Hypertension and hyperlipidaemia

Question 2

Epidemiology of HTN?

Answer 2

Question 3

What makes BP?

Answer 3

CO X SVR

Question 4

Why is BP regulated?

Answer 4

To maintain adequate tissue perfusion

Question 5

What stimulates renin to be released from the kidneys?

Answer 5

Low perfusion pressure

Question 6

Describe RAAS

Answer 6

Question 7

What hormonal control of BP is there?

Answer 7

Circulating catecholamines
Adrenaline + Noradrenaline

Question 8

What receptors do adrenaline and noradrenaline (circulating catecholamines) act on?

Answer 8

Question 9

Where are the sensors for blood pressure in our bodies?

Answer 9

Baroreceptors at the aortic arch
Carotid body sends signal to brainstem

Question 10

What is secondary HTN?

Answer 10

Question 11

What are the risk factors for essential HTN?

Answer 11

Question 12

What drugs can cause HTN?

Answer 12

Question 13

What are the clinical signs of renal artery stenosis?

Answer 13

Question 14

Does renal artery stenosis cause high or low renin secretion?

Answer 14

High - stimulated by renal under perfusion

Question 15

What pathologies cause renal artery stenosis?

Answer 15

Fibromuscular dysplasia in young

Atherosclerotic disease in arteriopaths

Question 16

How do you treat fibromuscular dysplasia?

Answer 16

Balloon dilation of renal arteries

Question 17

When would you stent renal arteries in renal artery stenosis caused by atherosclerotic disease?

Answer 17

If HTN is refractory
Medical management is first line

Question 18

What is the pathophysiology of CKD?

Answer 18

Question 19

Do ACE-I cause high or low K+?

Answer 19

High

Question 20

What are phaeochromocytomas?

Answer 20

Question 21

What are the symptoms of phaeochromocytomas?

Answer 21

Question 22

What are the signs of phaeochromocytoma?

Answer 22

Question 23

What tests do you do for phaeochromocytoma?

Answer 23

Question 24

How do you treat phaeochromocytomas?

Answer 24

Question 26

Why do you give both alpha and beta blockade for phaeochromocytomas?

Answer 26

If you just give BB it can cause unopposed alpha vasoconstriction leading to hypertensive crisis.

Question 27

What is the difference between cushings syndrome and cushings disease?

Answer 27

Question 28

When would you suspect cushings syndrome?

Answer 28

Question 29

How do you test for cushings syndrome?

Answer 29

Question 30

What is Conn's syndrome?

Answer 30

Question 31

When would you suspect Conn's syndrome?

Answer 31

Question 32

How would you diagnose Conn's syndrome?

Answer 32

Question 34

How do you treat Conn's syndrome?

Answer 34

Question 35

what is aortic coarctation?

Answer 35

Question 36

How would you recognise aortic coarctation clinically?

Answer 36

Question 37

How do you diagnose and treat aortic coarctation?

Answer 37

Question 38

What do you do for a BP under 140/90?

Answer 38

Re-check every 5 years

Question 39

What do you do if BP 180/120 or higher?

Answer 39

ECG - check for LVH Bloods - Check for kidney damage

Question 40

What is stage 2 HTN?

Answer 40

150/95 or more

Question 41

What is stage 1 HTN?

Answer 41

135/85 - 149/94

Question 42

What are the effects of chronic HTN?

Answer 42

Question 43

What are the acute effects of severe HTN?

Answer 43

Question 44

What is the lifestyle advice for HTN?

Answer 44

Question 45

What examination signs do you look for in HTN?

Answer 45

Question 46

What are the grades of hypertensive retinopathy?

Answer 46

Question 47

What blood tests do you do in HTN?

Answer 47

Question 48

What ECG changes can you get in HTN?

Answer 48

Question 49

What drug class are Ramipril, Lisinopril and Enalapril?

Answer 49

ACE-I

Question 50

What drug class are Candesartan and Losartan?

Answer 50

Angiotensin-II receptor blockers

Question 51

What drug class is Doxazosin?

Answer 51

Alpha blocker

Question 52

What drug class are Amlodipine, Diltiazem and Verapamil?

Answer 52

Calcium channel blocker

Question 53

What drug class is Sodium Nitroprusside?

Answer 53

Vasodilator (direct acting)

Question 54

What drug class is Glyceryl trinitrate and Isosorbide mononitrate?

Answer 54

Nitrates

Question 55

What drug class is Bumetanide and Furosemide

Answer 55

Loop diuretics

Question 56

What drug class is indapamide?

Answer 56

Thiazide like diuretics

Question 57

What drug class is Bendoflumethiazide?

Answer 57

Thiazide diuretics

Question 58

What drug class is Spironolactone?

Answer 58

Aldosterone antagonist

Question 59

What drug classes are less effective for HTN in Black African or African Caribbean patients?

Answer 59

ACE-I and AR2Bs

Question 60

First line treatment for HTN with T2DM?

Answer 60

ACEI or AR2B

Question 61

First line for HTN in someone >55 or who is black African or african-caribbean?

Answer 61

CCB

Question 62

What is step two of HTN management from NICE?

Answer 62

Question 63

What is step three of HTN management from NICE?

Answer 63

Question 64

What is step four of HTN management from NICE?

Answer 64

Question 65

What is the HTN treatment target for those with high risk diabetes?

Answer 65

130/80

Question 66

What is the HTN treatment target for those >80?

Answer 66

150/90

Question 67

Difference between chronic HTN and Gestational HTN in pregnancy?

Answer 67

Chronic <20/40 Gestational >20/40

Question 68

When would you treat HTN in pregnancy?

Answer 68

If >140/90

Question 69

What HTN treatment would you avoid in pregnancy and why?

Answer 69

ACE-I, ARB and diuretics = reduce placental blood flow

Question 70

What are the HTN drugs of choice in pregnancy?

Answer 70

Labetalol Nifedipine Methyldopa

Question 71

What BP would you aim for with HTN treatment in pregnancy?

Answer 71

<135/85

Question 72

Signs of accelerated HTN?

Answer 72

Visual disturbances and headaches

Question 73

Signs of hypertensive encephalopathy?

Answer 73

Confusion and seizures

Question 74

Signs of aortic dissection?

Answer 74

Acute chest pain AR murmur Absent pulses

Question 75

What conditions require rapid HTN control?

Answer 75

Question 76

What medications would you give in hypertensive emergencies?

Answer 76

Question 77

In hypertensive emergencies, what % decrease in BP do you want to aim for immediately?

Answer 77

25% and to normalise over 24 hours

Question 78

What are these stigmata of hyperlipidaemia?

Answer 78

Corneal arcus Triglyceride deposits/spots Xanthelasma (eyes/face) Xanthmata (hands)

Question 79

MOA of statins?

Answer 79

Question 80

What was the landmark trial that established benefits of statins in IHD?

Answer 80

Question 81

What secondary prevention dose for statins?

Answer 81

Question 82

What specific tests do you measure for lipids?

Answer 82

Question 83

When would you get a specialist review for high lipids?

Answer 83

Question 84

What are the

Question 85

Causes of secondary dyslipidaemia?

Answer 85

Question 86

When is statin primary prevention recommended?

Answer 86

Question 87

What statin is recommended for primary prevention and when would you re-check lipids?

Answer 87

Question 88

What % reduction do you aim for in lipids when starting statins?

Answer 88

>40% reduction in non-HDL cholesterol

Question 89

What do you give if you don't get a >40% reduction in non-HDL after statin treatment?

Answer 89

Ezetimibe

Question 90

How does Ezetimibe work?

Answer 90

Question 91

What drug class is Evolocumab?

Answer 91

PCSK9 inhibitor

Question 92

How does Evolocumab work?

Answer 92

Question 93

When would Evolocumab be used?

Answer 93

Question 94

Side effects of Evolocumab?

Answer 94

Question 95

What is first line treatment for patients with very nigh TGs?

Answer 95

Bezafibrate

Question 96

How do fibrates (bezafibrate) work and what are their side effects?

Answer 96