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CONTINUING PROFESSIONAL DEVELOPMENT
1. What should the BP target be for a
patient with type 2 diabetes?
a) 120/80 mmHg.
b) 130/80 mmHg.
c) 140/90 mmHg.
d) 140/95 mmHg.
2. Which medicine should be avoided
in patients with concurrent
hypertension and diabetes if there is
c) Thiazide diuretics.
d) Calcium channel blockers.
3. Which ONE of the following has a
renal protective effect but should
be used with caution in people with
b) Calcium channel blockers.
d) Thiazide diuretics.
4. Which statement is NOT a first
priority of immediate hospital
a) High BP, e.g. systolic BP >150 mmHg or
diastolic BP >100 mmHg.
b) Shortness of breath, coughing up blood.
c) Chest pain.
d) Palpitation, irregular heartbeat.
5. Which ONE of the followings is not a
modifiable risk factor?
b) Cigarette smoking.
d) Physical inactivity.
Another useful tool is the online AMH
CrCl calculator (www.amh.net.au). It can
calculate a person’s creatinine clearance,
demonstrating their kidney health to
a patient. This may increase awareness
of the importance of adherence to
medicines as prescribed, explaining that
some doses need to be adjusted based
on the kidney function. In this case the
patient’s CrCl is 61 mL/minute.
Using scales and an online calculator
as a visual aid to promote weight
management is easier to understand than
using just scales or verbal communication.
Point of hospital referral
• high BP with possible life-threatening
• very high BP, e.g. systolic BP
>180 mmHg or diastolic BP >110 mmHg
• shortness of breath, coughing up blood
(might be acute heart failure)
• chest pain (might be an acute angina)
• palpitation, irregular heartbeat (might
be an acute arrhythmia)
• severe chest or back pain plus very high
BP (might be acute dissecting aorta)
• numbness and tingling in the hands
and feet, confusion, speech or
movement problems (signs of stroke)
• fainting or seizure.
Back to Mr Johns
By calculating Mr Johns’ CVD risk, CrCl
and BMI the pharmacist can address his
risk factors and demonstrate the good
effect on his health if he could mitigate
them. Smoking cessation, weight
reduction, normal total cholesterol and
BP at target can reduce his CVD risks
from 22% to 6%. By having his BGL and
BP at target he can better protect his
kidneys from further damage.
Based on his comorbidities of
hypertension and type 2 diabetes his
• BP 130/80 mmHg. He needs to check
his BP at every doctor or pharmacy
visit, but at least every three months.
• Fasting BGL 4–6mmol/L OR
4–8 mmol/L two hours after meals.
He needs to monitor it at home
3–4 times a day, before breakfast, two
hours after a meal and at bedtime, or
as recommended by his doctor, and
record all readings in diary.
• His total cholesterol is indicative of
his lipid profile, should be kept as low
as <4 mmol/L, LDL <2 mmol/L, HDL
>1 mmol/L and TGs <2 mmol/L.
His current treatment regimen is
appropriate, however his adherence
is not, and avoiding night dosing
might be beneficial. Recommending
atorvastatin to replace simvastatin and
metformin XR once daily instead of
conventional metformin will also help
with better adherence.6
Advice on reducing alcohol intake and
body weight is essential. Keep in mind
that with a BMI of 52, collaboration
between the pharmacist and Mr
Johns’ doctor is vital to support his
efforts. Smoking cessation support is
Consider additional thorough history
taking through a home medication review
to investigate other issues that might not
been disclosed, such pain or depression.
Discuss with Mr Johns that eating only
his own farm produce might not be as
healthy as he thinks. Both portion control
and variety of food have big role to play in
1. Australian Bureau of Statistics. Prevalence of cardiovascular
diseases. 2011. At www.abs.gov.au/ausstats/abs@.nsf/
Lookup/4364.0 .55 .003main+features12011-2012.
2. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC 7). 2004. At: www.nhlbi.nih.gov/files/
3. Introducing ICD–10–AM in Australian hospitals. Med
J Aust 1998;169(8):32–5. At: https://www.mja.com.au/
4. National Heart Foundation of Australia (National Blood
Pressure and Vascular Disease Advisory Committee).
Guide to management of hypertension. 2008. At: www.
5. The National Prescribing Service. Management of
hypertension. At: www.nps.org.au/__data/assets/pdf_
6. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2014.
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