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AKT > Cardiology + Resp > Flashcards

Cardiology + Resp Flashcards

1
Q

What is the low dose ICS for adults and kids

A

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

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2
Q

What is the FIRST escalation in management of asthma

A

(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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3
Q

whats is mod dose ICS (adults + then kids)

A

beclometasone 300-500mcg BD
150-200mcg BD

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4
Q

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

A

referral
via pMDI + space

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5
Q

what is the rule with reducing therapy
In asthma ICS

A

reduced 25-50% every 3 months

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6
Q

what is the diagnostic criteria for COPD post bronchodilator spirometry

A

FEV1/FVC <0.7

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7
Q

what are some features of asthma/steroid responsiveness

A

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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8
Q

treat for exacerbation

A

30mg pred 5 days
amox/doxy/clarith

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9
Q

what is the severity of FEV1 30-49%

A

3 = severe

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10
Q

what is the MRC breathless score needed rehab

A

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

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11
Q

What are the regimen for those without asthma features

A

LABA + LAMA
- glycopyromiun + fometerol
- tiotropium + cladetal

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12
Q

What are the regimen for those with asthma features

A

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

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13
Q

triple therapy (trimbow pMDI)
- option after

A

theophylline

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14
Q

risk of regular ssteroids in copd

A

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

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15
Q

indications for LTO

A

<30% FEV1
02 stats 92%
cyanosis, polycythenia

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16
Q

what should be done on annual review for COPD

A
  • FEV1/FVC
  • BMI
  • MRC score (5)
  • sats if severe
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17
Q

What level is reduced EF

A

HFrEF <40%
- normal is >50%

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18
Q

what level of BNP should trigger assessment within 2 weeks

A

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

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19
Q

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

A

3 + 4 (medical support travelling)

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20
Q

when should you weight in HF

A

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

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21
Q

what is the mainstay of tx in HFrEF

A

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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22
Q

HFpEF mx

A

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

23
Q

what is a risk of Bendroflumethiazide

A

diabetes
- indapamide

24
Q

option to swap if peripehral oedema on amolpidine

A

felodipine

25
Q

stage 1 hypertension
- when give drugs

A

135-149 / 85-94
- <80 + CVD/Diabetes/Renal disease
- QRISK >10

If not = lifestyle review

26
Q

Stage 2 hypertension

A

150 / 90

27
Q

HTN in pregnancy management

A

labeletol/nifedipine/methydopa + 75mg aspirin from 12 weeks

target BP 135/85 then 140/90 after birth

28
Q

choice of HTN drug in <55yr or T2DM

A

ACE (ARB if black + diabetic)

29
Q

> 55 or African (not diabetic) for HTN

A

CCB

30
Q

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

A

thiazide-like diuretic ‘Indapamide’

31
Q

4th agent

A

<4.5 = add spironolactone (check U+Es within 1 month)
>4.5 - add alpha/BB

looking at routine referral then
- also if <40, seocndary

32
Q

what are the BP targets

A

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

33
Q

Indications for primary prevention
- atorvastatin 20mg

A

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

34
Q

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

A

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

35
Q

secondary prevention dose
aim for non-hdl

A

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

36
Q

conditions that cause dyslipidemia

A

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

37
Q

what level of chol should you refer

what level of simon broom criteria inidcate FHC

A

TC >9 or non-hdl >7.5

chol >7.5 or LDL >4.9
with mutation or tendon xanthomas or 1/2 relative

38
Q

when to stop statins

A

3m before preg
avoid grapefruit juice

Alt rise >3

39
Q

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

A

thiazide, non-selctive BB, unopposed estrogens

40
Q

rehab drugs post ACS

DVLA rules

A

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

41
Q

uncertain of angina - what can you refer for

A

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

42
Q

What are the three typical symptoms for a diagnosis of angina

A

constricting discomfort
brought on by exertion
relieved by GTN/Rest

43
Q

what is prinzmetal angina

A

occurs at rest due to spasm
- amlopdine or nifedepine good

44
Q

what is cardiac syndrome X

A

microvessel disease

45
Q

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

A

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

46
Q

what AVN blocks require referral

A

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

third degree - noassications

47
Q

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

DVLA rules

A

palpitations during exercise
syncope
FHx of cardiac death
2 or 3rd HB

stop driving till controlled for 4 weeks

48
Q

what drugs are CI in WPW (AVRT)

A

digoxin or verapamil

49
Q

what are increases the bleeding risk in AF (orbit)

A

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

50
Q

what needs warfarin rather DOAC

A

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

51
Q

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

A

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

52
Q

choices for rate control aiming pulse <110pbm

A

BB
rate limiting CCB (dilitazine or verapamil - mono)
if little exercise, digoxin

2nd line is dual BB/dilitiazem/dig (dig prefered if LVEF <40%)

53
Q

What increases Long QT risk

A

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

54
Q

Triglycerides >21 action

A

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

AKT (14 decks)

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