3a GP ILAs Flashcards
What is stage 1 hypertension in the clinic and then at home?
Clinic: 140/90mmHg to 159/99mmHg
ABPM: 135/85mmHg to 149/94mmHg
What is stage 2 hypertension in the clinic and then at home?
Clinic: 160/100mmHg to 180/120 mmHg
Home: 150/95mmHg or higher
What is stage 3 hypertension?
180/120mmHg
What is the definition of malignant hypertension?
Over 180/120 mmHg with end organ damage (signs of retinal haemorrhage and papilloedema)
If malignant hypertension is seen in GP what is the next course of action?
Same day referral to a specialist
What lifestyle advice should you give to patients with hypertension?
Diet and exercise
Reduce caffeine
Lower salt intake
Stop smoking
Less alcohol
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
In what age group would you suspect a secondary cause of hypertension?
Under 40 years
What is the stepwise management of stage 1 hypertension?
Lifestyle advice
Consider antihypertensive drug treatment
What is the treatment of Stage 2 hypertension?
Lifestyle advice
Antihypertensive treatment
Patient who is white british male aged 47, which first line antihypertensive?
ACE inhibitor or ARB
What is the first line antihypertensive in a 60 year old black female with T2DM?
ARB
What is the first line antihypertensive in a 70 year old white british female with T2DM?
ACE inhibitor
What is the first line antihypertensive in 62 year old caucasian male?
CCB
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
When antihypertensive treatment has been started when should you review patients?
Monitor blood pressure every 4 weeks until within the expected range
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
