Cardiology + Resp Flashcards by Alice MacArthur

What is the low dose ICS for adults and kids

beclomethasone 100-250mg BD
beclomethasone 50 - 100mg BD ‘Clenil’

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What is the FIRST escalation in management of asthma

(3 Ts prior)
- LTRA + r/v in 4-8weeks
- LABA (Salmeterol or fomterol fumarate)
—-> combo with ICS as MART is beclome + forneterol

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whats is mod dose ICS (adults + then kids)

beclometasone 300-500mcg BD
150-200mcg BD

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what should high dose steroids also have (>600mcg BD)

referral
via pMDI + space

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what is the rule with reducing therapy
In asthma ICS

reduced 25-50% every 3 months

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what is the diagnostic criteria for COPD post bronchodilator spirometry

FEV1/FVC <0.7

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what are some features of asthma/steroid responsiveness

Past history of asthma/atopy.
Significant symptom variability (based on history or tests: >400ml in FEV1/>20% in serial PEFRs).
Higher blood eosinophil count (NICE doesn’t specify a number but GOLD suggests >300/microL) .

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treat for exacerbation

30mg pred 5 days
amox/doxy/clarith

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what is the severity of FEV1 30-49%

3 = severe

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what is the MRC breathless score needed rehab

3 = can’t keep up with peers on flat
5 is breathless at AODL

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What are the regimen for those without asthma features

LABA + LAMA
- glycopyromiun + fometerol
- tiotropium + cladetal

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What are the regimen for those with asthma features

LABA + ICS
- fluticasone propionate + salmterol (seritde)
- budeonsonide + fometerol (syncort)

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triple therapy (trimbow pMDI)
- option after

theophylline

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risk of regular ssteroids in copd

sepsis + VTE
fracture
- consider bone protection if >3 course of oral sted a year

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indications for LTO

<30% FEV1
02 stats 92%
cyanosis, polycythenia

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what should be done on annual review for COPD

FEV1/FVC
BMI
MRC score (5)
sats if severe

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What level is reduced EF

HFrEF <40%
- normal is >50%

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what level of BNP should trigger assessment within 2 weeks

> 2000
400-2000 = sepcailist assessment within 6 weeks (after echo)

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what level of NY may require medical support/fit for fly prior

3 + 4 (medical support travelling)

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when should you weight in HF

on waking, after voiding, before eating
- report 2kg within 24-72hrs

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what is the mainstay of tx in HFrEF

ACE/ARB - low + slow, 2weeks bloods
BB (bisoprolol, nebivolol, carvediol)- aim pulse 60
- if overloaded dieuritcs
- afro/caribean = hydrazaine (high BP)
- Spirnolocatone if still symptomatic (NOT CKD >4 or K >5)
- SGLT2, ANRI, Invabrine if tachycarry

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HFpEF mx

control BP, ischaemia, arrythmia, valve
no prognostic benefit with acei, BP

what is a risk of Bendroflumethiazide

diabetes
- indapamide

option to swap if peripehral oedema on amolpidine

felodipine

stage 1 hypertension - when give drugs

135-149 / 85-94 - <80 + CVD/Diabetes/Renal disease - QRISK >10 If not = lifestyle review

Stage 2 hypertension

150 / 90

HTN in pregnancy management

labeletol/nifedipine/methydopa + 75mg aspirin from 12 weeks target BP 135/85 then 140/90 after birth

choice of HTN drug in <55yr or T2DM

ACE (ARB if black + diabetic)

> 55 or African (not diabetic) for HTN

CCB

2nd line add on option for HTN - especially with HTN with HF + oedema

thiazide-like diuretic 'Indapamide'

4th agent

<4.5 = add spironolactone (check U+Es within 1 month) >4.5 - add alpha/BB looking at routine referral then - also if <40, seocndary

what are the BP targets

<140/90 (135/85 at home) if <80yrs over 80 add 10 to sysotlic

Indications for primary prevention - atorvastatin 20mg

QRisk >10% or >85 T1DM if >40yrs, 10yr diagnosis, nephropathy CKD (eGFR <60) if <30 need to d/w renal FHC

what is the targets (after 3m) guidelines for LFTs

target >40% reduction in non-hdl (Total choletserol minus HDL) LFTs only if x3 upper normal limits

secondary prevention dose aim for non-hdl

80mg <2.5, if > think abouth inclusican (injection) or ezetimbibe

conditions that cause dyslipidemia

excess alochol, diabetes, hypoothyroid, liver disease, nephrotic syndrome

what level of chol should you refer what level of simon broom criteria inidcate FHC

TC >9 or non-hdl >7.5 chol >7.5 or LDL >4.9 with mutation or tendon xanthomas or 1/2 relative

when to stop statins

3m before preg avoid grapefruit juice Alt rise >3

triglycerides rpt after fasting if 10-20 what drugs could cause

thiazide, non-selctive BB, unopposed estrogens

rehab drugs post ACS DVLA rules

Statin (80mg, 20mg if ckd) Antiplatelts - apsirin life, 12m of ticgrelol or clop, prasugrel (if had PCI) BB - 12months, longer if reduced LV ejection fraction (rate limiting CCB if CI dilitiazem, verapamil) ACEi - titrate max tolerated annual HBA1c if raised Glucose spiro if LVSD 1 weeks after PCI 6 week if lorry driver

uncertain of angina - what can you refer for

rapid access chest pain clinic - excerise/stree ECHO - CT-coronary angiogram

What are the three typical symptoms for a diagnosis of angina

constricting discomfort brought on by exertion relieved by GTN/Rest

what is prinzmetal angina

occurs at rest due to spasm - amlopdine or nifedepine good

what is cardiac syndrome X

microvessel disease

what are the principes of angina treatment - 2nd prevention - symptoms relief - when refer

Aspirin ( + clop if recent MI or CVA) Atrovastatin ACEi GTN and BB - alternative is CCB (Nifedipine, Amlodipine, felodipine) caution/CI dilteazam or verapamil (esp HF) if BB + CCB together not effectibe considering ISMN, nicrandil (ulcer), ivabardaine, ranaolazine

what AVN blocks require referral

second degree type 2 - as PR constantly long with drop beats third degree - noassications

what red flags of an arrythmia history require referral (4) DVLA rules

palpitations during exercise syncope FHx of cardiac death 2 or 3rd HB stop driving till controlled for 4 weeks

what drugs are CI in WPW (AVRT)

digoxin or verapamil

what are increases the bleeding risk in AF (orbit)

etoh antiplatete therapy NSAIDs, SSRI uncontrolled BP anaemia poor INR control

what needs warfarin rather DOAC

mitral stenosis, mechanical valve, low creat, antiphopslid syndrome, left atrial appendice

who do you consider rhythm control with AF (cardioversion, second line is left atrial ablation) - would use bb for about 3m after

within 48hours onset - d/w specialist ?CV younger pt with normal heart - reversible trigger, HF that causes AF

choices for rate control aiming pulse <110pbm

BB rate limiting CCB (dilitazine or verapamil - mono) if little exercise, digoxin 2nd line is dual BB/dilitiazem/dig (dig prefered if LVEF <40%)

What increases Long QT risk

Erythromycin/clari, amitriptyline, citalopram, seratline, antipsychotics, amiodraone, terfodenaine, ondasteron

Triglycerides >21 action

Assess if due to alcohol intake or poor glycaemic control If not then refer for specialist review (pancreatis risk)