Pharmaceutical Care: Hypertension

Question 1

What are the symptoms?

Answer 1

Only appear if severe
Headaches
Retinal haemorrhage

Question 2

What is the primary cause?

Answer 2

NO real explanation
Age?

Question 3

Which medications can cause it?

Answer 3

Pill
nSAIDs
Steroids = corticosteroids

Question 4

What can be the secondary cause?

Answer 4

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

Question 5

When is the BP suggestive?

Answer 5

140/90 or higher

Question 6

What are the challenges of measuring BP?

Answer 6

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

Question 7

What can you do to overcome white coat syndrome?

Answer 7

Ambulatory BP monitoring
= at home 24hr monitoring

Question 8

How many stages of hypertension is there?

Answer 8

3

Question 9

What is stage 1?

Answer 9

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

Question 10

What is stage 2?

Answer 10

160/100 or 150/95 at home
Treat everyone

Question 11

What is stage 3?

Answer 11

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

Question 12

What lifestyle advice can you give people?

Answer 12

Exercise
Lose weight
Improve diet
Drink less
Decrease salt intake

Question 13

What is step 1 of treatment?

Answer 13

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

Question 14

What are examples of ACE?

Answer 14

Lisinopril
Enalapril
Ramipril

Question 15

What problems with ACE?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

What can ACE interact with?

Answer 17

Electrolytes + renal failure
Increase K+ levels = hypercalcemia

Question 18

What are examples of A2RBs?

Answer 18

Losartan
Candesartan
Irbesartan

Question 19

What is good about A2RBs?

Answer 19

Don’t cause chronic dry cough

Question 20

What are the problems with CCBs?

Answer 20

Headaches
Ankle oedema
Interact with grapefruit juice

Question 21

What are examples of thiazide-like diuretics?

Answer 21

Indapamide
Chlortalidone

Question 22

Would you use higher dose of thiazide-like diuretics?

Answer 22

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

Question 23

What is the problem with thiazide-like diuretics?

Answer 23

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

Question 24

What are the other types of diuretics?

Answer 24

Loop = NOT used to treat hypertension
K+ sparring

Question 25

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

Answer 25

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

Question 26

What is step 3?

Answer 26

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

Question 27

What is step 4? Above 140/90

Answer 27

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

Question 28

What is the problem with K= sparring diuretic?

Answer 28

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

Question 29

What do alpha blockers do?

Answer 29

Vasodilate

Question 30

What are examples of alpha blockers?

Answer 30

Doxazosin Prazosin Terazosin

Question 31

What are the side effects of alpha blockers?

Answer 31

Postural hypotension Urinary incontinence

Question 32

What are beta blockers mostly used for?

Answer 32

Angina

Question 33

What are examples of beta blockers?

Answer 33

Atenolol Bisoprolol Propranolol

Question 34

Why is there a caution when stopping beta blockers?

Answer 34

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

Question 35

What are the problems with beta blockers?

Answer 35

Selectivity of beta 1 + 2 Bronchospasm = asthma