HYPERTENSION

Question 1

List some complications of hypertension… (4)

Answer 1

• Stroke
• MI
• Heart Failure
• Renal Failure

Question 2

List some non-pharmacological ways to help reduce blood pressure (6)

Answer 2

• Reduce salt intake
• Reduce alcohol intake
• Reduce weight
• Increase fruit and veg intake
• Increase exercise
• Reduce smoking

Question 3

What is the first line treatment for hypertension in young, white patients?

Answer 3

ACE inhibitors

Question 4

What is the first line treatment for over 55 or black patients?

Answer 4

CCB’s

Question 5

What is the upper limit of normal blood pressure for most patients?

Answer 5

140/90 mmHg

Question 6

What is ‘white coat’ hypertension?

Answer 6

Excessive and unrepresentative blood pressure rises when attending doctor’s surgery

Question 7

Diabetics should have a target BP of

Answer 7

130/80mmHg

Question 8

ACE inhibitors can lead to ____ retention

Answer 8

Potassium

Question 9

What is a common side effect of ACE inhibitors?

Answer 9

Dry cough due to reduced breakdown of bradykinin

Question 10

What is the next therapy often considered if a patient cannot tolerate ACE inhibitors?

Answer 10

ARBs (angiotensin receptor blockers)

Question 11

Verapamil and diltiazem are ____ calcium channel blockers and should not be used in the control of blood pressure

Answer 11

Rate limiting

Question 12

Two side effects of CCBs include…

Answer 12

Ankle swelling and flushing

Question 13

What antihypertensive is recommended for use in pregnancy?

Answer 13

Methyldopa

Question 14

When should atorvastatin 20mg be suggested for primary prevention of CVD?

Answer 14

If QRISK2 score is 10% or greater

Question 15

Are diuretics needed in gravitational swelling of ankles?

Answer 15

No - compression stockings, keep moving, raise feet when not standing

Question 16

Statin should be prescribed for those with QRISK score of over…

Answer 16

10% or higher

Question 17

Verapamil is a…

Answer 17

RATE LIMITING CCB

Question 18

Lorsartan is…

Answer 18

an ARB (angiotensin 2 receptor blocker)

Question 19

What is classed as Stage 2 hypertension?

Answer 19

Clinic 160/100mmHg or higher

Question 20

What is classed as Severe hypertension?

Answer 20

Clinic systolic BP over 180mmHg or clinic diastolic BP 110mmHg or higher

Question 21

Offer antihypertensive treatment to those aged under 80 with stage 1 hypertension if… (5)

Answer 21

• Target organ damage
• Established CV disease
• Renal disease
• Diabetes
• 10 year CV risk 20% or higher

Question 22

What should be offered if cannot tolerate CCB?

Answer 22

Thiazide like diuretic (chlortalidone or indapamide)

Question 23

Should bendroflumethiazide be initiated/used?

Answer 23

NOT initiated - not in guidelines. This is a THIAZIDE diuretic not a thiazide LIKE diuretic

BUT keep on if stable on it

Question 24

What is step 2 treatment in white?

Answer 24

Add CCB to the ACE or ARB

Question 25

For black or afro caribbean step 2 add ARB to CCB in preference to a...

Answer 25

ACE inhibitor

Question 26

What is a side effect of statins that we should be aware of?

Answer 26

Muscle pain - myopathy

Question 27

Statins cannot be taken with what juice?

Answer 27

Grapefruit

Question 28

What is the first line then second line treatment of angina?

Answer 28

GTN spray then Beta blocker or CCB

Question 29

What should be used in angina to provide immediate relief and short term prevention?

Answer 29

GTN spray

Question 30

How should GTN spray be used?

Answer 30

- Before any planned exercise or exertion - Side effect = flushing, headache and light headedness - Sit down or find something to hold if light headed - Repeat dose after 5 mins if pain not gone

Question 31

When should ambulance be called in relation to angina pain and GTN spray?

Answer 31

- Call ambulance if pain not gone 5 mins after taking second dose

Question 32

Women should drink no more than __ to __ units per day

Answer 32

2 to 3 units a day

Question 33

Men should drink no more than __ to __ units per day

Answer 33

3 to 4 units a day

Question 34

What is a side effect of Verapamil?

Answer 34

Constipation

Question 35

If a Q-RISK score is over 10% then what should be started?

Answer 35

Atorvastatin 20mg daily

Question 36

How do sulfonylureas (tolbutamide, gliclazide, glipizide) work and when are they taken?

Answer 36

- Stimulate insulin release by beta cells of pancreas | - Taken with meals to prevent hypos

Question 37

How do biguanides (Metformin) work?

Answer 37

- Decrease gluconeogenesis and increases peripheral utilisation of glucose

Question 38

Thiazolidinediones work by WHAT?

Answer 38

- Enhancing tissue sensitivity to insulin

Question 39

Name a SGLT2 inhibitor and state how it works...

Answer 39

1) Canagliflozin, Dapagliflozin 2) SGLT2 receptor in kidney is responsible for glucose absorption, inhibiting this receptor means less glucose abs so you excrete it in urine

Question 40

How do DPP-4 inhibitors (Gliptins) work?

Answer 40

- Prevent breakdown of endogenous GLP-1 | - GLP-1 = decrease appetite, inc insulin secretion, reduce liver glucose output