Pharmaceutical Care: Hypertension Flashcards

1
Q

What are the symptoms?

A

Only appear if severe
Headaches
Retinal haemorrhage

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2
Q

What is the primary cause?

A

NO real explanation
Age?

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3
Q

Which medications can cause it?

A

Pill
nSAIDs
Steroids = corticosteroids

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4
Q

What can be the secondary cause?

A

Specific reason
eg. tumour in adrenal gland#
= more adrenaline secreted
= increased BP

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5
Q

When is the BP suggestive?

A

140/90 or higher

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6
Q

What are the challenges of measuring BP?

A

White coat syndrome
= seem to have high BP but don’t actually
Due to more stress + anxiety

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7
Q

What can you do to overcome white coat syndrome?

A

Ambulatory BP monitoring
= at home 24hr monitoring

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8
Q

How many stages of hypertension is there?

A

3

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9
Q

What is stage 1?

A

Greater than 140/90 or 135/85 at home
Treat on risk

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10
Q

What is stage 2?

A

160/100 or 150/95 at home
Treat everyone

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11
Q

What is stage 3?

A

180/110 or higher
Treat there + then
NO take home

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12
Q

What lifestyle advice can you give people?

A

Exercise
Lose weight
Improve diet
Drink less
Decrease salt intake

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13
Q

What is step 1 of treatment?

A

Patient under 55 = ACE
Over or black people of African or Caribbean = CCB
CCB NOT suitable = thiazide-like diuretic

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14
Q

What are examples of ACE?

A

Lisinopril
Enalapril
Ramipril

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15
Q

What problems with ACE?

A

Posterior hypotension = drop in BP when stand up
= make dizzy
Chronic dry cough

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16
Q

Because of posterior hypotension side effect of ACE, what do you do?

A

Start low + go slow with dose
Advise to take at night

17
Q

What can ACE interact with?

A

Electrolytes + renal failure
Increase K+ levels = hypercalcemia

18
Q

What are examples of A2RBs?

A

Losartan
Candesartan
Irbesartan

19
Q

What is good about A2RBs?

A

Don’t cause chronic dry cough

20
Q

What are the problems with CCBs?

A

Headaches
Ankle oedema
Interact with grapefruit juice

21
Q

What are examples of thiazide-like diuretics?

A

Indapamide
Chlortalidone

22
Q

Would you use higher dose of thiazide-like diuretics?

A

NO
= higher dose cause more side effects with little effect on BP

23
Q

What is the problem with thiazide-like diuretics?

A

Can disturb electrolytes
= increase uric acid + glucose
= diabetes problem

24
Q

What are the other types of diuretics?

A

Loop = NOT used to treat hypertension
K+ sparring

25
Q

What is step 2 of treatment?
BP NOT controlled by step 1

A

CCB in combo with ACE/ARB
If CCB not suitable = thiazide
For black people = CCB with ARB

26
Q

What is step 3?

A

First ensure step 2 doses are optimal + they are taking them
Combo of ACE (or ARB), CCB + thiazide

27
Q

What is step 4?
Above 140/90

A

= resistant hypertension
Additional diuretics, higher dose of thiazide or alpha/beta blocker
Dependent on patient

28
Q

What is the problem with K= sparring diuretic?

A

Hypercalcemia
= increases risk of high K+
Which can stop the heart

29
Q

What do alpha blockers do?

A

Vasodilate

30
Q

What are examples of alpha blockers?

A

Doxazosin
Prazosin
Terazosin

31
Q

What are the side effects of alpha blockers?

A

Postural hypotension
Urinary incontinence

32
Q

What are beta blockers mostly used for?

A

Angina

33
Q

What are examples of beta blockers?

A

Atenolol
Bisoprolol
Propranolol

34
Q

Why is there a caution when stopping beta blockers?

A

Reduce CO when used
= increase sympathetic NS
= if abruptly stopped still get sympathetic
= tachycardia

35
Q

What are the problems with beta blockers?

A

Selectivity of beta 1 + 2
Bronchospasm = asthma