MRCGP AKT Category: Cardiovascular Health

AKT-0471

Mary comes to see you for a medication review. She is a 65-year-old woman, with a past medical history of chronic kidney disease stage 3, hypertension and gout. Her current medication are amlodipine 10 mg daily and allopurinol 100 mg daily. Her blood pressure today is 151/93 mmHg. A recent urine dip was normal and her blood results are shown in the table below.

Na+ 137 mmol/L (135 – 145)
K+ 4.7 mmol/L (3.5 – 5.0)
Bicarbonate 27 mmol/L (22 – 29)
Urea 5.6 mmol/L (2.0 – 7.0)
Creatinine 130 µmol/L (55 – 120)
eGFR 55 ml/min/1.73m2 (>90)

What changes should you make to her medications?

AKT-0487

You assess a 68-year-old man with a history of angina and heart failure. He is currently taking aspirin, simvastatin, bisoprolol, glyceryl trinitrate, ramipril, and furosemide, but he continues to experience frequent angina attacks during physical activity. You decide to introduce a calcium channel blocker. Which of the following would be the most suitable to add?

AKT-0472

You are examining the results of an ambulatory blood pressure monitor (ABPM) for a 65-year-old man with suspected hypertension. You have also arranged an ECG, blood tests and a urine dipstick, all of which have been normal. According to QRISK, his 10-year cardiovascular risk is 7%. The ABPM results reveal an average daytime reading of 148/94 mmHg. What is the best course of action?

AKT-0473

A 63-year-old man presents with a three-month history of palpitation. He reports feeling his heart skip a beat regularly but denies any other symptoms such as dizziness, shortness of breath, chest pain, or fainting.

Upon examination, his chest is clear and his oxygen saturation is 98%. Heart sounds are normal and there is no peripheral edema. His blood pressure is 126/64 mmHg and his ECG shows an irregularly irregular rhythm with no P waves and a heart rate of 82/min.

What is the most appropriate next step in managing this patient?

AKT-0474

A 48-year-old man presents to the hypertension clinic with a recent diagnosis of high blood pressure. He has been on ramipril for three months, but despite titration up to 10 mg od, his blood pressure remains elevated at 156/92 mmHg.

What would be the most suitable course of action for further management?

AKT-0475

You are speaking with a 57-year-old man who is worried about his blood pressure control. He has been monitoring his blood pressure at home daily for the past week and consistently reads over 140/90 mmHg, with the highest reading being 154/86 mmHg. He has no chest symptoms and is otherwise healthy. He has a history of hypertension and is currently taking perindopril. He previously took amlodipine, but it was discontinued due to significant ankle edema. His recent blood test results are as follows:

Na+ 136 mmol/L (135 – 145)
K+ 4.6 mmol/L (3.5 – 5.0)
Bicarbonate 24 mmol/L (22 – 29)
Urea 5.1 mmol/L (2.0 – 7.0)
Creatinine 80 µmol/L (55 – 120)

What is the most appropriate next step in managing his hypertension?

AKT-0476

A 63-year-old Caucasian man with a history of hypertension and gout presented to the clinic seeking advice on controlling his blood pressure. He has been experiencing high blood pressure readings at home for the past week, with an average reading of 150/95 mmHg. He is currently asymptomatic and denies any chest discomfort. He is a non-smoker and non-drinker. His current medications include amlodipine and allopurinol, which he has been tolerating well. He has no known drug allergies. His recent blood test results are as follows:

– Sodium (Na+): 138 mmol/L (135 – 145)
– Potassium (K+): 4.0 mmol/L (3.5 – 5.0)
– Bicarbonate: 28 mmol/L (22 – 29)
– Urea: 6.7 mmol/L (2.0 – 7.0)
– Creatinine: 110 µmol/L (55 – 120)

What is the most appropriate next step in managing his hypertension?

AKT-0477

A 67-year old man with hypertension visited his general practitioner after an ambulatory blood pressure monitor showed a daytime average blood pressure of 155/98 mmHg. Despite taking optimal doses of ramipril and amlodipine with good adherence, which medication should be introduced to his treatment plan?

AKT-0478

A 54-year-old man has come in for his annual health check-up. He has a history of hypertension and is currently taking ramipril 10 mg once daily, felodipine 10 mg once daily, and bendroflumethiazide 2.5mg once daily. His blood pressure readings today are consistently high. Additionally, blood tests have been taken as part of the check-up. Based on this information, what would be the most suitable medication to initiate?

AKT-0479

A 67-year-old patient is being evaluated post-hospitalization for chest pain and has been prescribed standard release isosorbide mononitrate (ISMN) for ongoing angina. The medication instructions indicate taking it twice daily, but with an 8-hour interval between doses. What is the rationale behind this uneven dosing schedule?