Management of Hypertensive Emergencies
120 Questions
0 Views

Management of Hypertensive Emergencies

Created by
@CleanlyBoston

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which arteries are primarily affected by peripheral vascular disease (PVD)?

  • Subclavian and carotid arteries
  • Pulmonary and jugular veins
  • Coronary and cerebral arteries
  • Arteries of the lower limbs and renal arteries (correct)

    • What is the most important risk factor for developing peripheral vascular disease?

  • Family history of cardiovascular disease
  • Age greater than 65 years
  • Obesity
  • Smoking (correct)

    • Which of the following is NOT a manifestation of peripheral vascular disease?

  • Ischemic ulcers
  • Palpitations in the chest (correct)
  • Intermittent claudication
  • Rest pain when elevated

    • What lifestyle change is identified as the most crucial for managing peripheral vascular disease?

    <p>Stopping smoking</p> Signup and view all the answers

    Patients over what age are particularly at risk for developing peripheral vascular disease?

    <p>65 years</p> Signup and view all the answers

    Which treatment is recommended for managing hypercholesterolemia in peripheral vascular disease?

    <p>Statins</p> Signup and view all the answers

    Which symptom commonly presents with intermittent claudication in peripheral vascular disease?

    <p>Pain in the muscles when walking</p> Signup and view all the answers

    What is a common skin manifestation noticed in patients with peripheral vascular disease?

    <p>Cool, bluish skin</p> Signup and view all the answers

    What is the primary initial target for systolic blood pressure reduction in the first 1-2 hours during the management of hypertensive emergencies?

    <p>To lower systolic BP by no more than 25%</p> Signup and view all the answers

    Which of the following drugs is NOT recommended for use in the management of hypertensive emergencies?

    <p>Nifedipine</p> Signup and view all the answers

    Which of these conditions is associated with hypertensive emergencies and may result from untreated severe hypertension?

    <p>Cerebral stroke</p> Signup and view all the answers

    What should be the approach to lowering blood pressure in hypertensive emergencies to avoid ischemic events?

    <p>Lowering BP gradually within hours</p> Signup and view all the answers

    What is indicated in the management of hypertensive emergencies to prevent significant volume depletion?

    <p>Careful monitoring of volume overload</p> Signup and view all the answers

    Which symptom is NOT typically associated with hypertensive encephalopathy?

    <p>Rapid heartbeat</p> Signup and view all the answers

    What might occur if blood pressure is lowered too quickly in patients with chronic hypertension?

    <p>Cerebral, renal, and myocardial ischemic events</p> Signup and view all the answers

    Which clinical presentation is characteristic of hypertensive encephalopathy?

    <p>Focal neurologic signs</p> Signup and view all the answers

    What is the primary mechanism of action for pentoxifylline?

    <p>Inhibition of PDE enzyme leading to increased RBC deformability</p> Signup and view all the answers

    Which condition is pentoxifylline NOT primarily indicated for?

    <p>Congestive heart failure (CHF)</p> Signup and view all the answers

    What is the typical dosage regimen for pentoxifylline?

    <p>400 mg twice a day</p> Signup and view all the answers

    Which side effect is most commonly associated with cilostazol?

    <p>Headache</p> Signup and view all the answers

    Cilostazol is contraindicated in patients with which condition due to increased mortality risk?

    <p>Congestive heart failure (CHF)</p> Signup and view all the answers

    What significant benefit does clopidogrel offer over aspirin in diabetic patients?

    <p>Additional protective effects in peripheral vascular disease (PVD)</p> Signup and view all the answers

    Which enzyme does cilostazol inhibit?

    <p>PDE enzyme type 3</p> Signup and view all the answers

    What effect does pentoxifylline have on blood viscosity?

    <p>Reduces viscosity and improves blood flow</p> Signup and view all the answers

    Pentoxifylline is the second drug approved for treating intermittent claudication.

    <p>False</p> Signup and view all the answers

    Peripheral vascular disease (PVD) can affect arteries of the lower limbs, renal, and mesenteric vessels.

    <p>True</p> Signup and view all the answers

    Cilostazol increases platelet aggregation by inhibiting PDE type 3.

    <p>False</p> Signup and view all the answers

    Hypertension is considered a minor risk factor for developing peripheral vascular disease.

    <p>False</p> Signup and view all the answers

    Headache is reported as a common side effect of pentoxifylline.

    <p>False</p> Signup and view all the answers

    Intermittent claudication is characterized by muscle pain that occurs during resting.

    <p>False</p> Signup and view all the answers

    Skin symptoms associated with peripheral vascular disease can include coolness and bluish discoloration.

    <p>True</p> Signup and view all the answers

    Clopidogrel is an anticoagulant that is preferred over aspirin for patients without diabetes.

    <p>False</p> Signup and view all the answers

    Cilostazol has a contraindication for use in patients with congestive heart failure (CHF).

    <p>True</p> Signup and view all the answers

    Smoking cessation is considered a crucial lifestyle change for managing peripheral vascular disease.

    <p>True</p> Signup and view all the answers

    The typical dosage for pentoxifylline is 100 mg twice a day.

    <p>False</p> Signup and view all the answers

    Diabetes and smoking are irrelevant risk factors for developing peripheral vascular disease.

    <p>False</p> Signup and view all the answers

    Pentoxifylline decreases the deformability of red blood cells (RBCs) by inhibiting the PDE enzyme.

    <p>False</p> Signup and view all the answers

    Age over 65 years increases the likelihood of peripheral vascular disease.

    <p>True</p> Signup and view all the answers

    Clopidogrel is less effective than aspirin in reducing vascular events in diabetic patients with peripheral vascular disease.

    <p>False</p> Signup and view all the answers

    Management of hypercholesterolemia in peripheral vascular disease typically involves the use of nitrates.

    <p>False</p> Signup and view all the answers

    Hypertensive emergencies are defined by a blood pressure greater than 160/100 mmHg.

    <p>False</p> Signup and view all the answers

    One of the initial targets in hypertensive emergencies is to lower systolic blood pressure by no more than 20% in the first 1-2 hours.

    <p>False</p> Signup and view all the answers

    Drugs such as sodium nitroprusside and labetalol are considered standard treatment in managing hypertensive emergencies.

    <p>True</p> Signup and view all the answers

    Severe headache, mental confusion, and blurred vision are all symptoms associated with hypertensive encephalopathy.

    <p>True</p> Signup and view all the answers

    Furosemide is recommended for everyone managing hypertensive emergencies regardless of volume status.

    <p>False</p> Signup and view all the answers

    Nifedipine is a recommended drug for rapid management of hypertensive emergencies.

    <p>False</p> Signup and view all the answers

    Cerebral, renal, and myocardial ischemic events can develop if blood pressure is lowered too quickly in chronic hypertension.

    <p>True</p> Signup and view all the answers

    Hypertensive emergencies can result in aortic disentanglement if not treated promptly.

    <p>False</p> Signup and view all the answers

    What is the primary action of pentoxifylline on red blood cells (RBCs)?

    <p>It increases RBC deformability by inhibiting the PDE enzyme.</p> Signup and view all the answers

    For which conditions is pentoxifylline indicated in treatment?

    <p>Intermittent claudication, diabetic angiopathy, and chronic leg ulcers.</p> Signup and view all the answers

    Which specific PDE enzyme does cilostazol inhibit?

    <p>Cilostazol inhibits PDE enzyme type 3.</p> Signup and view all the answers

    What is the typical dosage of cilostazol recommended for patients?

    <p>The typical dosage is 100 mg twice a day.</p> Signup and view all the answers

    Which serious condition is cilostazol contraindicated for, and why?

    <p>Cilostazol is contraindicated in congestive heart failure (CHF) due to increased mortality risk.</p> Signup and view all the answers

    What advantage does clopidogrel have over aspirin in patients with diabetic PVD?

    <p>Clopidogrel provides additional benefits beyond what aspirin offers.</p> Signup and view all the answers

    How does pentoxifylline impact blood viscosity?

    <p>Pentoxifylline decreases blood viscosity.</p> Signup and view all the answers

    What is the most common side effect associated with cilostazol?

    <p>The most common side effect is a headache.</p> Signup and view all the answers

    What anatomical regions can be primarily affected by peripheral vascular disease?

    <p>Lower limbs, renal arteries, and mesenteric arteries.</p> Signup and view all the answers

    Identify two key risk factors for peripheral vascular disease that are modifiable.

    <p>Diabetes and smoking.</p> Signup and view all the answers

    What is the main symptom associated with intermittent claudication?

    <p>Pain in the muscles when walking.</p> Signup and view all the answers

    How does the skin typically present in patients with peripheral vascular disease?

    <p>Skin appears cool and may have a bluish discoloration.</p> Signup and view all the answers

    What lifestyle intervention is deemed the most important for managing peripheral vascular disease?

    <p>Smoking cessation.</p> Signup and view all the answers

    At what age do individuals typically begin to see increased risk of peripheral vascular disease?

    <p>Age over 65 years.</p> Signup and view all the answers

    What treatment is generally recommended for patients with hypercholesterolemia as part of peripheral vascular disease management?

    <p>Use of statins.</p> Signup and view all the answers

    Name a characteristic symptom that occurs at rest in patients with advanced peripheral vascular disease.

    <p>Rest pain in the soles of the feet.</p> Signup and view all the answers

    What are the potential consequences of rapidly lowering blood pressure in patients with chronic hypertension?

    <p>It can lead to cerebral, renal, and myocardial ischemic events.</p> Signup and view all the answers

    Explain the significance of the diastolic blood pressure target during the management of hypertensive emergencies.

    <p>Diastolic BP should be maintained at no less than 100 mmHg to prevent inadequate organ perfusion.</p> Signup and view all the answers

    List two drugs that are not recommended for managing hypertensive emergencies and explain why.

    <p>Nifedipine and nitroglycerin; they can cause sudden, severe reductions in BP, leading to ischemic events.</p> Signup and view all the answers

    What clinical presentation indicates hypertensive encephalopathy, and what may happen if left untreated?

    <p>It includes severe headache, mental confusion, and blurred vision; if untreated, it may progress to convulsions or coma.</p> Signup and view all the answers

    What initial target is set for the reduction of systolic blood pressure during the first hours of hypertensive emergencies?

    <p>The target is to lower systolic BP by no more than 25% in the first 1-2 hours.</p> Signup and view all the answers

    Why should furosemide only be used in specific situations when managing hypertensive emergencies?

    <p>It can cause significant volume depletion and should only be used if there is volume overload, like in pulmonary edema.</p> Signup and view all the answers

    Describe how parenteral therapy is administered in hypertensive emergencies and its urgency.

    <p>Parenteral therapy should be initiated to lower blood pressure rapidly within hours, using slow IV infusion.</p> Signup and view all the answers

    What is a serious risk associated with sudden drops in blood pressure during treatment of hypertensive emergencies?

    <p>A serious risk includes the development of ischemic events such as stroke or heart failure.</p> Signup and view all the answers

    The narrowing of the arteries in peripheral vascular disease primarily affects the arteries of the lower ______.

    <p>limbs</p> Signup and view all the answers

    Intermittent claudication is characterized by pain in ______ when walking.

    <p>muscles</p> Signup and view all the answers

    The most important risk factors for peripheral vascular disease include diabetes and ______.

    <p>smoking</p> Signup and view all the answers

    Skin symptoms associated with peripheral vascular disease can include coolness and ______ discoloration.

    <p>bluish</p> Signup and view all the answers

    Patients over the age of ______ years are particularly at risk for developing peripheral vascular disease.

    <p>65</p> Signup and view all the answers

    Treatment of hypertension and diabetes mellitus is part of the ______ factor control for managing peripheral vascular disease.

    <p>risk</p> Signup and view all the answers

    Stop smoking is considered the most crucial ______ change for managing peripheral vascular disease.

    <p>lifestyle</p> Signup and view all the answers

    Management of hypercholesterolemia in peripheral vascular disease often involves the use of ______.

    <p>statins</p> Signup and view all the answers

    Pentoxifylline increases RBC deformability by inhibition of the ______ enzyme.

    <p>PDE</p> Signup and view all the answers

    Pentoxifylline is the 1st drug approved to improve ______ circulation in patients with intermittent claudication.

    <p>microvascular</p> Signup and view all the answers

    Cilostazol is contraindicated in patients with ______ because inhibitors of PDE type 3 increase mortality.

    <p>CHF</p> Signup and view all the answers

    Clopidogrel offers additional benefits when compared with ______ in diabetic patients with PVD.

    <p>aspirin</p> Signup and view all the answers

    The typical dosage of pentoxifylline is ______ mg twice a day.

    <p>400</p> Signup and view all the answers

    Cilostazol inhibits PDE enzyme type ______, leading to decreased platelet aggregation.

    <p>3</p> Signup and view all the answers

    Headache is the most common ______ effect associated with cilostazol.

    <p>side</p> Signup and view all the answers

    Pentoxifylline reduces blood viscosity and facilitates passage of RBCs through narrow ______.

    <p>capillaries</p> Signup and view all the answers

    Hypertensive emergencies are associated with one or more of the following: BP > ______ mmHg.

    <p>180/120</p> Signup and view all the answers

    The clinical presentation of hypertensive encephalopathy consists of severe headache, mental confusion, blurred vision, and focal ______ signs.

    <p>neurologic</p> Signup and view all the answers

    The initial target in the first 1-2 hours is to lower systolic BP by no more than ______%

    <p>25</p> Signup and view all the answers

    Drugs commonly used include sodium nitroprusside, labetalol, fenoldopam, all given by slow ______ infusion.

    <p>i.v.</p> Signup and view all the answers

    Treatments such as ______ and hydralazine are not recommended as they can cause severe reductions in BP.

    <p>nifedipine</p> Signup and view all the answers

    Cerebral, renal, and myocardial ischemic events can develop if sudden lowering of BP is done due to autoregulatory changes in ______.

    <p>blood flow</p> Signup and view all the answers

    Hypertensive encephalopathy can progress over a period of ______ to convulsions, coma, and even death if untreated.

    <p>12–48 hours</p> Signup and view all the answers

    Furosemide should be used only if there is associated volume overload as in the case of pulmonary ______ and acute heart failure.

    <p>edema</p> Signup and view all the answers

    Match the following hypertensive emergencies with their associated target organ damage:

    <p>Cerebral Stroke = Encephalopathy Heart Failure = Aortic Dissection Papilledema = Acute Renal Failure Severe Headache = Mental Confusion</p> Signup and view all the answers

    Match the medications to their specific usage in the management of hypertensive emergencies:

    <p>Sodium Nitroprusside = Rapid blood pressure reduction Labetalol = Slow intravenous infusion Fenoldopam = Dopamine agonist for renal function Furosemide = Volume overload management</p> Signup and view all the answers

    Match the following drugs to their categorization regarding recommendations in hypertensive emergencies:

    <p>Nifedipine = Not recommended Nitroglycerin = Not recommended Hydralazine = Not recommended Sodium Nitroprusside = Recommended</p> Signup and view all the answers

    Match the symptoms of hypertensive encephalopathy with their descriptions:

    <p>Severe Headache = Intense pain often worsening Blurred Vision = Vision distortion due to nerve involvement Mental Confusion = Cognitive impairment or disorientation Focal Neurologic Signs = Specific deficits linked to brain injury</p> Signup and view all the answers

    Match the phases of blood pressure reduction in hypertensive emergencies with their target goals:

    <p>First 1-2 hours = Lower systolic BP by 25% Subsequent hours = Maintain diastolic BP at 100 mmHg Chronic Hypertension = Avoid rapid drops Improper Management = Can lead to ischemic events</p> Signup and view all the answers

    Match the types of organ damage with their related risk of hypertensive emergencies:

    <p>Cerebral = Stroke and Encephalopathy Cardiac = Heart Failure and Ischemia Renal = Acute Kidney Injury Eye = Papilledema and Visual Loss</p> Signup and view all the answers

    Match the management strategies for hypertensive emergencies with their appropriate rationale:

    <p>Hospitalization = Initiate parenteral therapy Gradual BP reduction = Prevent organ ischemia Monitor BP closely = Avoid sudden drops Use of specific agents = Targeted and effective treatment</p> Signup and view all the answers

    Match the following management interventions with their potential complications:

    <p>Sodium Nitroprusside = Potential cyanide toxicity Rapid BP Reduction = Risk of ischemic events Furosemide use = Volume depletion risks Labetalol administration = Heart rate effects</p> Signup and view all the answers

    Match the following drugs to their primary mechanism of action:

    <p>Pentoxifylline = Increases RBC deformability by inhibiting PDE enzyme Cilostazol = Inhibits PDE type 3 and reduces platelet aggregation Clopidogrel = Antiplatelet action against platelet aggregation Aspirin = Inhibits cyclooxygenase and reduces thromboxane production</p> Signup and view all the answers

    Match the drugs with their classification or type:

    <p>Pentoxifylline = Microvascular circulation enhancer Cilostazol = PDE inhibitor Clopidogrel = Thienopyridine antiplatelet agent Aspirin = Nonsteroidal anti-inflammatory drug (NSAID)</p> Signup and view all the answers

    Match the following side effects with their respective drugs:

    <p>Pentoxifylline = Headache Cilostazol = Headache Clopidogrel = Gastrointestinal bleeding Aspirin = Gastric ulcers</p> Signup and view all the answers

    Match the conditions with the appropriate drug indicated for treatment:

    <p>Pentoxifylline = Intermittent claudication Cilostazol = Intermittent claudication Clopidogrel = Peripheral vascular disease (PVD) Aspirin = Cardiovascular prevention</p> Signup and view all the answers

    Match each drug with its typical dosage for treating its indicated condition:

    <p>Pentoxifylline = 400 mg twice a day Cilostazol = 100 mg twice a day Clopidogrel = 75 mg daily Aspirin = 81-325 mg daily</p> Signup and view all the answers

    Match the following contraindications with the associated drug:

    <p>Pentoxifylline = None listed Cilostazol = Congestive heart failure (CHF) Clopidogrel = Active bleeding Aspirin = History of gastrointestinal ulcers</p> Signup and view all the answers

    Match the following drugs with their approval sequence for treating intermittent claudication:

    <p>Pentoxifylline = 1st approved Cilostazol = 2nd approved Clopidogrel = Not specifically approved for claudication Aspirin = Not specifically approved for claudication</p> Signup and view all the answers

    Match each drug with its type of therapy:

    <p>Pentoxifylline = Vasodilator therapy Cilostazol = Vasodilator and antiplatelet therapy Clopidogrel = Antiplatelet therapy Aspirin = Antiplatelet therapy</p> Signup and view all the answers

    Match the following risk factors with their relation to peripheral vascular disease (PVD):

    <p>Diabetes = Major risk factor Age &gt; 65 = Increased risk Hypercholesterolemia = Minor risk factor Obesity = Unrelated</p> Signup and view all the answers

    Match the following symptoms with their description in the context of peripheral vascular disease:

    <p>Intermittent claudication = Muscle pain during walking Rest pain = Pain while feet are elevated Cool skin = Indicates ischemic condition Ischemic ulcers = Healthiest skin manifestation</p> Signup and view all the answers

    Match the following management strategies with their purpose for peripheral vascular disease:

    <p>Stop smoking = Most crucial lifestyle change Statins = Control hypercholesterolemia Treatment of hypertension = Reduces overall PVD risk Diet alteration = Has no impact on PVD</p> Signup and view all the answers

    Match the following arteries with their relationship to peripheral vascular disease:

    <p>Lower limbs = Commonly affected Renal arteries = Occasionally affected Coronary arteries = Not affected by PVD Cerebral arteries = Affected by PVD</p> Signup and view all the answers

    Match the following management strategies with their respective conditions they address:

    <p>Statins = Hypercholesterolemia Antihypertensives = Hypertension management Weight loss = Obesity treatment Physical therapy = Intermittent claudication</p> Signup and view all the answers

    Match the following consequences with their context in peripheral vascular disease:

    <p>Coolness of skin = Indicates poor circulation Bluish discoloration = Sign of ischemia Pain upon elevation = Common in rest pain Muscle weakness = Typical during active periods</p> Signup and view all the answers

    Match the following treatments with their intended effects in peripheral vascular disease:

    <p>Pentoxifylline = Improves red blood cell flexibility Cilostazol = Inhibits platelet aggregation Nitrates = Treats hypercholesterolemia Furosemide = Manages fluid retention</p> Signup and view all the answers

    Match the following lifestyle modifications with their intended impact on peripheral vascular disease:

    <p>Smoking cessation = Reduces disease progression Regular exercise = Improves circulation High-fat diet = Exacerbates symptoms Increased alcohol consumption = Improves health outcomes</p> Signup and view all the answers

    Study Notes

    Management of Hypertensive Emergencies

    • Hypertensive emergencies occur when blood pressure exceeds 180/120 mmHg, often accompanied by target organ damage.
    • Target organ damage may include cerebral stroke, encephalopathy, heart failure, aortic dissection, or papilledema (optic disc edema).

    Hypertensive Encephalopathy

    • Characterized by severe headache, mental confusion, blurred vision, and focal neurologic signs.
    • If untreated, it can progress to convulsions, coma, and death within 12-48 hours.

    Management Protocol

    • Immediate hospitalization is essential with parenteral therapy for rapid BP reduction, ideally within hours rather than minutes.
    • Sudden drastic BP reduction can lead to ischemic events in the brain, heart, and kidneys due to chronic hypertension-related autoregulation changes.
    • Initial goal: reduce systolic BP by no more than 25% in the first 1-2 hours, while maintaining diastolic BP above 100 mmHg.
    • Commonly used medications include sodium nitroprusside, labetalol, and fenoldopam, all administered via slow intravenous infusion.

    Medications to Avoid

    • Nifedipine, nitroglycerin, and hydralazine are contraindicated due to the potential for causing severe and uncontrolled BP reductions.
    • Furosemide should only be used if there is volume overload, such as in pulmonary edema or acute heart failure.

    Peripheral Vascular Disease (PVD)

    • PVD is characterized by the narrowing of arteries other than coronary and cerebral vessels, commonly affecting lower limbs and renal/mesenteric arteries.

    Risk Factors

    • Major risk factors include diabetes and smoking, along with age over 65, hypercholesterolemia, hypertension, and obesity.

    Manifestations

    • Intermittent claudication: muscle pain during walking.
    • Rest pain in feet, worsening when elevated.
    • Skin changes may include coolness, bluish discoloration, and ischemic ulcers.

    Management Strategies

    • Lifestyle Modifications:
      • Smoking cessation is crucial.
      • Risk factor control, including statins for hypercholesterolemia and treatment for hypertension and diabetes.

    Drug Therapy

    • Pentoxifylline:

      • Increases RBC deformability by inhibiting PDE enzyme, reducing blood viscosity, and facilitating RBC passage in ischemic sites.
      • Approved for improving microvascular circulation in intermittent claudication, diabetic angiopathy, and chronic leg ulcers. Typical dosage: 400 mg twice daily.

    • Cilostazol:

      • Recently approved for intermittent claudication, it inhibits PDE3, reduces platelet aggregation, and causes vasodilation.
      • Common side effect is headache and contraindicated in patients with congestive heart failure due to increased mortality risk.

    • Clopidogrel:

      • This antiplatelet agent (75 mg daily) provides additional benefits over aspirin for diabetic patients with PVD.

    Management of Hypertensive Emergencies

    • Hypertensive emergencies occur when blood pressure exceeds 180/120 mmHg, often accompanied by target organ damage.
    • Target organ damage may include cerebral stroke, encephalopathy, heart failure, aortic dissection, or papilledema (optic disc edema).

    Hypertensive Encephalopathy

    • Characterized by severe headache, mental confusion, blurred vision, and focal neurologic signs.
    • If untreated, it can progress to convulsions, coma, and death within 12-48 hours.

    Management Protocol

    • Immediate hospitalization is essential with parenteral therapy for rapid BP reduction, ideally within hours rather than minutes.
    • Sudden drastic BP reduction can lead to ischemic events in the brain, heart, and kidneys due to chronic hypertension-related autoregulation changes.
    • Initial goal: reduce systolic BP by no more than 25% in the first 1-2 hours, while maintaining diastolic BP above 100 mmHg.
    • Commonly used medications include sodium nitroprusside, labetalol, and fenoldopam, all administered via slow intravenous infusion.

    Medications to Avoid

    • Nifedipine, nitroglycerin, and hydralazine are contraindicated due to the potential for causing severe and uncontrolled BP reductions.
    • Furosemide should only be used if there is volume overload, such as in pulmonary edema or acute heart failure.

    Peripheral Vascular Disease (PVD)

    • PVD is characterized by the narrowing of arteries other than coronary and cerebral vessels, commonly affecting lower limbs and renal/mesenteric arteries.

    Risk Factors

    • Major risk factors include diabetes and smoking, along with age over 65, hypercholesterolemia, hypertension, and obesity.

    Manifestations

    • Intermittent claudication: muscle pain during walking.
    • Rest pain in feet, worsening when elevated.
    • Skin changes may include coolness, bluish discoloration, and ischemic ulcers.

    Management Strategies

    • Lifestyle Modifications:
      • Smoking cessation is crucial.
      • Risk factor control, including statins for hypercholesterolemia and treatment for hypertension and diabetes.

    Drug Therapy

    • Pentoxifylline:

      • Increases RBC deformability by inhibiting PDE enzyme, reducing blood viscosity, and facilitating RBC passage in ischemic sites.
      • Approved for improving microvascular circulation in intermittent claudication, diabetic angiopathy, and chronic leg ulcers. Typical dosage: 400 mg twice daily.

    • Cilostazol:

      • Recently approved for intermittent claudication, it inhibits PDE3, reduces platelet aggregation, and causes vasodilation.
      • Common side effect is headache and contraindicated in patients with congestive heart failure due to increased mortality risk.

    • Clopidogrel:

      • This antiplatelet agent (75 mg daily) provides additional benefits over aspirin for diabetic patients with PVD.

    Management of Hypertensive Emergencies

    • Hypertensive emergencies occur when blood pressure exceeds 180/120 mmHg, often accompanied by target organ damage.
    • Target organ damage may include cerebral stroke, encephalopathy, heart failure, aortic dissection, or papilledema (optic disc edema).

    Hypertensive Encephalopathy

    • Characterized by severe headache, mental confusion, blurred vision, and focal neurologic signs.
    • If untreated, it can progress to convulsions, coma, and death within 12-48 hours.

    Management Protocol

    • Immediate hospitalization is essential with parenteral therapy for rapid BP reduction, ideally within hours rather than minutes.
    • Sudden drastic BP reduction can lead to ischemic events in the brain, heart, and kidneys due to chronic hypertension-related autoregulation changes.
    • Initial goal: reduce systolic BP by no more than 25% in the first 1-2 hours, while maintaining diastolic BP above 100 mmHg.
    • Commonly used medications include sodium nitroprusside, labetalol, and fenoldopam, all administered via slow intravenous infusion.

    Medications to Avoid

    • Nifedipine, nitroglycerin, and hydralazine are contraindicated due to the potential for causing severe and uncontrolled BP reductions.
    • Furosemide should only be used if there is volume overload, such as in pulmonary edema or acute heart failure.

    Peripheral Vascular Disease (PVD)

    • PVD is characterized by the narrowing of arteries other than coronary and cerebral vessels, commonly affecting lower limbs and renal/mesenteric arteries.

    Risk Factors

    • Major risk factors include diabetes and smoking, along with age over 65, hypercholesterolemia, hypertension, and obesity.

    Manifestations

    • Intermittent claudication: muscle pain during walking.
    • Rest pain in feet, worsening when elevated.
    • Skin changes may include coolness, bluish discoloration, and ischemic ulcers.

    Management Strategies

    • Lifestyle Modifications:
      • Smoking cessation is crucial.
      • Risk factor control, including statins for hypercholesterolemia and treatment for hypertension and diabetes.

    Drug Therapy

    • Pentoxifylline:

      • Increases RBC deformability by inhibiting PDE enzyme, reducing blood viscosity, and facilitating RBC passage in ischemic sites.
      • Approved for improving microvascular circulation in intermittent claudication, diabetic angiopathy, and chronic leg ulcers. Typical dosage: 400 mg twice daily.

    • Cilostazol:

      • Recently approved for intermittent claudication, it inhibits PDE3, reduces platelet aggregation, and causes vasodilation.
      • Common side effect is headache and contraindicated in patients with congestive heart failure due to increased mortality risk.

    • Clopidogrel:

      • This antiplatelet agent (75 mg daily) provides additional benefits over aspirin for diabetic patients with PVD.

    Management of Hypertensive Emergencies

    • Hypertensive emergencies occur when blood pressure exceeds 180/120 mmHg, often accompanied by target organ damage.
    • Target organ damage may include cerebral stroke, encephalopathy, heart failure, aortic dissection, or papilledema (optic disc edema).

    Hypertensive Encephalopathy

    • Characterized by severe headache, mental confusion, blurred vision, and focal neurologic signs.
    • If untreated, it can progress to convulsions, coma, and death within 12-48 hours.

    Management Protocol

    • Immediate hospitalization is essential with parenteral therapy for rapid BP reduction, ideally within hours rather than minutes.
    • Sudden drastic BP reduction can lead to ischemic events in the brain, heart, and kidneys due to chronic hypertension-related autoregulation changes.
    • Initial goal: reduce systolic BP by no more than 25% in the first 1-2 hours, while maintaining diastolic BP above 100 mmHg.
    • Commonly used medications include sodium nitroprusside, labetalol, and fenoldopam, all administered via slow intravenous infusion.

    Medications to Avoid

    • Nifedipine, nitroglycerin, and hydralazine are contraindicated due to the potential for causing severe and uncontrolled BP reductions.
    • Furosemide should only be used if there is volume overload, such as in pulmonary edema or acute heart failure.

    Peripheral Vascular Disease (PVD)

    • PVD is characterized by the narrowing of arteries other than coronary and cerebral vessels, commonly affecting lower limbs and renal/mesenteric arteries.

    Risk Factors

    • Major risk factors include diabetes and smoking, along with age over 65, hypercholesterolemia, hypertension, and obesity.

    Manifestations

    • Intermittent claudication: muscle pain during walking.
    • Rest pain in feet, worsening when elevated.
    • Skin changes may include coolness, bluish discoloration, and ischemic ulcers.

    Management Strategies

    • Lifestyle Modifications:
      • Smoking cessation is crucial.
      • Risk factor control, including statins for hypercholesterolemia and treatment for hypertension and diabetes.

    Drug Therapy

    • Pentoxifylline:

      • Increases RBC deformability by inhibiting PDE enzyme, reducing blood viscosity, and facilitating RBC passage in ischemic sites.
      • Approved for improving microvascular circulation in intermittent claudication, diabetic angiopathy, and chronic leg ulcers. Typical dosage: 400 mg twice daily.

    • Cilostazol:

      • Recently approved for intermittent claudication, it inhibits PDE3, reduces platelet aggregation, and causes vasodilation.
      • Common side effect is headache and contraindicated in patients with congestive heart failure due to increased mortality risk.

    • Clopidogrel:

      • This antiplatelet agent (75 mg daily) provides additional benefits over aspirin for diabetic patients with PVD.

    Management of Hypertensive Emergencies

    • Hypertensive emergencies occur when blood pressure exceeds 180/120 mmHg, often accompanied by target organ damage.
    • Target organ damage may include cerebral stroke, encephalopathy, heart failure, aortic dissection, or papilledema (optic disc edema).

    Hypertensive Encephalopathy

    • Characterized by severe headache, mental confusion, blurred vision, and focal neurologic signs.
    • If untreated, it can progress to convulsions, coma, and death within 12-48 hours.

    Management Protocol

    • Immediate hospitalization is essential with parenteral therapy for rapid BP reduction, ideally within hours rather than minutes.
    • Sudden drastic BP reduction can lead to ischemic events in the brain, heart, and kidneys due to chronic hypertension-related autoregulation changes.
    • Initial goal: reduce systolic BP by no more than 25% in the first 1-2 hours, while maintaining diastolic BP above 100 mmHg.
    • Commonly used medications include sodium nitroprusside, labetalol, and fenoldopam, all administered via slow intravenous infusion.

    Medications to Avoid

    • Nifedipine, nitroglycerin, and hydralazine are contraindicated due to the potential for causing severe and uncontrolled BP reductions.
    • Furosemide should only be used if there is volume overload, such as in pulmonary edema or acute heart failure.

    Peripheral Vascular Disease (PVD)

    • PVD is characterized by the narrowing of arteries other than coronary and cerebral vessels, commonly affecting lower limbs and renal/mesenteric arteries.

    Risk Factors

    • Major risk factors include diabetes and smoking, along with age over 65, hypercholesterolemia, hypertension, and obesity.

    Manifestations

    • Intermittent claudication: muscle pain during walking.
    • Rest pain in feet, worsening when elevated.
    • Skin changes may include coolness, bluish discoloration, and ischemic ulcers.

    Management Strategies

    • Lifestyle Modifications:
      • Smoking cessation is crucial.
      • Risk factor control, including statins for hypercholesterolemia and treatment for hypertension and diabetes.

    Drug Therapy

    • Pentoxifylline:

      • Increases RBC deformability by inhibiting PDE enzyme, reducing blood viscosity, and facilitating RBC passage in ischemic sites.
      • Approved for improving microvascular circulation in intermittent claudication, diabetic angiopathy, and chronic leg ulcers. Typical dosage: 400 mg twice daily.

    • Cilostazol:

      • Recently approved for intermittent claudication, it inhibits PDE3, reduces platelet aggregation, and causes vasodilation.
      • Common side effect is headache and contraindicated in patients with congestive heart failure due to increased mortality risk.

    • Clopidogrel:

      • This antiplatelet agent (75 mg daily) provides additional benefits over aspirin for diabetic patients with PVD.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Management of Hypertensive Emergencies PDF

    Description

    This quiz covers the management and implications of hypertensive emergencies, focusing on the critical condition defined by blood pressure levels exceeding 180/120 mmHg. Special emphasis is placed on recognizing signs of target organ damage such as hypertensive encephalopathy and the associated risks if left untreated.

    More Like This

    Mastering Hypertensive Emergencies
    3 questions

    Mastering Hypertensive Emergencies

    ReadyErudition avatar
    ReadyErudition
    Hypertensive Crises
    15 questions

    Hypertensive Crises

    UserFriendlyIntelligence avatar
    UserFriendlyIntelligence
    Hypertensive Emergencies: Immediate Therapy and Risks
    26 questions

    Hypertensive Emergencies: Immediate Therapy and Risks

    TantalizingComet avatar
    TantalizingComet
    Hypertensive Emergencies Objectives and Cases
    10 questions

    Hypertensive Emergencies Objectives and Cases

    ImpressiveEarthArt avatar
    ImpressiveEarthArt
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser