3a GP ILAs Flashcards by Caitlin E Furness

What is stage 1 hypertension in the clinic and then at home?

Clinic: 140/90mmHg to 159/99mmHg
ABPM: 135/85mmHg to 149/94mmHg

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What is stage 2 hypertension in the clinic and then at home?

Clinic: 160/100mmHg to 180/120 mmHg
Home: 150/95mmHg or higher

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What is stage 3 hypertension?

180/120mmHg

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What is the definition of malignant hypertension?

Over 180/120 mmHg with end organ damage (signs of retinal haemorrhage and papilloedema)

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If malignant hypertension is seen in GP what is the next course of action?

Same day referral to a specialist

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What lifestyle advice should you give to patients with hypertension?

Diet and exercise
Reduce caffeine
Lower salt intake
Stop smoking
Less alcohol

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What investigations should be carried out in a new case of hypertension?

Urine albulmin:creatinine ration
HbA1C
U&E
Lipids
12 lead ECG
Examine the eyes
Calculate Q risk

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In what age group would you suspect a secondary cause of hypertension?

Under 40 years

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What is the stepwise management of stage 1 hypertension?

Lifestyle advice
Consider antihypertensive drug treatment

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What is the treatment of Stage 2 hypertension?

Lifestyle advice
Antihypertensive treatment

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Patient who is white british male aged 47, which first line antihypertensive?

ACE inhibitor or ARB

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What is the first line antihypertensive in a 60 year old black female with T2DM?

ARB

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What is the first line antihypertensive in a 70 year old white british female with T2DM?

ACE inhibitor

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What is the first line antihypertensive in 62 year old caucasian male?

CCB

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Stepwise management of hypertension.

ACE inhibitor, ARB or CCB (dependent on the person)
Give the other one in addition, try CCB in those who had ACE inb to start.
Thiazide like diuretic
ACE Inhibitor, CCB, thiazide like diuretic, add small dose spironolactone

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When antihypertensive treatment has been started when should you review patients?

Monitor blood pressure every 4 weeks until within the expected range

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What blood tests before starting antihypertensive treatment?

U&E to check kidney function

What are the common side effects a patient may experience from ace inhibitors?

Cough
Dizziness and headaches
Angiooedema

What is the most common electrolyte disturbance in patients taking ACE inhibitors?

Hyperkalaemia

What are the most common electrolyte disturbances seen in thiazide like diuretics?

Hyperglycaemia
Hypokalaemia
Hyponatraemia
Hypochloraemic alkalosis

What are the common side effects in CCB’s?

Abdo pain, nausea and vomitting
Angio oedema
Dizziness
Peripheral oedema

What are the typical symptoms seen in heart failure?

Breathlessness
Peripheral oedema
Paroxysmal nocturnal dyspnoea
Orthopnoea

Pharmacological treatment of HF.

ACE inhibitor
Beta blocker
Loop diuretic for symptom control (furosemide or bumetanide)

If symptoms of heart failure persist after ACE inhibitor and beta blocker which pharmacological treatment next?

Aldosterone antagonist such as spironolactone
Hydralazine

What are the most common causes of Heart failure?

CAD, hypertension and valvular disease

What blood test can be used to look for HF?

BNP

next course of action if BNP > 2000?

Urgent 2-week referral to specialist

Course of action if BNP is 400-2000?

6 week referral to specialist for assessment and ECHO

What are the CXR findings in HF?

A - Alveolar oedema B - Kerley B lines C - Cardio megaly D - Upper lobe blood vessel dilation E - Pleural effusion F - Fluid in horizontal fissure

Side effects of spironolactone?

Hyperkalaemia Renal impairment Gynaecomastia Breast tenderness Hair growth Changes in libido

What is the fever pain score?

A score used to assess when patients with a sore throat and pharyngitis have strep infections

What are the 5 criteria of the fever PAIN score?

Fever in past 24 hours Abscence of cough Symptom onset in the last 3 days Purulent tonsils Severe tonsil inflammation

Name 5 of the most common notifiable diseases?

Measles Rubella Scarlet fever Meningitis Whooping cough TB

What is the definition of multimorbidity?

People with multiple health conditions which are often longterm

What is the definition of polypharmacy?

Concurrent use of multiple medications in an individual

What are the 7 main side effects of anticholinergic medications?

Blurred vision and dry eyes Dry mouth Drowsiness, dizziness and confusion Rapid heart rate Constipation Skin flushing and overheating Urine retention

What are the 3 main opioid receptors in the body?

MOR KOR DOR

Whereabouts are opioid receptors found?

Distributed throughout the CNS

How should you treat chronic pain?

Non-pharmacological treatments first Try non-opioid analgesia such as NSAIDS, paracetamol, Cox-2 inhibitors Opioid analgesia to be used slow and low, intermittent use

What are some signs of abuse and dependency on opioids?

Use of meds for stuff other than pain Impaired control Compulsive use of medication Craving or escalation of medication use Early refils