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Consultation skills > Hypertension from prescribing > Flashcards

Hypertension from prescribing Flashcards

1
Q

According to CG127 what are the diuretics of choice?

A

Indapamide or Chlortalidone

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2
Q

Patients who are well controlled on which drug can be allowed to remain taking it?

A

Bendroflumethiazide.

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3
Q

Smoking has what effect on blood pressure?

A

Temporarily increases it at time of smoking a cigarette but has no long term impact. Recommended to stop as it has other cardio risks.

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4
Q

What are the modifiable risk factors for hypertension?

A

BMILipid levelsSmoking levelsBlood pressure

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5
Q

What is the HOME blood pressure target for those under 80 years of age?

A

Below 135/85mmHg

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6
Q

What is the HOME blood pressure target for those over 80 years of age?

A

Below 145/85mmHg

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7
Q

What is the clinic BP target for those aged under 80?

A

Below 140/90mmHg

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8
Q

What is the clinic BP target for those aged over 80?

A

Below 150/90mmHg

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9
Q

Antihypertensive treatment should be offered to people under 80 with stage 1 hypertension AND what? [5]

A

Target organ damage. Established cardiovascular disease.Renal disease. Diabetes. A 10-year cardiovascualr risk of higher than 20%

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10
Q

Why would people under 40 years of age with stage 1 hypertension be referred to specialists?

A

This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these people.

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11
Q

What is the definition of stage 1 hypertension?

A

Clinic >140/90mmHg. At home >135/85 mmHg

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12
Q

What is the definition of stage 2 hypertension?

A

Clinic >160/100mmHgAt home >150/95mmHg

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13
Q

What is the definition of SEVERE hypertension?

A

Clinic systolic blood pressure >180 or diastolic >110mmHg.

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14
Q

If the systolic blood pressure of a person falls by 20mmHg or more when they are standing what must be done? [3]

A

Review medication.Measure subsequent BP with person standing.Consider referral if systoms of postural hypotension persist.

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15
Q

What should be done if a person has a clinic BP of 140/90mmHg or higher? [2]

A
  1. ABPM to confirm presence of hypertension. (unless severe, in which case: start treatment)2. Investigate for any target organ damage and CVD risk.
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16
Q

What treatment should someone under 55 with hypertension be offered?

A

ACEI or low cost ARB. If ACEI not tolerated use ARB.

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17
Q

Can ACEI and ARB be used in conjunction to treat hypertension?

A

No

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18
Q

What should someone of afrocarribean origin be offered as treatment for hypertension?

A

CCB or thiazide-like diuretic (chortalidone or indapamide)

19
Q

If BP is not controlled by step 1 treatment what is step 2?

A

CCB +ACEI or ARB

20
Q

If BP is not controlled by step 1 treatment what is step 2 if CCB are not tolerated?

A

Thiazide-like diuretic such as chortalidone or indapamide and ACEI or ARB.

21
Q

CCB or thiazide-like diuretic is the treatment for

A

Hypertension in those over 55 or black.

22
Q

If BP is not controlled by step 1 treatment what is step 2 for those of afro-carribean origin?

A

CCB + ARB in preference to ACEI.

23
Q

Why would beta blockers be used as initial therapy for hypertension? [4]

A

Younger people:Intolerance to ACEI and ARB.Women of child bearing potential.People with evidence of increased sympathetic drive.

24
Q

If therapy is initiated with a beta-blocker and a second drug is required what class should be used and why?

A

CCB instead of thiazide-like diuretic to reduce chance of developing diabetes.

25
Q

If BP is still not controlled after step 1 and step 2 treatment options what must occur?

A

Medication review.

26
Q

If BP is still not controlled after step 1 and step 2 treatment options what can be used as treatment?

A

IF three drugs needed:ACEI or ARB + CCB + thiazide-like diuretic.

27
Q

What is resistant hypertension?

A

BP >140/90mmHg after treatment with optimal doses of ACEI or ARB + CCB + thiazide-like diuretic.

28
Q

How is resistant hypertension treated?

A

Low-dose spironolactone if the potassium level is 4.5 or lower. Higher dose thiazide-like diuretic if the potassium is higher than 4.5.

29
Q

What new monitoring must occur during treatment of resistant hypertension?

A

When using further diuretic therapy for resistant hypertension at step 4, monitor blood sodium and potassium and renal function within 1 month and repeat as required thereafter.

30
Q

What drug class is used to treat resistant hypertension in those people who cannot tolerate further diuretic therapy?

A

Alpha or beta blocker.

31
Q

When would low-dose spironolactone be used to treat resistant hypertension?

A

If K+ is 4.5 or lower.

32
Q

When would high-dose thiazide-like diuretic be used to treat resistant hypertension?

A

If K+ is >4.5

33
Q

An appropriate dose of an appropriate drug for initial treatment of stage 2 hypertension is:

A

5mg Amlodipine or other CCB

34
Q

What is the target BP for someone diagnosed with stage 2 hypertension?

A

140/90 in clinic, 135/85 at home

35
Q

What counselling is needed for CCB?

A

Swollen ankles means need to switch to alternative drug class.

36
Q

When would a review of someone newly diagnosed with stage 2 hypertension and prescribed 5mg Amlodipine need to be carried out?

A

Within a month, check BP and occurrence of side effects.

37
Q

What is the treatment for stage 2 hypertension in T2 diabetic?

A

ACEI or ARB, Ramipril etc.

38
Q

ACEI cause hyponatremia

A

true

39
Q

ACEI cause hyperkalemia

A

True

40
Q

ACEI cause hypernatremia

A

false

41
Q

ACEI cause hypokalemia

A

false

42
Q

ACEI cause what electrolyte imbalances?

A

low sodium high potassium

43
Q

How do ACEI cause hyperkalemia?

A

Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can cause retention of potassium

44
Q

Why is the second treatment step for afrocarribean a CCB + ARB, in preference to an ACEI?

A

They have lower renin levels.

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