Antihipertensivos Generalidades. Energencias y Urgencias Hipe

7/31/2019 Antihipertensivos Generalidades. Energencias y Urgencias Hipe

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ANTIHIPERTENSIVOSGENERALIDADES. ENERGENCIAS YURGENCIAS HIPERTENSIVAS

Prof. Luis Magaldi M
http://images.google.co.ve/imgres?imgurl=www.niddk.nih.gov/health/urolog/uibcw/medicamentos/images/hipertension.jpg&imgrefurl=http://www.niddk.nih.gov/health/urolog/uibcw/medicamentos/medica.htm&h=284&w=320&prev=/images%3Fq%3D%2BHIPERTENSI%25C3%2593N%26svnum%3D10%26hl%3Des%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8%26sa%3DG


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INTRODUCCIN

- Hipertensin (HTA): Patologa multifactorique se caracteriza por niveles mantenidos dePresin Aterial (PA) superiores a 140 mmHde sistlica y 90 mmHg de diastlica.

- Prevalencia: > 20% Poblacin Mundial- la Incidencia: I.R, IC, ICC, ACV
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CLASIFICACIN

- HTA Primaria: 95 % PacientesCausas: no identificables.Asintomtica

- HTA Secundaria: 5 % PacientesCausas: IR, Feocromocitoma,S.de Cushing, Aldosteronismo.


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CLASIFICACIN

J.N.CCategora PAS (mmHg) PAD (mmHg)

ptima < 120 < 80Normal < 130 < 85Nornal Alta 130 - 139 85 - 89

HipertensinEstadio 1 140 - 159 90 - 99Estadio 2 160 - 179 100 - 109Estadio 3 180 110


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FACTORES DE RIESGO

- Obesidad

- Na - Cigarrillo- Alcohol

- Estrs- Gentica- Sedentarismo
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REGULACIN DE LA PA

Func. Renal

Sed

SRA

Simptico Tono Arteriolar y

PAM = GC x RVP

FCFcnt

RVFactores Humorales

AgII,Tx, NO, Endot

Volumen Circulante Tono Venoso


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S.R.A

Angiotensingeno

Angiotensina IRenina

Angiotensina II

ECA

Sec. AldosteronaVasoconstriccinNa, Ho

RVP


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CRISIS HIPERTENSIVAS

EMERGENCIAS- PAD > 130mmHg- Posible dao rganos

blanco- PA (min) - Va IV- U.C.I

URGENCIAS- PAD > 120 mmHg- Sn dao en rganos

blanco- PA ( min -h)- VO, SL, IV- Oservacin del Pac.


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CRISIS HIPERTENSIVAS

EMERGENCIAS:- Encefalopatias- Eclampsia- HTA con IM en progresin- Hemorragia Int. Cran- Aneurisma Artico- Trombosis Cerebral

URGENCIAS:- Cefalea- Epistaxis- Isquemia Venosa en

progresin- Sobre dosis de Simpa-

ticomimticos- Supresin brusca de

Clonidina y Bloque.
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CLASIFICACIN DE LOS

ANTIHIPERTENSIVOSI- Inhibidores de la Actividad Simptica:

- Centrales:. metildopa, Clonidina, Reserpina

- Perifricos:

. Bloqueantes: Prazosin

. Bloqueantes : Propranolol, Atenolol

. Bloqueantes :Labetalol, Carvedilol
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DATOS FARMACOLGICOS

DE LOS I.A.S metildopa: falso neurotrasmisor, NA

Clonidina: agonista , NA Labetalol: Bloq y Todos GC y RVP

Propranolol: y GC Atenolol: GC Prazosin: RVP


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RAMs DE LOS I.A.S

Centrales:H. Ortosttica, boca seca,retencin hidrosalina, sueo.Perifricos ( bloq.):bradicardia, depresin,impotencia,trigliceridos - bloq: taquicardia, fatiga
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CLASIFICACIN A.H.T

II- Reductores de Volumen:- Diurticos:. Tbulo Distal: Tiacidas. Asa de Henle: Furosemida. Antag. de la Aldosterona:Espironolactona, Amilorida


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EFECTO y RAMs DE

LOS DIURTICOSTiacidas:Na 5-10%Furosemida: Na > 15%Espironolactona: Na < 5%y Amilorida

Desbalance hidroelectroltico Na K Ca Mg , K
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CLASIFICACIN A.H.T

III- Sobre el SRA:- Inhibidores de la ECA:

Captopril, Enalapril,Ramipril, Perindopril

- Antagonistas de los Receptores Ang: ARA-Losartan, Valsartan, Ilbesartan, Candesartan
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EFECTOS y RAMs DE

LOS IECAS y ARA-IICaptopril, Enalapril:R.V.P

- Neutropenia, toxicidad fetaltos, exantema, angioedema

Losatan, Valsartan:R.V.P - Toxicidad fetal, angioedema
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CLASIFICACIN A.H.T

IV- Bloqueantes de los Canales del Ca:

. Dihidropiridinas: Nifedipina, Amlodipina. Bencilalquilaminas: Verapamil

. Benzotiazepinas: Diltiazem

V-Vasodilatadores Directos: . Hidralazina, Diazxido. Minoxidil, Nitroprusiato de Na
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EFECTO y RAMs

DE LOS BLOQ. Ca Bloqueo canales de Casubtipo LVasodilatacin ArteriolarR.V.P AHT, Antianginososy Antiarrtmicos (SV) Cefalea, mareos, rubor estreimiento, edema maleolar- Verapamil, Diltiazem: Bradicardia
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EFECTO y RAMs DE LOSVASODILATADORES DIRECTOS

Hidralazina:

Vasodilatador arteriolarNitroprusiato de Na: NO Vasodilatador ateriovenoso

Taquicardia, cefaleapalpitaciones, nuseasisquemia miocrdica
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TTO. EMERGENCIAS H.T

1- Ingreso a la U.C.I2- Monitoreo Permanente3- TTo. por va IV:

. Nitroprusiato de Na

. Labetalol, Hidralacina

. Fentolamina, Furosemida4- Meta = PAD < 120 mmHg5- Inicar TTo. AHT VO
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TTO. URGENCIAS HT

1- rea de emergencias2- TTO. VO, SL, IV:. Captopril SL . Nifedipina SL. Propranolol. Furosemida

3- Meta = PAD < 110 mmHg
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AHT DE ELECCIN

Situacin Frmacos

Embarazo -metildopa, NifedipinaPreeclampsia Labetalol, HidralazinaDiabetes IECAS, AAT Ins. Coronaria -Bloqueantes, Bloq.CaIns. Cardaca IECA, Diurticos, AAT Arritmias SV -Bloqueantes, Bloq.CaHiperlipidemias IECAs, ATII, Bloq Ca


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ACCIONES DE

ENFERMERA- Monitoreo continuo de la PA

- Evitar caidas bruscas de la PA

- Control de ingesta y excrecinde lquidos
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ACCIONES DE

ENFERMERA- Observacin cuidadosa de las RAMs

- Apoyo emocional al paciente

- Educar sobre factores de riesgoy uso adecuado de frmacos
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Antihipertensivos Generalidades. Energencias y Urgencias Hipe

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