ILA 1 - Hypertension & Heart failure

Question 1

Marker of heart failure

Answer 1

BNP (B-type natriuretic peptide)

Question 2

Chest x-ray in LV failure signs

Answer 2

ABCDE
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Dilated prominent upper lobe vessels 
Pleural Effusion

Question 3

Nonpharmacological management of heart failure

Answer 3

Stop smoking, less salt, optimise weight and nutrition

prevent exacerbating factors (anaemia, thyroid, infection BP)

Question 4

Drugs to avoid in heart failure and why?

Answer 4

NSAIDS - fluid retention and renal impairment

Verapamil - negatively ionotropic

Question 5

Drug pathway for heart failure

Answer 5

ACEi
Add b-blocker
Spironolactone / diuretic
Digoxin + refer and seek advice

Question 6

Things to remember when adding b-blockers in heart failure

Answer 6

CI in asthma / pregnant

start low, go slow

Question 7

Investigations in heart failure

Answer 7

Bloods - Anaemia, TSH, HBA1C
ECG - ischemia
BP

Question 8

Eg of diuretic in heart failure? What to do if it reduces k<3.2mmol?

Answer 8

furosemide

use k sparing eg spironolactone

Question 9

what to do if cough is a problem with ACEi?

Answer 9

use ARB eg candesartan

Question 10

What can be used if intolerant to ACEi and ARB?

Answer 10

Vasodilators (hydralazine & isorbide dinitrate )

Question 11

Target bp in hypertension? Diabetes? >80yr?

Answer 11

140/90
130/80
15/90

Question 12

Why higher target bp in >80

Answer 12

vessels lose elasticity

Question 13

When taking bp how should it be done?

Answer 13

Rest for 15 mins with arms at heart level

both arms, sitting and standing

Question 14

What is white coat hypertension

Answer 14

peoples BP rises when a doctor takes it

Question 15

Hypertension drug pathway?

Answer 15

<55 - ACEi
>55 / black - CCB
A+Diuretic / C +D
A+C+D

Question 16

What to do If hypertensive on A+C+D

Answer 16

Resistant HTN and refer

Question 17

eg of ACEi

Answer 17

Ramipril

Question 18

eg of CCB

Answer 18

Amlodipine

Question 19

What monitoring with Ramipril

Answer 19

Check renal function - U&E after each dose change

Question 20

Side effects of amlodipine?

Answer 20

ankle swelling

Question 21

Side effect of diuetics ?

Answer 21

Wee alot

Question 22

Eg of thiazide like diuetic?

Answer 22

indapamide

Question 23

Things to remember in polypharmacy

Answer 23

increase falls, deaths,
physcological impact
need good vision and dexterity