QuestionSBA
QuestionChoice
There are 2 types of calcium channel blocker, dihydropyridine like nifedipine and amlodipine are used as antihypertensive medication. Non-dihydropyridine like verapamil and diltiazem are for rate control medication in arrythmias
34492
c
Start verapamil 80mg PO TDS
QuestionChoice
Starting on spironolactone would be the most appropriate management for a poorly controlled hypertension patient who have been started on ACEi, CCB and diuretics with a K <4.5mmol. [Click here for more information on NICE guidance](https://pathways.nice.org.uk/pathways/hypertension)
34490
a
Start spironolactone 25mg PO OD
QuestionChoice
This patient has resistant hypertension as his BP remains high despite on three different antihypertensives. NICE recommends the use of spironolactone as the next step if the patients potassium is 4.5 or less. If his K is more than 4.5, an alpha or beta blocker can be considered
34491
b
Start doxazosin 1mg PO OD
QuestionChoice
Although his BP remains poorly controlled with three antihypertensive, the maximal recommended dose for ramipril is 10mg OD. 15mg OD will be more than the recommended dose
34494
e
Increase dose of ramipril to 15mg PO OD
QuestionChoice
This patient has resistant hypertension as his BP remains high despite on three different antihypertensives. NICE recommends the use of spironolactone as the next step if the patients potassium is 4.5 or less. If his K is more than 4.5, an alpha or beta blocker can be considered
34493
d
Start bisoprolol fumarate 5mg PO OD
QuestionComment
Would you not change him to a CCB now he is over 55 years of age?
6845
QuestionComment
he is already on amlodipine
8229
User
subscriber
Axillary JAK
User
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Giggy G
QuestionComment
would you add bendroflumethiazide before jumping to spironolactone?

17438
QuestionComment
He's already on Indapamide
25741
User
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Cristiano Ronaldo 7
User
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Kawasaki Bendroflumethiazide
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2841
Spironolactone Uptitration
Topic
75
GP
6909
Case Presentation:




A 56-year-old man presents to his GP for review of his medication. PMH Hypertension. DH Ramipril 10mg PO OD, Amlodipine 10mg PO OD, Indapamide 2.5mg PO OD


 **On Examination**
BP 157/60 mmHg


HR 85/min


RR 14


O2 sats 96% RA


 **Investigations**


||||
|---------------------------|:-------:|--------------------|
|Sodium|140 mmol/L|135 - 145|
|Potassium|4 mmol/L|3.5 - 5.3|
|Urea|6 mmol/L|2.5 - 7.8|
|Creatinine|85 µmol/L|60 - 120|




Question:
Select the most appropriate decision option with regard to the treatment of his hypertension based on these data.
a