Hypertension Flashcards Preview

CCC > Hypertension > Flashcards

Flashcards in Hypertension Deck (22)
Loading flashcards...
1
Q

If a patient who is previously well presents with an unusual infection what should you consider?

A

Diabetes

2
Q

How would you treat a skin infection?

A

Oral flucloxicillin 500mg QDS, if pen allergic then Erythromycin 500mg qds

3
Q

If the skin infection was itchy, what should you prescribe?

A

Cetirizine 10mg od (non-drowsy) or chlorpheniramine (piriton) 4mg prn qds (can cause drowsiness but useful if pt not sleeping well due to pain/ itching).

4
Q

If it was painful?

A

Ibuprofen 400mg tds

5
Q

If someone has a high bp, what else should you examine?

A

Weight/BMI, pulse, bp in other arm, heart sounds, lungs, fundi

6
Q

If the blood pressure in the clinic was >140/90, what should you offer next?

A

Ambulatory blood pressure monitor

Twice a day for 7 days
Each BP recording must be done twice, at least 1 minute apart with patient seated
Discard readings for Day 1
Take an average of the rest

7
Q

What is stage 1 hypertension?

A

Clinic BP > 140/90

and…

ABPM/ HBPM 135/85

8
Q

What is stage 2 hypertension?

A

Clinic BP > 160/100

and…

ABPM/ HBPM > 150/95

9
Q

What is stage 3 hypertension?

A

Clinic systolic 180

or

Clinic diastolic 110

10
Q

What is the white coat effect?

A

Discrepancy of > 20/10mmHg between clinic & average home or ambulatory BPs at the time of diagnosis

11
Q

Which q risk score is defined as high risk?

A

Over 20% (more then a 20% chance of having cardiovascular disease in the next 10 years)

12
Q

What is first line bp treatment in below 55s?

A

Ace-inhibitor

13
Q

What is first line treatment in afro-carribeans over 55s?

A

Calcium- channel blockers

14
Q

What is step 2 for afro-carribeans?

A

Add an ARB

15
Q

And step 2 for <55s?

A

Ace + calcium channel

16
Q

Step 3?

A

Ace+ calcium channel + thiazide (these decrease body sodium, therefore reduce blood volume and venous return)

17
Q

Step 1

A

ACE Inhibitor if aged<55
CCB if aged >55 or African/ Caribbean family origin
BUT if heart failure or high risk of heart failure – opt for a thiazide-like diuretic
Indapamide/ Chlortalidone

18
Q

Step 2

A

A + C

Patients of African/ Caribbean family origin can have an ARB at this stage instead of ACE1

B-Blockers + Thiazides = increased risk of diabetes

19
Q

Step 4 treatment?

A

Consider Spironolactone if potassium level 4.5 or lower (caution in patients with low eGFR as higher risk hyperkalaemia)

Higher dose thiazide-like diuretic if K+ > 4.5

Alpha or beta-blocker

20
Q

Recommendations with ramipril?

A

Start Ramipril 2.5mg od
Take first one in bed at night to avoid hypotension
Thereafter, take every morning
Sfx – dry cough, impotence
Check U&E in 2 weeks (renal artery stenosis)
Review pt and recheck BP in 4 weeks

21
Q

Side effects of calcium channels?

A

Ankle swelling
Headache, dizziness
Flushing
Nausea

22
Q

What should you cover at annual review?

A
BP
Urine dipstick
U&amp;E
Lifestyle – diet, exercise
Weight
Side effects