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Resume 25mg oral metoprolol twice daily
100%
2/2
Increase to 50mg oral metoprolol twice daily
0%
0/2
Administer 5mg metoprolol via IV
Administer 1 mg/kg furosemide via IV
Better control the patient's pain
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This patient's elevated blood pressure without symptoms and normal labs is consistent with hypertensive urgency. Since he has a nasogastric tube in place to suction, oral administration will be ineffective and intravenous administration will be required. Hypertensive urgency refers to BP > 180/120 without evidence of new or worsening end-organ injury. Hypertensive urgency can be managed more slowly (24-48 hours versus within minutes) than hypertensive emergencies (which presents with symptomatic or laboratory evidence of end-organ damage); however, it should be addressed before it progresses further. Oral anti-hypertensive are slower-acting, and the goal is to control blood pressure in the acute phase first, before resuming home medications. Incorrect Answers: Answers 1-2: Oral administration of antihypertensives will not be effective in a patient who is NPO with an NG tube in place. Furthermore, doubling his home dose is not indicated. Answer 4: Furosemide is a loop diuretic that is often part of a hypertension regimen, especially in those with heart failure. This patient is not showing signs of volume overload, and thus this medication would not be the initial treatment for his hypertensive urgency. Answer 5: The patient complains of only 3/10 pain, which is likely not the major contributor to his hypertensive urgency.
3.5
(11)
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