10 Complex patients Flashcards
what is the difference between co and multi morbidity
Multi-morbidity is generally considered to be the presence of more than one long-term condition;
Co-morbidity is a long-term condition that exists in the presence of another long-term condition.
STEMI +Heart Failure+ Depression
antudepressants in CV disease - drug srug interactions
aspirin + SSRIs is bleed risk
PPIs + SSRI cause low sodium in the lederly
AF + Hypothyroid or Hyperthyroid
Amioderone - thyroid effects.
If hypo then treat,
if hyper stop amiodarone
OR is AF caused by the hyperthyoidism/overtreatment of hypothyroidism?
Hypertension + Diabetes + STEMI
Managment of diabetes in acute illness
beta blockers mask hypos
Asthma + Heart failure
beta agonist v beta blockers
use a cardio selective beta blocker, you may still need to up the step of asthma treatment
COPD + UC / Crohn’s
increased steroid requirements - cushings?
Smoking is protective in UC but bad for COPD
RA + COPD
can they use inhalers
Parkinson’s Disease + Dementia
conflicting pharmacology -treating one worsens the other. Consider what patient needs treating more
Diabetes + Neuropathic pain + Depression
TCA use higher depression dose and hope it works for pain. Caution they may end up on both.
Diabetes + Heart failure + CKD
dose adjustment nightmare
Osteoporosis + CKD
must use activated vitamin D.
Benifits vs risks or treatment
Diabetes + Idiopathic thrombocythaemia (↑platelets) + Leg ulcers
Ulcer the side effect of treatment for IT or consquence of poor diabetes control
Hypertension + AF + Risk of falls
Anticoagulation vs risk associated with falling.
Benefit v risk.
10 steps so appropriate prescribing
Indication for drug Is it working? Correct dose? Clear directions? Can the patient use it? Interactions – drug/drug? Interactions – drug /disease? Duplication of pharmacology? Course? Or long term? Value for money?
Continuation of medicines questions
is the drug still needed?
has the condition changed?
can the pt continue to benifit?
has the evidence changed?
is the drug being used to treat an itraogenic problem?
what are the ethical issues of withholding care
would discontinuation cause problems?