18&19 - Cardiorespiratory Medicine Flashcards
Five smoking risks to the mother?
- Maternal DVT
- Pre-eclampsia
- Pre-term birth
Premature membrane rupture - Ectopic/Praevia
- Miscarriage
What are three methods of smoking cessation?
- NHS Stop Smoking
- Pharmaceuticals (NRT)
- E-Cigarettes
Smoking Cessation - Pharmaceuticals
Smoking cessation
1. Nicotine replacement Transdermal Lozenge Gum Inhaled Nasal
- Bupropion hydrochloride (150-300mg)
Or
Varenicline (500mcg-1mg) Attenuates withdrawal symptoms
- Clonidine (0.1-0.4mg) and nortriptyline (25-100mg)
Smoking cessation follow-up
Smoking cessation follow-up
- 2/52 of NRT
- 4/52 of Bupropion (antidepressant)/Vareniclone
3. Adherence CO level ADRs Withdrawal How’s it going?
E cigarettes
- Evidence
- ADRs
- Relative danger
E-cigarettes
- Growing evidence
- No CO
No Tar - Less harmful
Than liquid
Than vapour
Asthma reversibility test?
- Spirometry
- Salbutamol (2x200mgc)
Large volume spacer - 20-30 minutes
- Repeat spirometry
FEV1/FVC
What are different SABA inhalers?
Salbutamol
- MDI
Ventolin 100mcg
Salamol 100mcg
Airomir 100mcg - DPI
Ventolin 200mg
Terbutaline
Bricanyl 500mcg
What are different ICS inhalers?
ICS
Belclometasone
Clenil modulite 50mcg
QVAR 50 Autohaler 50mcg
Fluticasone
Flixotide propionate 50mcg
ICS/LABA
- Seretide 250/25
Fluticasone with salmeterol - Symbicort 200/10
Budesonide with formoterol - Fostair (100/6)
Beclometasone with formoterol
LABA Inhalers
- Salmeterol
Serevent 25mcg
Neovent 25mcg - Formoterol
Formoterol Easyhaler 12mcg
LAMA Inhaler
LAMA
- Spiriva
(Tiotropium) - Incruse
(Umeclinidium)
HFPEF
- Chronic Mx
Chronic HFPEF Mx
Conservative
- Diet + exercise
- Smoking and alcohol
Medical
- BP, DM, Lipids
- ACEi/ARB
- Ramipril
- Lorsartan - Furosemide/bumetanide
- Spironolactone/metolazone - BBlocker
- Bisoprlol
- Metoprolol
- Carvedilol
HFPEF
- Acute Mx
Acute HFPEF Mx
- Dieuretic
- Furosemide/bumetanide
- Spironolactone - Oxygen
- ACEi/ARB
- Nesiritide
Hypertensive emergency
5. IV GTN/nitroprusside
AF
- Beta blocker/CCB/Digoxin
- Anticoagulate
- ?Amiodarone
COPD
- GOLD Stages
Global initiative for chronic Obstructive Lung Disease
1 Early
- FEV-1: > 80%
- SoB walking fast
2 Moderate
- FEV-1: 50-79%
- SoB on level ground
3 Severe
- FEV-1: 30-49%
- SoB to leave house
4 Very severe
- FEV-1: <30%
- SoB at rest
COPD
- GOLD Groups
GOLD Groups
Group A
- Low risk
- Fewer symptoms
Group B
- Low risk
- More symptoms
Group C
- High risk
- Fewer symptoms
Group D
- High risk
- More symptoms
COPD
- Acute Management
Acute COPD Mx
Gold A
- SABA/SAMA
- Salb/ipra - LABA/LAMA
- Salm/tiot
Gold B
- LABA/LAMA
- SAMA/SABA
- Pulmonary rehab
Gold C
- LAMA
- SABA
- Pulmonary rehab
Gold D
- LAMA or LABA/LAMA or LABA/ICS
- SABA
- Pulmonary rehab
COPD
- Ongoing management
Ongoing COPD Mx
- Long-acting combination
- LABA/LAMA
- LABA/LAMA/ICS - SABA PRN
- Oxygen/Ventilation
- Mucolytic
- Theophylline
- Bronchoscopy
- Surgery
- Palliation
COPD
- Persistent exacerbation
Persistent COPD
- Roflumilast
- PDE4 Inhibitor - Azithromycin
- Macrolide - Erdosteine
- Mucolytic - Theophylline
- Non-selective PDEi - Bronchoscopy
- Surgery
- Palliation
DM
- Five Drug Classes
DM Drugs
- Metformin
- Biguanide
- Decreased gluconeogenesis
- Increased cellular uptake - Sitagliptin
- DPP-4i
- Reduced GLP breakdown - Exenatide
- GLP1
- Increased insulin secretion - Gliclazide
- SU
- Bind to K+(ATP)
- Increased insulin secretion - Empa/Dapa
- SGLT-2 i
- Reduced renal absorption
DM
- HbA1c levels
HbA1c
<6.0 Target
- 42%
6-6.5 Pre-diabetic
- 48%
> 6.5 Diabetic
48%
DM
- Random plasma glucose
Random plasma glucose
<11.1
- Not diabetes
> 11.1
- Diabetes
Hyperosmolar Hyperglycemic State
- Definition
HHS
- Very high blood glucose
- Common in concomitant illness
Insulin resistance syndrome
- Definition
Insulin resistance syndrome
- Metabolic syndrome
- Obesity
- HTN
- Hyperlipidaemia
- DM T2