Drugs and Blood pressure problems

Question 1

Patient comes in with high Bp what else do we want to know?

Answer 1

• has she ever had this before
• any other CVS issues
• diabetes, cholesteroel, stroke
• diet sodium intake, activity levels, alcohol, stress
• non-steroidals

Question 2

What would we want to examine /investigaionts

Answer 2

• repeated measurements over the next month
• heart sounds
• cardiac exam
• test for organ damage - renal funciton, rpoteinuria, glucose ect.

Question 3

Started on a bendrofluazide , what are potential adverse effects?
what if its od workign after a couple of weeks?

Answer 3

this is a thiazide diuretic

• can get hypokalemia
• dont give if atient has gout
• wait for later

Question 4

Would doublign the dose beenfit her or not/

Answer 4

no, would just get side effects. Add an ace inhibitor

then add a calcium chanel blocker - side effects - dry cough
-can change to angiotensin 2 inhibitor which so dont get dry cough

Question 5

Senario 2

• man with hypertension and angina
• allergy to aspirin

Answer 5

• give a calcium channel blocker (diltiazem) - sde efects - face flushign, oedema
• or give a beta blocker (metoprolol) - however, thsi is bad for asthma - bronchoconstriciton, also fatigue

Question 6

what is a typical combonation for someonewith high cardiovascualr risk

Answer 6

-beta blocker
-anitplatelet agent
-satin
(ace inhibitor or calcium channel blocker if this is not workign)

Question 7

what is paryoximal dyspnoea suggestive of?

Answer 7

-heart failure

Question 8

3 main causes of heart attack

Answer 8

• Ischaemia (has had previous stroke)
• vascular heart disease
• hypertension

Question 9

What to investigate for someone who has CCF, and AF, obese, hypertensionln, SOB

Answer 9

diagnose CCF - with echo, cxr, bnp

AF - ecg
Hypertension - test for end organ damage - ceratinne, protein uria

-also look for lipids and glucose - diabetes

Question 10

What do we do in short term - give her fruzamine for fluid overload and an ace inhibitor to bring her back to normal fluid statis

Long term - beta blocker, statin, anticoagulant

weight reduction - exercis e

Answer 10

Lifestyle measures – Diet (Na+)
– Exercise
– Weight reduction
• Pharmacological – Loop diuretic
– ACE inhibitor
– beta-blocker
– spironolactone
(frusemide 40mg) (cilazapril 5mg) (metoprolol)

Question 11

What are secondary causes for hypertension (for young people)

Answer 11

Adrenal - mineralcorticoid - aldosterone increased (conns)

Phaeo - 
crushings
RAS
coartation of the aorta 
alchol 
recreation drugs - amphetamines, cocaine - good social history 

Licroice - active ingredeint - inhibits an enzyme - that breaks down cortisol increases aldosterone

Question 12

how can we investigate these?

Answer 12

Obese (Cushingoid)
• BP – appropriate size cuff
• BMI
• R-F delay (palpable femorals) • Abdominal bruit
• Renal masses
• Fundi

• MR – renal arteries/coarctation • Plasma metanephrines
• Aldosterone / renin ratio
• U + E, Glucose • Urine dipstick
• ECG
• CXR
-echo

Question 13

why is she hypokalemic ?

Answer 13

• because she is taking diuretic
• aslo could be due to icnrease aldosterone (aldoseteonr producing tumour)
• if get too much aldosterone, then get renin feedback so decreases renin
• and then get decrease potassium

-could do an MRI to see if there is a tumour