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ANTIHIPERTENSIVOSGENERALIDADES. ENERGENCIAS YURGENCIAS HIPERTENSIVAS
Prof. Luis Magaldi M
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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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