Blood pressure

Question 1

Stages of hypertension and what to do (3)

Answer 1

140/90 Lifestyle advise
160/100 = Treat all
> 180 Systolic > 110 Diastolic = HYPERTENSIVE CRISIS

Question 2

What are the clinical blood pressure targets:

Under 80
Over 80 
Renal disease 
Diabetic 
Pregnant

Answer 2

Under 80 :  < 140/90 
Over 80 :  < 150/90 
Renal disease : 
•	<140/90 
•	< 130 / 80 if CKD / DM 
Diabetic : < 140/80 
Pregnant: 
•	<150/100 Chronic hypertension 
•	<140/90 Chronic hypertension if there is target organ damage or the pt just gave birth

Question 3

ACE Side effects

Answer 3

Dry cough 
Hyperkalaemia (highest in DM + renal patients)
Anaphylactoid reaction
Renal effects 
Hepatic effects

Question 4

Renal effects in ACE , which drugs to avoid

Answer 4

Reno protective in renal disease e.g. CKD
Nephrotoxic in acute kidney injury
Avoid DAMN : = Diuretics / Ace inhibitors /ARBs / Metformin / NSAID’s

Question 5

Hepatic effects in ACE , when should ACE be stopped

Answer 5

• Cholestatic jaundice
• Hepatic failure
• Should be stopped in transaminase is 3X normal or jaundice occurs

Question 6

Should ACE be used in pregnancy

Answer 6

NO

Question 7

Drug interaction of ACE , which drug classes should you avoid (5)

Answer 7

• Hyperkalaemia (ARB’s , K+ sparing diuretics / Aldosterone antagonists)
• Nephrotoxic and reduced eGFR (NSAID’s)
• Hypotension (diuretics)
• Renin angiotensin drugs (ACE + ARB – reduces the risk of renal impairment)
• Renal impairment (hyperkalaemia and hypotension)

Question 8

Types of beta blockers and properties

Answer 8

Ice PACO 
-	Less bradycardia 
-	Less coldness of extremities 
-	Pindoplol Acebutol Celiperolol – Oxyprenolol 
Water CANS 
-      less nightmare 
-	less sleep disturbances 
-	Celiprolol , Atenolol , Nadolol, Sotalol, 
BeAMAN 
-	B Bisprolol 
-	A Tenolol 
-	M etoprolol 
-	A cebutol 
-	N ebivolol 
-	Cardioselective so less bronchospasm 
BACoN 
-	Long duration OD dosing 
-	Bisoprolol 
-	Atenolol 
-	Cicloprolol 
-	Nadolol

Question 9

Side effects of Beta Blockers

Answer 9

Bradycardia
Hypotension
Hyperglycaemia
Hypoglycaemia

Question 10

Contraindications of Beta Blockers

Answer 10

COPD
Asthma
Bradycardia

Question 11

When to avoid Beta Blockers?

Answer 11

Asystole and hypotension

Hyperglycaemia avoid in diabetes and pt with high risk of diabetes.

Question 12

Dihydropyridine calcium channel blockers:

Answer 12

• Amlodipine – drug of choice in heart failure
• Felodipine
• Lacidipine
• Lercanidipine
• Nifedipine (maintain same MR brand

Question 13

Rate limiting CCB and cautions (2)

Answer 13

• Verapamil , causes constipation and is the only CCB licences for arrythmias
• Diltiazem , patient should stick to the same brand when dosing

Question 14

Interactions with CCB (1)

Answer 14

• Grapefruit juice

Question 15

Side effect of CCB

Answer 15

• Ankle swelling
• Flushing
• Headaches

Question 16

When to avoid rate limiting calcium channel blockers + why

Answer 16

• Heart failure (reduces ejection fraction)

Question 17

Should pregnant women take blood pressure medication and why

Answer 17

• No

- Risk of congenital abnormalities.

Question 18

Pregnant women at risk of high blood pressure and risk of pre-eclampsia what should they take instead and for how long?

Answer 18

• Aspirin from 12 weeks until gestation

Question 19

Women with bp higher than 140 or with preeclampsia should take which drugs?

Answer 19

• Labetalol
• Nifedipine (unlicenced)
• Methyldopa (unlicenced)

Question 20

What medication do you give for hypertension and shock (2) + what is the side effect (1)

Answer 20

• Noradrenaline
• Phenylephrine (longer acting)
• Side effect: Reduced perfusion to the heart