DOSE
-0.5-8mcg/kg/min
-start at lowest end of dosage range
-average dose: 3mcg/kg/min |
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Term
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Definition
-Risks for thiocyanate toxicity
--liver impairment
--renal impairment
--treatment longer than 48-72hrs
--DOSE: .5mcg/kg/min
SIGNS OF TOXICITY
-metabolic acidosis
-Thiocyanate levels >10mg/dl
-CNS changes |
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Term
Nitroprusside (Nipride)
ADVERSE EFFECTS |
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Definition
-Hypotension
-nausea, vomiting
-thiocyanate toxicity
CAUTION-protect fromlight, mix in D5W |
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Term
Nitroprusside (Nipride)
(cont) |
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Definition
-metabilized to cyanide
-Hepatically converted to thiocyanate
-renal elimation |
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Term
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Definition
EFFECTS
--Alpha-1 post-synaptic and non-selective beta blocker
-Decreases peripheral vascular resistance |
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Term
Labetalol (Normodyne)
PHARMOKINETICS |
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Definition
-ONSET: 5-10min
-DURATION: 3-6hrs
DOSE:
BOLUS: 20-80mg every 5-10min up to 300mg
Infusion: 0.5-2mg/min |
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Term
Labetalol (Normodyne)
SIDE EFFECTS |
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Definition
-n/v
-scalp tingling
-heart block
-bronchspasm |
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Term
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Definition
DEFINITION-Diastolic BP greater than 120mmHg in the presence of end organ damage
GOALS OF THERAPY
-to decrease diastolic BP to 100mmHg or by 25% within 1-2 hrs, whichever value is higher
-Avoid rapid reduction
-normalize BP over 1-2 weeks |
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Term
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Definition
Hypertensive encephalopathy
-failure of autoregulation
-severe headache
-n/v
-visual changes
-confusion
-focal or generalized weakness |
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Term
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Definition
CNS-papilledema, AV nicking, hemorrhage, seizures, obtundation, rule out intracranial pathology
DRUGS OF CHOICE-Nitroprusside, labetalol, diazoxide
AVOID: methyldopa, Clonidine |
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Term
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Definition
-acute renal failure, hematuria, protenuria, casts
-cause and effect of accelerated hypertension
DRUGS OF CHOICE-Nitroprusside, Calcium Channel antagonists
AVOID-beta blockers |
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Term
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Definition
-Ischemia, Increased O2 demand
-CHF, pulmonary edema, MI
DRUGS OF CHOICE: Nitrates-decrease SVR and improve coronary perfusion
--Labetalol
--Calcium channel blockers
--Nitroprusside-use cautiously
AVOID-hydralazine, Diazoxide |
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Term
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Definition
DEFINITION-BP greater than 140/90 after the 20th gestational week with edema, proteinuria, seizures
DRUGS OF CHOICE: Hydralazine, Labetalol, Calcium channel blockers
AVOID-Nitroprusside, Beta blockers |
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