CCCRN - CV (hypertensive crisis, emergency)

labetalol

-intermittent IV doses preferred to continuous infusion due to possibility of continuing drug beyond maximum dose of 300 mg -duration of effect persists 4-6 hours after IV dose is discontinued

nitroprusside

-preload and afterload reducer -assess for cyanide toxicity secondary to drug metabolite (thiocyanate): mental status change (restless, lethargy), tachycardia, seizure, a need for an increase in dose, unexplained metabolic acidosis, especially in those with renal impairment or when drug is used >24 hours

what is the biggest risk with a hypertensive crisis?

stroke!

hypertensive crisis or emergency

elevated bp with evidence of end organ damage (brain, heart, kidney, retina) that can be related to acute hypertension

hypertensive urgency

elevated bp without evidence of acute end organ damage

treatment of hypertensive crisis

nitroprusside & labetalol