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Z YEAR 2 CSI > NHS Health Check > Flashcards

NHS Health Check Flashcards

1
Q

What does the NHS health check tell your risk of?

A
  1. heart disease
  2. diabetes
  3. kidney disease
  4. stroke
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2
Q

What sort of advice could you receive?

A
  1. how toimprove your dietand the amount ofphysical activityyou do
  2. taking medicines to lower yourblood pressureorcholesterol
  3. how tolose weightorstop smoking
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3
Q

Why is NHS health check good?

A
  1. for every 30 to 40 people having an NHS Health Check, 1 person is diagnosed with high blood pressure
  2. for every 80 to 200 people having a Health Check, 1 person is diagnosed with type 2 diabetes
  3. for every 6 to 10 people having an NHS Health Check, 1 person is identified as being at high risk of cardiovascular disease
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4
Q

What is a TIA?

A
  • TIA (transient ischemic attack, also sometimes called a “mini-stroke”) begins just like an ischemic stroke; the difference is that in a TIA, the blockage is temporary and blood flow returns on its own
  • Since blood flow is interrupted only for a short time, the symptoms of a TIA don’t last long – usually less than hour.
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5
Q

What are some effects of hypertension?

A
  1. TIA
  2. Stroke
  3. Retinopathy
  4. Optic neuropathy
  5. Coronary Artery disease
  6. Left ventricular hypertrophy
  7. Glomeruloscelerosis
  8. Kidney failure
  9. Atheroscelrosis
  10. Aneruysm
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6
Q

What is the order for managing hypertension?

A
  1. Recheck BP
  2. 24 hour ambulatory BP monitoring
  3. Lifestyle advice
  4. Recheck BP
  5. Start medication
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7
Q

What tests do you order for people with hypertension?

A
  1. Urine sample for albumin:creaitnine ratio and test for haematuria using a reagent strip
  2. Blood sample to measure HbA1C, electrolytes, creatinine, eGFR, total cholesterol and HDL
  3. Examine fungi for presence of hypertensive retinopathy
  4. 12 lead ECG
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8
Q

What does the P wave show?

A

Atrial depolarisation

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9
Q

What does the QRS interval show?

A

Ventricular depolarisation

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10
Q

What is the ST segment

A

Isoelectric (should be neutral) - time between ventricular depolarisation and ventricular repolarisation (T wave)

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11
Q

What is the T wave?

A

Ventricular repolarisation

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12
Q

How do you decide with CCB to take?

A

-Drug taken once and less cost

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13
Q

What do you prescribe?

A

5mg Amlodipine

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14
Q

Why could his blood level still raised in 3 months?

A
  1. Non-adherence
  2. Side effects
  3. Multiple drugs required
  4. Ethnicity
  5. White coat syndrome
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15
Q

How does hypertension affect the heart?

A

Left ventricular hypertrophy

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16
Q

Why is left ventricular hypertrophy bad>

A
  1. Not good as this muscle uses more oxygen and no new blood vessels, areas where blood can get to and other areas where blood can’t get there, and when blood can’t get to those areas and deliver oxygen get MI
  2. Or left heart doesn’t compensate and then get left heart failure - left heart can’t generate pressure required to move blood around - so can do 5L not 6L but not compensating completely - heart failure after years and years if high BP
17
Q

What supplements are not recommended for hyperntesion?

A

Calcium, magnesium or potassium

18
Q

What sort of salt reduction should be encouraged for hypertension?

A

reduction to 4.4 g per day results in a reduction of ~4/2 mm Hg in blood pressure (BP)

19
Q

What is stage 1 hypertension?

A

BP in surgery/clinic is ≥140/90 mm Hg and ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) ranges from 135/85 mm Hg to 149/94 mm Hg

20
Q

What is stage 2 hypertension?

A

BP in surgery/clinic is ≥160/100 mm Hg but less than 180/120 mm Hg and ABPM or HBPM is ≥150/95 mm Hg

21
Q

What is stage 3 hypertension?

A

systolic BP in surgery/clinic is 180 mm Hg or higher or diastolic BP is 120 mm Hg or higher.

22
Q

What initial antihypertensive treatment should be given If the patient is young (≤55 years) and non-black?

A
  1. (A)angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB).
  2. An ARB may be appropriate if ian ACE inhibitor is not tolerated (eg, due to cough).
  3. Do not combine an ACE inhibitor with an ARB.
23
Q

What initial antihypertensive treatment should be given If the patient is aged >55 years?

A
  1. (C)calcium-channel blocker (CCB).
  2. (D)thiazide-like diuretic if CCB not suitable - eg, indapamide ((1.5 mg modified-release once daily or 2.5 mg once daily).
24
Q

What initial antihypertensive treatment should be given If the person is of black African or Caribbean family origin?

A
  1. Offer a calcium channel blocker if the person does not have type 2 diabetes.
  2. Consider an ARB rather than an ACE inhibitor unless the person has type 2 diabetes, in which case either can be offered.
25
Q

What initial antihypertensive treatment should be given For people with evidence of heart failure?

A
  1. Offer a thiazide-like diuretic.
  2. Use indapamide in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.
  3. Continue with bendroflumethiazide or hydrochlorothiazide, for adults with hypertension who are already on such medication, and who have stable, well-controlled blood pressure.
26
Q

What are step 2 choices?

A
  1. Before moving on to step 2, check that the person is compliant with step 1.
  2. ACE inhibitor or ARB with CCB or a thiazide-like diuretic.
  3. If initially started on a CCB, add an ACE inhibitor, ARB or a thiazide-like diuretic.
  4. Consider an ARB rather than an ACE inhibitor with a CCB in black people of African or Afro-Caribbean origin.
27
Q

What are step 3 choices?

A
  1. Before moving on to step 3, review whether the person is taking optimal tolerated doses and is compliant with treatment.
    2 Use an ACE inhibitor or ARB and a CCB and a thiazide-like diuretic.
28
Q

What are step 4 choices?

A
  • Reistant hypertension
    6. Add a fourth antihypertensive drug or consider referral to a specialist.
    7. Consider further diuretic therapy with low-dose spironolactone for adults who have a blood potassium level of 4.5 mmol/L or less. Use particular caution in people with a reduced estimated glomerular filtration rate as they have an increased risk of hyperkalaemia. Monitor blood sodium, potassium and renal function within one month of starting treatment. Repeat as necessary.
    8. Consider an alpha-blocker or beta-blocker for adults with resistant hypertension starting step 4 treatment who have a blood potassium level of more than 4.5 mmol/L.
    9. If blood pressure remains uncontrolled in people taking the optimal tolerated doses of four drugs, seek specialist advice
29
Q

How do you manage hypertension in T1D?

A
  1. lifestyle review is particularly important in people with type 1 diabetes
  2. An ACE inhibitor or ARB is the recommended first-line option.
  3. Selective beta‑adrenergic blockers may be considered. 4. Low-dose thiazides may be combined with beta‑blockers. If CCBs are considered, long-acting preparations are recommende
30
Q

How do you manage hypertension with atrial fibrillation?

A
  • if rate control is needed, add a beta-blocker (but not sotalol) or a rate-limiting CCB such as diltiazem
  • If on amlodipine, change to a rate-limiting CCB such as diltiazem
31
Q

How do you manage hypertension with chronic kidney disease?

A

treatment depends on whether there is diabetes or not and on the albumin:creatinine ratio (ACR)

Z YEAR 2 CSI (7 decks)

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