10 Complex patients Flashcards

1
Q

what is the difference between co and multi morbidity

A

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.

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2
Q

STEMI +Heart Failure+ Depression

A

antudepressants in CV disease - drug srug interactions
aspirin + SSRIs is bleed risk
PPIs + SSRI cause low sodium in the lederly

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3
Q

AF + Hypothyroid or Hyperthyroid

A

Amioderone - thyroid effects.
If hypo then treat,
if hyper stop amiodarone

OR is AF caused by the hyperthyoidism/overtreatment of hypothyroidism?

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4
Q

Hypertension + Diabetes + STEMI

A

Managment of diabetes in acute illness

beta blockers mask hypos

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5
Q

Asthma + Heart failure

A

beta agonist v beta blockers

use a cardio selective beta blocker, you may still need to up the step of asthma treatment

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6
Q

COPD + UC / Crohn’s

A

increased steroid requirements - cushings?

Smoking is protective in UC but bad for COPD

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7
Q

RA + COPD

A

can they use inhalers

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8
Q

Parkinson’s Disease + Dementia

A

conflicting pharmacology -treating one worsens the other. Consider what patient needs treating more

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9
Q

Diabetes + Neuropathic pain + Depression

A

TCA use higher depression dose and hope it works for pain. Caution they may end up on both.

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10
Q

Diabetes + Heart failure + CKD

A

dose adjustment nightmare

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11
Q

Osteoporosis + CKD

A

must use activated vitamin D.

Benifits vs risks or treatment

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12
Q

Diabetes + Idiopathic thrombocythaemia (↑platelets) + Leg ulcers

A

Ulcer the side effect of treatment for IT or consquence of poor diabetes control

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13
Q

Hypertension + AF + Risk of falls

A

Anticoagulation vs risk associated with falling.

Benefit v risk.

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14
Q

10 steps so appropriate prescribing

A
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?
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15
Q

Continuation of medicines questions

A

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?

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